Were Thousands Improperly Dropped from Pennsylvania’s Medicaid Program?

Between August 2011 and May 2012, the number of Pennsylvania residents covered by its Medicaid program dropped by nearly 130,000 people. Out of that number, 89,000 children were removed from the state’s Medicaid rolls, despite a steady increase in the number of children covered by the program in the past years. The federal government has taken notice after advocates for the poor received hundreds of reports from residents who claimed to have been improperly denied participation in the program.

In a letter issued by the federal Centers for Medicare and Medicaid Services (CMS) to the Pennsylvania Department of Public Welfare (DPW) on June 14, 2012, CMS noted that an unusually high number of cases were closed for “failure to return renewal form” or “failure to provide information” during a period of time that the state was ill-equipped to review cases in a timely manner. The letter stated that DPW was suspected of failing to follow protocol given that these rejections occurred “when DPW has reported that it was unable to process within appropriate time frames all the information beneficiaries had submitted to verify their eligibility.”

The letter also addressed an April 2012 meeting between DPW and CMS officials, in which DPW agreed to re-review 12,000 closed cases and re-instate Medicaid benefits to any cases that had been improperly closed, as well as identify patterns in that re-review that may have contributed to the improper denial of benefits. Three thousand pregnant women and babies were to be included in the initial review. CMS indicated that it was still awaiting DPW’s findings from the re-review, which needs to answer a number of questions such as whether any “systemic problems” were discovered, whether those residents wrongfully dropped from the rolls had their benefits reinstated, and whether DPW has a plan to avoid improper case closures in the future. In April, DPW had promised to produce its findings “soon.”

Last week, a DPW spokesperson stated that human error is a factor that could have resulted in the improper loss of benefits, but that the department would “correct it as expeditiously as [it] can.” She revealed that DPW had not completed the re-reviews as of that time.