Pennsylvania Medicaid Renewal: How to Keep Coverage (2026)

Ignoring a renewal packet from your County Assistance Office can end your Medical Assistance even if you still qualify. Medical Assistance is the state's name for Medicaid, and federal law (42 CFR 435.916) requires the state to try to renew your coverage automatically from data it already holds before it asks you for a single form, but once a packet does reach you, it has to come back on time.

Renew online at COMPASS · Find your County Assistance Office

Recertification is the most consequential recurring moment in a Pennsylvania Medicaid case. Eligibility is set once at the initial application through your County Assistance Office (CAO), but it is redetermined every 12 months afterward, and a missed renewal can end coverage even for someone who still qualifies.1 A case that closes procedurally usually belonged to someone still eligible who did not return the packet in time, which is what the 90-day reconsideration window below exists to fix.

For the eligibility rules behind a renewal, see Pennsylvania Medicaid income and eligibility limits.

The Pennsylvania Medicaid Renewal and Recertification Cycle

Under 42 CFR 435.916, the Pennsylvania Department of Human Services (DHS) must redetermine eligibility for most recipients once every 12 months.1 Your renewal month is set when you are first approved and recurs in the same calendar month each year. Eligibility casework happens at the county level: each of Pennsylvania's 67 counties has at least one CAO, and the CAO that decided your application is the office that runs your annual recertification.

Renewals split into two procedural paths by eligibility category:

• MAGI populations (children, pregnant women, parents and caretakers, and the ACA expansion adult group, which Pennsylvania covers): renewed using Modified Adjusted Gross Income methodology. Income is confirmed through the federal data services hub, including Social Security Administration records, Internal Revenue Service tax data, and commercial wage data, supplemented by Pennsylvania state wage records.
• Non-MAGI populations (Aged, Blind, and Disabled; nursing-facility and Community HealthChoices long-term services; and Medicare Savings Programs): renewed under a framework that includes an asset test. DHS must still attempt an ex parte renewal, but because federal law requires the state to verify assets at renewal through an Asset Verification System (Section 1940 of the Social Security Act, 42 U.S.C. 1396w), expect a request for current bank statements, retirement-account statements, life-insurance documentation, and a signed financial-records authorization. Refusing or revoking that authorization is itself a ground for DHS to find you ineligible.3

Ex Parte Pennsylvania Medicaid Renewal: the Federal Mandate

The single most important federal rule in modern renewal is the ex parte default at 42 CFR 435.916(b)(1). Before DHS asks you for any information, it must redetermine eligibility without requiring anything from you whenever it can do so from reliable information already in your account or otherwise available to the agency, including electronic data sources. Only when it cannot may it request information from you.1

In Pennsylvania, ex parte renewal draws on Social Security benefit and earnings records, Internal Revenue Service tax filings, commercial and state wage data, other DHS benefit records such as SNAP and cash assistance, and Medicare entitlement data. If those sources confirm your income and household have not changed, the renewal processes automatically and DHS sends a notice that coverage continues for another 12 months with no action required.

When ex parte cannot be completed, DHS must send a renewal form with the information it already has and give you at least 30 days from the date of the renewal form to respond, supply any missing information, and sign. The clock runs from the form's date, not the day it arrives.1 That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Pennsylvania may follow the same procedures but is not required to, so ask your CAO which deadlines apply.1 DHS may not require an in-person interview to renew. Ex parte most often fails for self-employment or cash income that never appears in wage databases, for the non-MAGI asset check, for a household change, and for income close to a threshold.

How to Renew Pennsylvania Medicaid: Your Channels

Under 42 CFR 435.916, a renewal may be submitted through any of the modes DHS offers, and the agency may not require an in-person interview.1

COMPASS (Commonwealth of Pennsylvania Access to Social Services) is the statewide benefits portal. If you created a COMPASS account when you applied, use it; if not, you can create one with the applicant's name, date of birth, and Medical Assistance case number from any notice or the ACCESS card. For the full application and form walkthrough, see how to apply for Pennsylvania Medicaid.

