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DHS COVID-19 PROVIDER RESOURCES // OMAP

Provider Quick Tips #244: MA Eligibility During COVID-19 Emergency Disaster Declaration 

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.