Important Information about Changes to Adult Medical Assistance Benefits

     This week the Pennsylvania Department of Human Services (formerly DPW) is sending notices to 1.1 million adult Medicaid (Medical Assistance) recipients, telling them which Medicaid benefits package they will receive starting January 1.  Now is the time to review these notices and file an appeal if the notice assigns a recipient to the “Healthy” or “Private Coverage Option” package and the recipient needs better coverage. Filing an appeal within 10 days of the date on the notice permits the recipient to keep his/her current benefits and present health plan! 

Appealing is easy. 

Use the form included with the benefit plan notice.  Do not miss the 10-day deadline for getting the appeal form to the welfare office, make a copy and get a receipt.

·      Individuals assigned to the “Healthy” plan will face severe benefits cuts, including a limit of only four specialist doctor visits per year, and only $350 worth of lab work per year.  

·     Individuals assigned to the Private Coverage Option (PCO) will lose their current health plan and CBH coverage.  Persons can choose (or will be assigned to) a new PCO plan with very restricted provider networks.  Those assigned to the PCO will also lose transportation and dental benefits

·    There is no need to appeal

if the notice assigns a person to the “Healthy Plus” plan.

Attached are flyers with advice for people assigned to each of the three new Medicaid benefits packages (Healthy, Private Coverage Option, and Healthy Plus).