The 90-Day Pennsylvania Medicaid Reconsideration Window

If your coverage closed because you missed the recertification paperwork, you usually do not have to start over.

Under 42 CFR 435.916, when coverage is terminated for failure to return the renewal form (a procedural termination, not an eligibility-based one), DHS must reconsider eligibility and treat the late-returned form as the renewal if you submit it within 90 days of the termination, without requiring a new application. That duty is federal for MAGI-based coverage and a state option on the non-MAGI pathways above, so ask your CAO.1

In practice: if your case closed on June 30 because the form did not come back, you have until roughly the end of September to submit it. If you remained otherwise eligible, DHS reconsiders and can restore coverage without a new application.

One timing detail matters: the 90-day clock runs from your termination date, not from the date of the notice, so read your closure notice carefully.

To use the window, resubmit the renewal form (often the same one you received) through COMPASS, your CAO, or the Consumer Service Center. If you no longer have the form, log in to COMPASS or contact your CAO to request a new one, and note the closure date prominently so the case is routed correctly.

Children's 12-Month Continuous Eligibility

Section 5112 of the Consolidated Appropriations Act, 2023 amended the Social Security Act to require every state to give children under age 19 enrolled in Medicaid or the Children's Health Insurance Program (CHIP) 12 months of continuous eligibility beginning on the date the child is determined eligible, effective January 1, 2024.2 In Pennsylvania, that reaches both Medical Assistance children and CHIP enrollees.

Once a child is enrolled, coverage is locked in for 12 months regardless of changes in family income. If a parent loses Medical Assistance mid-year because household income rose, the children stay covered until their next annual renewal. Under the federal rule, the 12-month period ends early only if the child turns 19 or ceases to be a Pennsylvania resident.2

The practical takeaway: a parent worried about rising income should still report the change. Reporting accurately protects you from a later fraud finding, and your children keep coverage through the rest of their 12-month period either way.

Postpartum Coverage After Pregnancy

Federal law gives states a permanent option, under Section 1902(e)(16) of the Social Security Act, to extend Medicaid coverage for a full 12 months after a pregnancy ends rather than the historic 60 days.2 Where a state has elected it, someone eligible while pregnant keeps full coverage through the twelfth postpartum month regardless of income, and the annual renewal cycle resumes only after that. Confirm the length of your postpartum coverage and your next renewal date with your CAO.

Community HealthChoices and Long-Term Care Renewals: Two Reviews

If you receive long-term care, your renewal has two independent parts, and both must stay current. Most Pennsylvania long-term-care recipients are enrolled in Community HealthChoices (CHC), Pennsylvania's mandatory Medicaid managed care program for dually eligible individuals and individuals with physical disabilities, and the capitated program through which the DHS Office of Long-Term Living delivers managed long-term services and supports.4 CHC covers adults 21 and over who have both Medicare and Medicaid or who receive Medicaid-funded nursing-facility or waiver services, and it is organized into five zones, each of which is covered by all three CHC managed care organizations: AmeriHealth Caritas, PA Health & Wellness, and UPMC Community HealthChoices.4

Your CAO runs the financial redetermination on the annual 12-month cycle, including the asset test federal law requires the state to verify through the Asset Verification System.3 The financial redetermination reviews income, countable resources, the signed asset-verification authorization, and, for a nursing-facility resident, the patient-pay calculation. In 2026, a Pennsylvania Medicaid nursing-facility resident keeps a Personal Needs Allowance of $60 per month, and the community spouse keeps a protected resource share equal to one-half of the couple's total countable resources, subject to a floor of $32,532 and a maximum standard of $162,660. Read $162,660 as the top of that standard, not as a cap on what a community spouse may keep: under 55 Pa. Code 178.124(a)(3) the county deducts the greatest of four amounts, and two of them, resources transferred under a court support order and an amount set by a Departmental hearing decision, name no dollar figure at all. Section 178.124(b) supplies the hearing route where the allowance does not generate enough income to reach the community spouse's monthly maintenance need allowance, and the institutionalized spouse's own income must be applied first.5 See Pennsylvania spousal impoverishment protections.

