DHS Prioritized Reducing The Backlog And Cutting Red Tape, And Now, Medicaid Recipients Have More Health Care Providers Available And More Options For Care.

To provide better service to both Medicaid recipients in Pennsylvania and health care providers participating in the program, the Shapiro Administration today announced the Department of Human Services (DHS) has, within the first 100 days, reduced the backlog of Medicaid provider enrollment and revalidation applications by 75 percent for those more than 30 days old.

Facing a backlog of providers needing to enroll with DHS to become or stay a provider for the Medicaid program, the department prioritized tackling the waiting list using additional resources while also managing new applications. Since the Shapiro Administration took office in January, this backlog has fallen from 34,682 applications waiting for more than 30 days to less than 8,500.

"When this Administration became aware of provider wait times, we took immediate action to commit additional resources to this backlog and remove roadblocks to processing applications quickly," said DHS Acting Secretary Dr. Val Arkoosh. "The Shapiro Administration is dedicated to reducing, and eventually eliminating, the backlog of provider applications to be sure that health care providers can efficiently join or stay enrolled in the program and provide Pennsylvanians with the care they deserve. Providers aren't able to offer care to patients under the MA program until they are enrolled -- so this move to ensure they are enrolled timely ensures that care is more accessible for all Pennsylvanians -- regardless of income."

By federal law, Medicaid service providers must be revalidated by DHS every five years to provide medical assistance services to more than 3.6 million Medicaid recipients across Pennsylvania. Providers who do not submit a revalidation application before their revalidation date and have their enrollment closed must seek reactivation of their enrollment. Processing new and reactivated provider enrollment applications affects providers' ability to bill for services and participate in Managed Care Organization (MCO) networks. 

The system put in place in 2016 to meet Affordable Care Act requirements was meant to handle a much lower volume of applications, but DHS is working to institute process improvements and system efficiencies to process applications more quickly and prevent further delays.

As of March 2023, DHS has seen a downward trend in total applications, meaning that more applications are being processed per week than the department is receiving. DHS will continue to evaluate its processes and become more efficient to better serve health care providers within the Commonwealth.

The Shapiro Administration is committed to transforming Pennsylvania government to more effectively and efficiently serve Pennsylvanians, and DHS' efforts to reduce wait times and backlogs for Medicaid service providers are in addition to Governor Shapiro's Executive Order to improve the Commonwealth's licensing, permitting, and certification processes.