November 12
Why Did My Medicaid Coverage Change?
Why Did My Medicaid Drop Me? What to Do If You’re Losing Medicaid Coverage
Finding out that there is a change in Medicaid coverage for your health insurance can be a scary moment. But there is no need to panic. LCH Health and Community Services is the first call for many Chester County residents who receive a notification that coverage has been terminated.
You are definitely not alone, and you still have options for reinstating Medicaid or enrolling in a new health insurance plan. The most important thing to keep in mind is that you can and should still keep up with your healthcare, even if you do not have insurance. Keep reading to learn more about possible reasons why Medicaid dropped your coverage and what to do next.
Common reasons Medicaid drops people
There are many reasons people get a notice that their Medicaid insurance has been terminated. Some are related to losing Medicaid eligibility, like a change in income, household size, or age that means you need a different type of health insurance plan. Other reasons are related to missing the renewal period. This can happen if you did not complete your re-enrollment on time, if you forgot to update your contact information and missed your renewal notice, or if you thought that renewal was still automatic under the COVID-19 rules. If you have been wondering if Medicaid is going away, it definitely is not at this time.
Annual redeterminations: When does Medicaid end?
During the COVID-19 pandemic, you were able to stay continuously enrolled in Medicaid. In 2023, continuous enrollment came to an end, and Pennsylvania had to reinstate annual Medicaid renewals by the beginning of January 2026. This left many people asking the question, “When does Medicaid end?”
Medicaid is most certainly still a health insurance option, and many people who have to reapply for Medicaid are still eligible! The only change is that your eligibility has to be confirmed every year. Starting in 2027, some adults will have to renew Medicaid every 6 months. So if you recently found out that you lost your Medicaid coverage because you missed your re-enrollment period, you can still submit your renewal to get back on track.
Income and household changes that affect eligibility
Medicaid is a health insurance program for households that are considered low income. This means that the makeup of your household and your income are the main things that determine your Medicaid eligibility. For Medicaid in Pennsylvania, household income needs to be a certain percentage or less over the Federal Poverty Level (FPL), depending on the number of children also living in the home.
If your income is higher than the requirement, or you have children who age out of your household eligibility when they turn 19, you may no longer be eligible for Medicaid. Never assume that you earn too much, or that a change in your household makes you ineligible. Always reapply when you receive your Medicaid Renewal pink envelope in order to make sure. Even if you are not eligible for Medicaid anymore, you will still get helpful information on how to find affordable health insurance. LCH Social Assistance counselors are only available for LCH patients to navigate the next steps if they are dropped from Medicaid due to eligibility.
Is Medicaid going away?
While it’s easy to get concerned and wonder if Medicaid is going away because of new laws and policies at the state or national level, rest assured that Medicaid is not going away anytime soon. Laws do change, and that means coverage or eligibility can change. But the reality is that these policies do not change quickly. Even if a new approach to Medicaid is signed into law, states would have a generous amount of time to prepare people for what comes next.
For now and the foreseeable future, both the federal and state sides of the Medicaid program are in place to ensure that low-income Pennsylvanians have access to health coverage. Community Health Centers like LCH work closely with county, state, and federal agencies to stay informed about proposed changes to the Medicaid program. We are committed to passing relevant information along to our Medicaid patients.
What to do right away if you lost Medicaid
If you just found out that you lost Medicaid, remember not to panic. Taking the next steps for what to do when you lose Medicaid should be your priority to avoid gaps in coverage, but the pathway is manageable.
Step 1 – Check your notice letter
Pennsylvania’s Department of Human Services (DHS) is required to send you a notice before terminating your coverage. If you received your notice, read it carefully. It will tell you why your coverage ended and whether or not you can appeal the decision. If you do not think you ever got your notices to renew Medicaid or that you are being dropped, your contact information might be out of date. Log in to your COMPASS account or call the PA Medicaid Hotline at 866-550-4355 to update your address and find out your Medicaid coverage status.
Step 2 – Appeal or reapply quickly
Pennsylvania allows a 90-day grace period following Medicaid termination to reapply or appeal coverage denial. Take advantage of this grace period right away to either complete your renewal or appeal the decision.
If Medicaid was terminated due to a paperwork error or because you missed your re-enrollment window within those 90 days, a successful appeal or renewal will reinstate your coverage back to the date of when your renewal should have happened. Even though you have 90 days, complete your appeal or renewal as soon as you find out your Medicaid was dropped. Getting your coverage back on track quickly is key to making sure you and your family have access to quality healthcare.
Step 3 – Don’t skip your healthcare while you wait
Even if you do not have health insurance, please know that you can still receive medical care anytime you need it. A Federally Qualified Health Center, which is what LCH is, provides services to patients whether or not they have insurance or any ability to pay.
