DHS COVID-19 PROVIDER RESOURCES // OMAP
Provider Quick Tips #244: MA Eligibility During COVID-19 Emergency
Issued: April 17, 2020
On March 13, 2020, President Trump declared a national emergency due to COVID-19. Federal regulations
allow for exceptions to normal processing procedures for Medical Assistance (MA) eligibility in special
circumstances such as a national emergency. Upon the Governor’s authorization in accordance with the
disaster emergency proclamation, the Secretary of the Department of Human Services (Department)
suspended any MA eligibility determinations associated regulations outlined in the Pennsylvania Code.
Thus, individuals having MA coverage on March 18, 2020, should retain their MA eligibility unless they are
no longer a resident of Pennsylvania, the individual requested their MA benefits be closed, the individual
has passed away or the individual is incarcerated.
County Assistance Offices are instructed not to close or decrease Medical Assistance (MA) benefits during
the disaster declaration. The Office of Medical Assistance Programs (OMAP) is aware of individuals whose
MA eligibility was incorrectly closed. Members whose MA benefits have terminated on or after March 18,
2020 will have them reinstated.
It is OMAP’s determination that members having MA coverage as of March 18, 2020 and enrolled in
Physical Health (PH) HealthChoices Managed Care (MCO) will retain their eligibility until the end of the
emergency declaration. OMAP, along with OMHSAS and OLTL, are working to keep the individuals
enrolled in the same managed care organizations, continuously during the emergency disaster, unless the
individual has moved counties.
Providers and MCOs should understand that EVS, which is the system providers use to determines an
individual’s eligibility for MA, may not reflect MA eligibility or may reflect eligibility for MA Fee-for-Service
(ACCESS) and not the MCO they were covered under prior to March 31, 2020. The Department is working
to correct these eligibility issues.
In EVS if a member is showing as eligible for ACCESS, but had previous managed care coverage, providers
should contact that MCO to verify enrollment. If in EVS the member is showing as no longer eligible for
any coverage on or after March 18th, please instruct the member to contact their county assistance office.
Providers should continue to check the Department of Human Service’s COVID-19 website and the
Department of Health’s website for updates regarding COVID-19.