End of PHE Glossary
Appeal and Reconsideration Rights
Appeal rights are provided with any decision made about Medical Assistance (MA) coverage. MA recipients have the right to ask for a hearing to appeal a decision that affects their MA benefits. Information about how to appeal is included with all notices from us.
An automatic renewal occurs when our eligibility system uses information from electronic data sources to renew MA without requiring the recipient to provide their renewal packet. If we cannot renew MA with electronic data sources, we will mail a renewal packet. A mailed renewal packet MUST be completed, signed and returned to us for us to determine if MA can be continued.
Children's Health Insurance Program (CHIP) provides health coverage to children and teens (age 18 and under) who do not have health insurance and are not eligible for or already getting MA. CHIP offers high quality, affordable coverage on three tiers based on family income: full cost, low cost, and free. CHIP provides eligible children with health services such as medical, dental, vision, and behavioral health.
The CHIP Helpline can help callers with applying for CHIP or questions about their coverage. The number is 1-800-986-KIDS (5437).
COMPASS is the Department of Human Services' (DHS') online portal to access many of Pennsylvania's health and human services benefits. COMPASS allows users to learn about benefits and see if they qualify. People can also apply for, renew, and manage benefits.
County Assistance Office
County Assistance Offices (also called CAOs) are Department of Human Services (DHS) offices where anyone can apply for benefits, submit verification documents, or receive help from staff. There is at least one CAO in every county. You can find a list of CAO locations
Coverage refers only to health care insurance. This can include Medical Assistance, CHIP, insurance through Pennie, or private medical insurance. Health coverage is used to pay for personal medical expenses like doctor visits, medication, dental and vision care, and other covered medical costs.
Customer Service Center
The Statewide Customer Service Center is a point of contact for applicants and recipients to ask questions about their benefits, report changes to their information, or seek help in managing their benefits without having to go to a CAO. The Customer Service Center is available Monday – Friday 8 a.m. - 4:30 p.m. at 1-877-395-8930 or 215-560-7226 in Philadelphia.
To be disenrolled means that MA or CHIP coverage has ended. MA managed care coverage ends at the end of the month in which the disenrollment occurs.
In this case, eligible means that a person meets the requirements to receive MA or CHIP coverage. If a person is ineligible, it means that they do not meet the requirements for MA or CHIP coverage and we may then send information to Pennie to get health coverage through a Qualified Health Plan (QHP).
Eligibility Review Process
A CHIP applicant or enrollee may request that an impartial Eligibility Review be completed if an application or renewal determination results in an adverse action to the case.
Some people who sign up for certain coverage options through Pennie may qualify for some of their insurance premium to be paid for, also known as a
subsidy. This financial help lowers the individual's monthly payments and out-of-pocket costs (co-pays, deductibles, and others). The amount of financial help one receives is mostly based on income and the number of people in their household.
Medical Assistance (MA)
Medical Assistance (MA) in Pennsylvania includes Medicaid, which is a federal program that provides eligible individuals with health services such as medical, vision, and dental care health coverage.
Note: There are also other state-funded programs that provide health services. Those programs were not impacted by the Public Health Emergency.
myCOMPASS PA mobile app
myCOMPASS PA is Pennsylvania's free mobile app that allows users to access their My COMPASS Account from their mobile device or smartphone and perform certain actions like changing their contact information or uploading verification documents.
Pennie® is Pennsylvania's official health and dental coverage marketplace and the only link to financial assistance to help reduce the cost of coverage and care. Pennie® allows people to shop for the best medical coverage options for themselves and their families. In 2020, Pennie® replaced HealthCare.gov (also known as Affordable Care Act (ACA) coverage) as the official health insurance marketplace for Pennsylvania.
A premium is the amount a person pays for their health insurance every month. In addition to the premium, people usually must pay other costs when getting healthcare services, including deductibles, co-payments, and co-insurance. If you have a health plan through Pennie, you may be able to lower your monthly premium with financial assistance.
Public Health Emergency
The Public Health Emergency (PHE) is a federal declaration that began in 2020 in response to the COVID-19 pandemic. During the PHE, states must maintain the eligibility of most people receiving MA even when they were found to be ineligible.
Qualified Health Plan (QHP)
Any health insurance that meets the Affordable Care Act standards for comprehensive coverage. Qualifying health coverage is also referred to as Minimum Essential Coverage or MEC. All plans available on Pennie must meet these standards and must cover emergency room services, doctor and hospital charges, pregnancy care, treatment for all pre-existing conditions, mental health and substance abuse services, lab work, and a list of essential health benefits. Some include dental coverage.
Reconsideration is a period of time when we can accept required documents after MA has closed. If the renewal packet and/or necessary information is not returned by the renewal date, the recipient can provide the renewal packet and/or information up to 90 days after MA closes, and MA can be reopened with no gap in coverage if eligible. The recipient does not need to specifically request reconsideration for the County Assistance Office (CAO) to review for reopening MA.
A renewal is the process of reviewing a person's eligibility for Medical Assistance (MA) or CHIP. A renewal must take place every year and includes updating information to determine if the person receiving MA or CHIP still meets eligibility requirements.
A renewal packet will be mailed to every person receiving MA whose renewal cannot be completed via an Automatic Renewal. These forms must be completed and returned by the due date.
An appeal made within the period of time specified on the renewal. If the appeal is made within that time MA coverage may be maintained during the appeal process and until the appeal is adjudicated.
Verification documents are paperwork the Department of Human Services (DHS) needs to show proof that the information given to us is correct. This can be identification (ID), paystubs, bank statements, financial award letters, or any other documents with the needed information.