At LCH, we use a sliding-scale fee program that allows all of our patients to receive affordable healthcare and medical services regardless of insurance status. Never let your finances or insurance status stand in the way of visiting a healthcare provider for your family’s needs.
Low-income health insurance options if you don’t qualify for Medicaid
If you do not qualify for Medicaid, you and your family still have many options for health insurance and affordable healthcare. The Social Assistance team at LCH works closely with our patients to review the health coverage that is most affordable for their household. Even though your income may be high enough that you are not eligible for Medicaid, we can still help you find low-income medical insurance that keeps you covered.
ACA Marketplace plans and subsidies
Losing Medicaid coverage triggers a Special Enrollment period, which gives you 60 days to enroll in another health insurance plan. Pennie is Pennsylvania’s official health insurance marketplace under the Affordable Care Act. On the Pennie marketplace, you will find various plans with a range of premiums. Some plans have $0 monthly premiums, allowing you to maintain medical insurance even without Medicaid.
CHIP for children and teens
The Children’s Health Insurance Program (CHIP) provides health insurance to children and teens who are not covered by Medicaid. CHIP is affordable and available for many children whose parents do not qualify for Medicaid or cannot afford family health insurance for other reasons. You can apply for CHIP directly from your existing COMPASS account, by calling 800-986-KIDS, or through a paper application. If you are an LCH patient, schedule a Social Assistance appointment at your nearest LCH location, or at the Chester County Assistance Office for help with a paper application for CHIP.
| LCH Kennett Square | LCH Oxford | LCH West Grove | Chester County Assistance Office |
| 731 West Cypress St., Kennett Square, PA19348 | 14 South 3rd St.Oxford, PA19363 | 105 Vineyard WaySuite #103, 200West Grove, PA 19390 | 100 James Buchanan Dr, Thorndale, PA 19372 |
What does Medicaid not cover and how to fill those gaps
Whether you have Medicaid or another health insurance plan, you may find that there are some healthcare services that are not covered. It’s very important to know what Medicaid does not cover, or what coverage is limited, so that you can plan for those expenses when needed:
- Dental services – excluded for adults, although pregnant women and children have dental coverage under Medicaid.
- Vision care – routine eye exams are covered for children and adults, and glasses are covered for children. Adults with certain medical conditions will have glasses covered, and there are affordable added value plans that provide credits for glasses and contact lenses for adults.
- Specialty prescription drugs – are strictly limited to medical conditions, while experimental procedures and over-the-counter medicines or supplements are not covered at all.
- Cosmetic surgery – is not covered for children or adults unless the procedure is proven to be a medical necessity.
- Behavioral health services – may be covered with approval under standard Medicaid, or may require a specific behavioral health coverage plan. Pennsylvania’s behavioral health Medicaid coverage is robust, but it is important to understand what is covered for a specific diagnosis.
As a Community Health Center, LCH provides comprehensive health services for children and adults regardless of their insurance coverage or ability to pay. If you have a healthcare or medical need that falls under what Medicaid does not cover, please do not let that stop you from seeking care for yourself, your child, or another family member.
As Sara C. says, “Everyone from making the appointment to getting my paperwork at the end were friendly and caring. My insurance is limited, and this was the option that had a holistic approach from what I could tell. They absolutely delivered.”
LCH offers dental care, behavioral health services, pediatrics, chiropractic care, and women’s health services in addition to primary healthcare in our Southern Chester County locations. Our providers are dedicated to serving each patient with high-quality affordable healthcare.
How LCH can help with healthcare, with or without insurance
Losing Medicaid coverage may be stressful, but it does not mean that you are locked out of receiving healthcare or medical attention. As a Federally Qualified Health Center in Southern Chester County, LCH is prepared to treat every patient with any health insurance status. At all of our locations, we accept Medicaid, Medicare, CHIP, and most private health insurance plans. For patients who do not have health insurance, we offer our sliding-scale fee discount program for eligible patients so that healthcare is always affordable and accessible.
Carol M. shared how important this assistance was for her circumstances, “I’ve been coming since I first was unemployed and they helped my family both medically and socially in getting insurance and assistance. Now years later, I’m employed and better off but still make LCH my chosen medical provider.”
Patients can visit any of our three locations to receive comprehensive healthcare, speak with staff in English or Spanish, and get help renewing or applying for Medicaid or other health insurance. For primary care or social assistance, go to the LCH location that is most convenient to you: Kennett Square, Oxford, or West Grove. Women’s health, pediatrics, dental, and behavioral health are all located in our West Grove Health Center.