As widely reported, the County Assistance Offices (CAOs) had a backlog of 154,000 Medicaid cases overdue for Re-Determination as of July 1. DPW/Office of Medical Assistance Programs ordered the CAOs to review these cases in a shortened timeframe with reduced staffing and an already high volume of every day workloads. The results of the clearing of the backlog were that 77,000 people lost their benefits—more than double the average case closings for the prior 18 months.

Of those people who lost benefits: 82 percent did not provide the required verification, 14 percent were determined to be no longer eligible, 2.5 percent voluntarily closed their cases and 2.5 percent failed to show up for their CAO appointment scheduled after they properly responded. As of Oct. 20, there had been a net closure of 105,000 Medicaid cases. OMHSAS cites that the overwhelming majority of the terminations are legitimate however advocates continue to hear from eligible people who had their benefits terminated.

What to Do if You or Your Family Member Believes Benefits Were Wrongly Terminated

• File an appeal to the advance termination notice within 13 days on the postmarked date (make a copy to keep).
• Mail the appeal via certified mail and request a return receipt or hand deliver the appeal to the CAO and ask for a receipt.
• Contact the OMHSAS Western Operations Field Office in Pittsburgh at 412-565-5226.
• Contact your respective state legislators to inform them of your situation.
• Please contact the NAMI Southwestern Pennsylvania office as we are attempting to track the number of people living with mental illness that are affected.

People needing assistance with filing appeals or who have other questions related to benefits can contact the PA Health Law Project Helpline at 1-800-274-3258.

Update from Kaiser Health News, June 30, 2009: The Health and Human Services Department Monday "rescinded three controversial Bush administration regulations governing Medicaid and said it would postpone and possibly change or rescind a fourth," according to CQ Politics.

Democrats had been particularly critical of the regulations, which had upset health care providers, state governments and advocates for the poor, and the decision to rescind them was not unexpected. CQ Politics reports: "Critics charged that the [Bush] administration was trying to shift to the states, from the federal government, the burden for about $19.6 billion in Medicaid spending over five years. Medicaid, a health insurance entitlement program for the poor, is a shared federal-state program, and there is constant tension between the two over costs" (Wayne, 6/29).

Modern Healthcare also reports: "Specifically, the Obama administration will be rescinding all or part of three Medicaid regulations that were previously issued. The rulemakings in total would have eliminated reimbursement for school-based administrative and transportation costs; limited the outpatient hospital and clinic service benefit for Medicaid; and restricted beneficiary access to case management services. The CMS also plans to delay until June 30, 2010, parts of a regulation that clarified limitations on healthcare-related tax programs, to determine whether states need additional clarification or guidance. A moratorium for most of the regulations had been set to expire on July 1, under a provision set by the American Recovery and Reinvestment Act of 2009" (Lubell, 6/29).

The Official U.S. Government Site for People with Medicare

The Office of Medical Assistance Program administers the joint state/federal Medical Assistance (also known as Medicaid) program that purchases health care for close to 1.9 million Pennsylvania residents.

Local County Assistance Offices determine eligibility for Medical Assistance.