Medicaid Rapid Reinstatement Project Established to Expedite Reinstatement of Benefits
Under an agreement with the Department of Public Welfare approximately 100,000 individual who were were terminated from Medical Assistance in the past year will be receiving a letter with instructions on how to seek expidited reinstatement of their benefits.
Community Legal Services of Philadelphia and Morgan Lewis hosted a webinar on October 26, 2012 to discuss the Medical Assistance Rapid Reinstatement Project. To view a playback of that webinar, click here.
Please watch this webinar to learn more about the program and how to assist your clients in obtaining an expedited reinstatement of benefits. Additional information on the program is outlined below.
General Information
In July 2011, the Department of Public Welfare (DPW) announced that it would be sending out redetermination packets to thousands of individuals who were overdue for a redetermination. From July 2011 until approximately January 2012, legal services and community agencies saw a significant increase in individuals losing Medical Assistance (MA) due to failure to return required verification. Approximately 90,000 children lost their MA during this time period.
Because of the concerns shared by many organizations across the Commonwealth about this sharp decline in enrollment, Community Legal Services and its law firm partner Morgan, Lewis & Bockius LLP began discussions with DPW to find a mutually agreeable solution.
Starting in late October or early November 2012, DPW will send a letter on blue paper to approximately 100,000 individuals who were terminated from Medical Assistance in the past year, advising them how they may seek expedited reinstatement of their benefits. Enclosed with this letter will be a very simple 2-page form to fill out.
Individuals have 30 days to fill out the form and send it back to DPW. Along with the form, individuals should also provide:
- Pay stubs if anyone in the household works
- Unpaid medical bills from the time they didn’t have Medical Assistance OR receipts from medical bills paid while they didn’t have Medical Assistance.
The form or supporting documentation should NOT be returned to a local County Assistance Office because all reinstatement forms will be reviewed in a central location. Instead, the form should be returned in the envelope provided. Decisions on eligibility will be made within 30 days unless more information is needed.
County specific legal aid phone numbers were listed on the blue letters. Legal aid offices can expect to receive phone calls from individuals who have questions or concerns about this process.
Other advocacy organizations can expect to see individuals coming to them with questions about the process.
INFORMATION FOR LEGAL AID ORGANIZATIONS
AND COMMUNITY GROUPS
If you receive questions, please do the following:
- If the individual has general questions about filling out the forms, please answer the questions based on the information provided above. Links to a sample blue letter and reinstatement form are included below. Please do NOT provide these documents to individuals who do not receive them in the mail from DPW.
- If the individual sent in the blue reinstatement form and then was denied Medical Assistance, evaluate whether you can represent them in an appeal or refer them as needed. Appeals should be sent to the central office administering this process.
- If the individual is experiencing any of the following problems, try to resolve them with DPW AND contact Community Legal Services (Justine Elliot, 215-981-3721). We would like to keep track of any problems with this process. Possible problems with this rapid reinstatement process include:
- Difficulty reaching the 800 number listed on the blue letter
- Difficulty receiving reimbursement for paid medical bills or receiving payment for unpaid medical bills
- Problems with lost paperwork
- Problems with receiving an eligibility decision within 30 days (unless more information is needed, in which case a decision should be made within 45 days)
- Appeals not being properly processed or resolved
- In Philadelphia, you can also refer general questions and problems to our helpline dedicated to this initiative. The helpline number is 267-765-6494.
If your office begins to receive numerous calls about the “blue letter” process, even if just for general questions, please let Justine Elliot or Richard Weishaupt at Community Legal Services know. It is very important that we track how this process goes across the state.