The level-of-care reassessment is separate. Your CHC plan's service coordinator (or the nursing facility for institutional care) reviews whether you still meet nursing-facility level of care, updating the assessment of daily activities, cognition, and medical need. The two reviews are independent: you can pass one and fail the other. If level of care is no longer met, long-term-care coverage ends, but you may continue on standard Aged, Blind, and Disabled Medical Assistance if otherwise eligible. See Pennsylvania long-term care and nursing-home Medicaid.

Medicare Savings Program and Dual-Eligible Renewals

Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) eligibility is redetermined on the same 12-month non-MAGI cycle, with DHS attempting an ex parte renewal first.1 Ex parte works comparatively well here because Social Security retirement and disability income sits in the federal data hub.

Keeping QMB, SLMB, or QI through your annual renewal keeps you automatically deemed eligible for the Medicare Part D Low-Income Subsidy (Extra Help); losing the Medicare Savings Program ends that deemed status and requires a separate Extra Help application. Dual eligibles keep Medicare regardless, but QMB cost-sharing protection ends with a Medicaid termination. Free counseling is available through PA MEDI (pa.gov), Pennsylvania's State Health Insurance Assistance Program, at 1-800-783-7067.6

Returned Mail: What Happens If DHS Can't Reach You

The federal rules that required an agency to search for a new address before acting on returned mail were removed from the Code of Federal Regulations effective July 31, 2026. Federal law now says only that an agency may act without advance notice when mail comes back with no forwarding address and your whereabouts are unknown, and that coverage must be reinstated if your whereabouts become known while you are still eligible.7 Pennsylvania may still have procedures of its own, so if your packet was returned to the CAO as undeliverable, call your County Assistance Office and ask where your case stands.

To avoid a returned-mail closure, update your address through COMPASS the moment you move, update it with your CHC plan, and file a USPS change-of-address form.

Procedural vs. Eligibility-Based Termination

This distinction decides whether you have a 90-day reconsideration window or must file a new application.1

Read the reason on your termination notice. If it references missed paperwork or no response to a renewal, you have the 90-day window. If it references an income calculation, an asset limit, or a categorical change, your remedy is a new application or an appeal of the eligibility finding.

Appeal Rights: the Bureau of Hearings and Appeals

If your renewal is denied or your coverage is terminated, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220.2 In Pennsylvania, hearings are conducted and decided by the DHS Bureau of Hearings and Appeals (BHA), a single statewide office, before an Administrative Law Judge.8

Federal rule caps the request window at 90 days from the date the notice is mailed. That 90 days is a ceiling on the window a state may allow, not a floor you are guaranteed: a state may set a shorter window, and a shorter state deadline is enforceable against you.8 Pennsylvania sets its window at 30 days from the date of the written notice under 55 Pa. Code 275.3, so the deadline that governs your case is the one printed on your own notice, not 90 days. Two extensions apply under the same rule: 60 days when no written notice was required or the agency failed to act, and up to 6 months when the required notice of the action and of your right to appeal was never sent at all. You file the appeal in writing with the CAO or program office that took the action, which forwards it to BHA to docket and schedule.8

Continuation of benefits. Under 55 Pa. Code 275.4, which mirrors the federal rule at 42 CFR 431.230, your Medical Assistance continues during the appeal if you request the hearing within the advance-notice period, before the action takes effect.9,8 Because DHS must give advance notice before terminating, requesting the hearing inside that window preserves coverage pending the decision. If DHS acted with no advance notice at all, 42 CFR 431.231(c) requires reinstatement when you request the hearing within 10 days of receiving the notice. If the agency's action is later sustained, federal rules permit it to recoup the cost of services furnished solely because benefits continued.9

