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More than 100,000 Pennsylvania households who were booted from Medicaid amid a state effort to purge the program of waste will get a chance to have their medical benefits reinstated, advocates announced Tuesday.
Lawyers said they have reached a settlement with the Department of Public Welfare to resolve claims that eligible families were improperly purged from the health insurance program for the poor and disabled.
"We are happy to say that both sides have reached an agreement that benefits working families and people with disabilities," Richard Weishaupt, an attorney for Community Legal Services of Philadelphia, said in a statement.
Under terms of the agreement, households will be able to submit a one-page form asking for reinstatement. Eligible families will be reimbursed for any out-of-pocket medical expenses they incurred while they were removed from the program.
The dispute began in 2011 as the Department of Public Welfare tackled a backlog of 385,000 cases that state officials said were overdue for eligibility reviews. Advocates became alarmed as nearly 90,000 children disappeared from Medicaid rolls between August 2011 and August 2012. The federal government asserted that a large number of cases were closed for "failure to provide information" or "failure to return renewal form" at a time when department caseworkers were so bogged down they couldn't adequately review the information that people submitted to verify their eligibility.
DPW spokeswoman Carey Miller disputed the agency had removed eligible recipients.
"We do not believe we improperly removed anyone from the Medicaid program," Miller said Tuesday. "We came to an agreement ... to send letters to those who did not turn in their paperwork for the re-determination process, as required. This letter is an added step to ensure that we are doing everything possible to reach out to those individuals."
In July, however, Miller did not deny that mistakes had been made, blaming "human error" as caseworkers processed paperwork.
Under the settlement announced Tuesday, DPW will rely more heavily on electronic databases to confirm eligibility, rather than on paper verification.
Medicaid insures about 2.2 million Pennsylvania residents. The federal government pays 55 percent of the cost while the state picks up the rest.
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