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 under 42 CFR 435.916 it is redetermined every 12 months afterward, and a missed renewal can end coverage even for someone who still qualifies. When a case closes for procedural reasons, the person usually remained eligible and simply did not return the packet in time, which is exactly 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. 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 every state to verify assets at renewal through an Asset Verification System (Section 1940 of the Social Security Act, 42 U.S.C. 1396w), non-MAGI renewals clear automatically far less often and usually require the recipient to submit current bank statements, retirement-account statements, life-insurance documentation, and a signed verification authorization.

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.

In Pennsylvania, ex parte renewal draws on Social Security Administration benefit and earnings records, Internal Revenue Service tax filings, commercial wage data and Pennsylvania state wage records, other DHS benefit records such as SNAP and cash assistance, and Medicare entitlement data. If those sources confirm you remain within the income limit for your category and that household composition and other requirements have not changed, the renewal processes automatically, and DHS sends a notice stating 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. 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. 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 asset check required in non-MAGI cases, for a household change (a birth, a move, a marriage, or a death), and for income sitting 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.

Channel Where Notes
Online compass.state.pa.us or the myCOMPASS PA app Fastest, real-time confirmation, document upload supported, recommended
Phone DHS Consumer Service Center Telephonic renewal accepted; supporting documents go to the CAO or through COMPASS
Mail Your County Assistance Office Return the signed packet to the address printed on it
In person Any County Assistance Office Free language interpretation is available on request

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.

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 the missing paperwork. If you do, and you remained otherwise eligible during that window, DHS reconsiders your eligibility 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. 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.

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. Where a state has elected the extension, a person who was eligible while pregnant keeps full coverage through the end of the twelfth postpartum month regardless of income changes, and the annual renewal cycle resumes only after that period. If you were covered during a pregnancy, 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. 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.

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. 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 ceiling of $162,660. See Pennsylvania spousal impoverishment protections for how the community-spouse figures work.

The level-of-care reassessment is separate. Your CHC managed care organization's service coordinator (or the nursing facility for institutional care) reviews whether you still meet nursing-facility level of care, updating the functional assessment of activities of daily living, cognition, and medical need. The two reviews are independent: you can pass the financial redetermination and fail the level-of-care review, or the reverse. 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 for non-long-term-care coverage if otherwise eligible. For the full framework, 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. Ex parte works comparatively well here because Social Security retirement and disability income sits in the federal data hub.

If you keep QMB, SLMB, or QI through your annual renewal, you stay automatically deemed eligible for the Medicare Part D Low-Income Subsidy (Extra Help); losing your Medicare Savings Program coverage ends that deemed status and requires a separate Extra Help application. Dual eligibles keep continuous Medicare regardless of the Medicaid renewal, but the QMB cost-sharing protection ends with a Medicaid termination. Free counseling on this interaction is available through PA MEDI, Pennsylvania's State Health Insurance Assistance Program, at 1-800-783-7067.

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. 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.

Because your managed care plan's records are often more current than the ones DHS holds, keeping your plan updated is a high-value failsafe. To avoid a returned-mail closure, update your address through COMPASS the moment you move, update it with your CHC managed care organization, 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.

Termination type What it means Reconsideration available?
Procedural Failure to return the renewal form, a missing signature, or no response to a request for information Yes, 90 days from the termination date
Eligibility-based DHS determined you no longer meet income, residency, citizenship, age, disability, or another categorical rule No, file a new application (or appeal)

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. 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.

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. 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.

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., Because DHS must give advance notice before terminating, requesting the hearing inside that window preserves coverage pending the decision. If the agency's action is later sustained, federal rules permit it to recoup the cost of services furnished solely because benefits continued.

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. 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. 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. 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. For hundreds of thousands of Pennsylvania expansion adults, this means twice-yearly recertification starting in 2027.

The same law separately excuses a longer list of people from its new community-engagement (work) requirement, including someone who is medically frail or the parent or caretaker relative 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.

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. Through the end of 2026, the three-month window remains the rule. The practical lesson for families is unchanged: ex parte will catch more eligible recipients without paperwork, but the renewal packet is the failsafe, and ignoring it can end coverage even for someone who still qualifies.