Community HealthChoices participants challenging a plan's service or payment decision follow a different track: you must first exhaust the managed care organization's internal Complaint or Grievance process, and then you may request a BHA Fair Hearing within 120 days of the mail date on the plan's first-level decision.8 After a BHA decision, you may seek reconsideration by the Secretary of Human Services within 15 days or petition Commonwealth Court within 30 days. Free legal help is available from the Pennsylvania Health Law Project at 1-800-274-3258.10 For the full appeal ladder, see Pennsylvania Medicaid appeals and fair hearings.

Citizenship and Immigration Reverification

Recipients whose eligibility depends on satisfactory immigration status may have that status reverified at renewal. When DHS cannot promptly verify a declared citizenship or immigration status, federal law (42 CFR 435.956) requires a reasonable opportunity period, generally ending the earlier of verification or 90 days, during which it may not delay, deny, reduce, or terminate benefits for someone it otherwise finds eligible.11 Renewal reverification is usually faster than the first application because status was already confirmed once.

What Changes After 2026: 6-Month Renewals for Expansion Adults

Pennsylvania is an ACA Medicaid expansion state, so its working-age adult expansion group is directly affected by a new federal change. Section 71107 of the 2025 federal budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months, rather than every 12 months, for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027. Its only exemption covers an Indian or Urban Indian as defined in the Indian Health Care Improvement Act, a California Indian, and anyone otherwise determined eligible as an Indian for the Indian Health Service, and it turns on the state's own determination rather than on what you tell them.2 For hundreds of thousands of Pennsylvania expansion adults, this means twice-yearly recertification starting in 2027.

The same law separately excuses a longer list from its new community-engagement (work) requirement, including someone medically frail or the parent of a dependent child 13 and under. A work-requirement exemption is not a renewal exemption: an expansion adult who is medically frail still renews every six months.2

The same law also shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees and one month for the expansion group, down from the long-standing three-month default.2 Through the end of 2026 the three-month window is the federal outer boundary, not a guarantee: the exact effective date inside it is a state-plan choice, and a demonstration waiver can shorten a state's window, so confirm Pennsylvania's with your CAO. The lesson is unchanged: ex parte catches more people without paperwork, but the renewal packet is the failsafe.

Common Pennsylvania Recertification Mistakes

1. Treating the packet like junk mail. Pull anything from DHS, your County Assistance Office, or COMPASS out of the pile and open it the day it arrives.
2. Assuming ex parte will handle everything. Ex parte succeeds for only a portion of renewals, especially non-MAGI cases with an asset test; the rest need the packet back by the deadline printed on it.1
3. Updating your address with Social Security or your health plan but not with DHS. DHS does not auto-sync with SSA; update through COMPASS, the CAO, and your CHC plan.7
4. Not knowing the 90-day reconsideration window exists. A procedural closure can be reconsidered within 90 days with no new application (required for MAGI-based coverage; a state option otherwise).1
5. Missing the asset-verification signature for an ABD or long-term-care renewal. Without your signed authorization, DHS cannot run the required bank-record check and the renewal stalls.3
6. Assuming children lose coverage when a parent does. Children under 19 keep coverage for their full 12-month period regardless of family income changes.2
7. Waiting past Pennsylvania's 30-day appeal window. The federal ceiling is 90 days, but Pennsylvania's deadline is 30 days from the notice, so act quickly to preserve both the appeal and continued benefits.8

Pennsylvania Medicaid Renewal: Contacts and Resources

These offices can help you complete a renewal, recover coverage lost in the past 90 days, or appeal a termination.

If you are unsure whether your renewal has been processed, log in to COMPASS and check your case status, or contact your CAO. Brevy's Medicaid guides and the Pennsylvania Medicaid hub cover the eligibility rules behind a renewal.

Learn More

Find personalized help renewing Pennsylvania Medical Assistance at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.