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.
  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.
  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).
  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.
  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.
  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.

Frequently Asked Questions

How often do I have to renew Pennsylvania Medical Assistance?

Once every 12 months for most recipients under 42 CFR 435.916. Your renewal month is set at your initial approval and stays the same each year. One change is coming: Pennsylvania's ACA expansion adults move to a 6-month cycle for renewals scheduled on or after January 1, 2027.

What happens if I miss my Pennsylvania Medicaid renewal deadline?

Your coverage closes at the end of your renewal month. If the closure was procedural, you have a 90-day reconsideration window under 42 CFR 435.916 to submit the renewal form and have your eligibility reconsidered without a new application (required for MAGI-based coverage; a state option otherwise). If the reconsideration window has closed, file a new application through COMPASS.

My income went up. Does my child lose Medical Assistance?

No. Under federal continuous-eligibility rules, made mandatory nationwide effective January 1, 2024, children under 19 have 12 months of continuous eligibility beginning on the date they are determined eligible. Even if your income rises above the threshold, your child keeps coverage until the next annual renewal, unless the child ages out at 19, moves out of state, or the case ends for one of a few narrow reasons.

Can I appeal a Pennsylvania Medicaid denial, and will my coverage continue?

Yes. Federal rule allows up to 90 days from the notice date, but Pennsylvania's operational deadline is 30 days under 55 Pa. Code 275.3, so act quickly. If you request the hearing before the action takes effect, your coverage continues pending the decision under 55 Pa. Code 275.4. File in writing with your County Assistance Office, which forwards the request to the Bureau of Hearings and Appeals. The Pennsylvania Health Law Project at 1-800-274-3258 provides free legal help.

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.

COMPASS Renew online, upload documents, update your address, and check case status. compass.state.pa.us
County Assistance Office (CAO) Runs your recertification, accepts renewals and appeals, and answers case questions. pa.gov/agencies/dhs
Pennsylvania Health Law Project (PHLP) Free legal help with renewals, terminations, and fair hearings. 1-800-274-3258https://www.caregiver.va.gov/CAREGIVER/Caregiver_Support_Line.asp
Bureau of Hearings and Appeals (BHA) Decides Medical Assistance fair hearings statewide. 1-717-783-3950https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E/section-431.221
Independent Enrollment Broker Community HealthChoices and HCBS waiver enrollment help. 1-877-550-4227https://www.pa.gov/agencies/dhs/resources/medicaid/chc/chc-contact-information paieb.com
PA MEDI Free Medicare and Medicare Savings Program counseling. 1-800-783-7067https://cms.gov/contacts/pennsylvania-medicare-education-and-decision-insight-pa-medi/general-beneficiary-contact/1562186

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

MedicaidHow to Apply for Pennsylvania MedicaidHow to apply for Medicaid in Pennsylvania in 2026: COMPASS online, the County Assistance Office, or the new phone line, plus PA-600/600 LTC forms and timelines. MedicaidPennsylvania Medicaid Income and Eligibility LimitsPennsylvania Medicaid income limits for 2026: the $2,982 long-term-care income cap, the two-tier $2,400/$8,000 asset limit, and how seniors qualify. MedicaidPennsylvania Community HealthChoicesHow Community HealthChoices works in Pennsylvania in 2026: the three CHC plans, who must enroll, the carve-outs, Services My Way, and how to choose a plan. MedicaidPennsylvania Medicaid Appeals and Fair HearingsHow to appeal a Pennsylvania Medicaid denial, reduction, or termination, keep your benefits during the appeal, and request a fair hearing before the state BHA. MedicaidPennsylvania Long-Term Care and Nursing-Home MedicaidDoes Pennsylvania Medicaid pay for a nursing home? A 2026 guide to Pennsylvania Medicaid nursing home coverage, eligibility, patient pay, and estate recovery. MedicaidPennsylvania Medically Needy Spend-DownHow Medicaid Pennsylvania medically needy spend-down works in 2026: the MNIL, six-month cycle, eligible bills, and the Miller Trust comparison.

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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.