Important changes to your Children's Health Insurance Program (CHIP) eligibility process

Starting April 17, 2023, the Pennsylvania Department of Human Services (DHS) will begin processing applications and renewals instead of your child(ren)'s CHIP health insurance company. Your child(ren) will remain enrolled with their current health insurance company. There will be no changes to you child(ren)'s CHIP benefits or services.

After April 17, 2023, CHIP families should contact DHS directly with questions about eligibility and application processing. Attached with this letter is a frequently asked questions insert. The frequently asked questions insert includes specific information on:

  • How to apply for/renew healthcare benefits.
  • Where to provide requested verification documents.
  • Contact information for all questions regarding your child(ren's) eligibility and application/renewal processing.
  • Changes to the unique identifier number (UFI).
  • Upgraded COMPASS usage capabilities.
  • Access to myCOMPASS® PA mobile application.
  • Appeal rights and responsibilities.

You will receive a welcome letter from DHS that includes additional information in approximately two weeks. You may continue to contact your child(ren's) health insurance company directly with questions about insurance benefits and services.

Contacting us

If you have any questions, please call us at 800.KIDS.101, or 800.543.7101 (TTY: 711). Our office is open and available during the following times: Monday—Friday, 8:00 AM to 6:00 PM.

For more information on healthcare options for children in Pennsylvania, please visit the CHIPCoversPAKids website.

Frequently asked questions

All paper CHIP applications, renewals, and verification documents should be submitted to DHS starting April 3, 2023. More information about how and where to submit paper applications can be found in the Renewals section of this page.

There will be NO changes to your CHIP Health insurance.

What type of changes are coming due to this transfer?

CHIP eligibility will now be reviewed as another form of healthcare along with Medical Assistance (MA) by DHS. CHIP enrollees and potential enrollees will need to engage in a new process for eligibility and communication through DHS. CHIP families will see changes in the following areas:

  • CHIP applications and renewals will be processed by caseworkers at local DHS County Assistance Offices (CAOs).
  • Questions about eligibility and application processing can be addressed by calling the Statewide Customer Service Center at 877.395.8930 or 215.560.7226 in Philadelphia.
  • Communications about eligibility for CHIP and application processing will come from DHS, including but not limited to eligibility notices, renewal packets, and verification requests.
  • A new appeal process for eligibility determinations and appeal communications will come from DHS.
  • CHIP families will use a record number instead of their Unique Family Identifier (UFI) number for easy identification in DHS systems and their My COMPASS Account.
  • CHIP families will be able to do more with the myCOMPASS PA mobile application: upload verifications, leave messages for the caseworker, review correspondence, and choose paperless communications.

What is not changing?

  • Your CHIP health insurance company and benefits.
  • Income limits to qualify for CHIP.
  • Requirements to verify income, citizenship, and identity.
  • Premiums will continue to be handled by your insurance company.
  • You will still contact your health insurance company with questions about health insurance benefits, providers, and premiums.

Will my child(ren)’s CHIP coverage change?

No. There are no changes to your CHIP health insurance coverage or services. Your child will remain enrolled in coverage with their current health insurance company with no lapse in coverage.

  • Health insurance member services will still answer benefit or services questions as well as assist if you need to change your primary care physician (PCP).
  • Your choice of doctors will not change. Continue to contact your insurance company about in-network providers and services.
  • Your insurance cards will remain the same.

Who do I contact if I don’t agree with a treatment or coverage decision?

If you do not agree with treatment, provider, or coverage decisions, you will continue to use the current complaint/grievance process that is provided to you by your health insurance company.

When will these changes take place?

CHIP families will begin to receive communications from DHS in early 2023. You will receive a letter in early April 2023 with your new record number. CAOs will begin processing CHIP applications and renewals starting April 17, 2023.

It is extremely important to open and read any mail or emails from DHS as they will contain important information about your application or current CHIP coverage.

Contacts

Where do I send applications, renewals, and verifications?

Starting April 3, 2023, you will be able to submit applications, renewals, and verification documents in several ways:

  • Online at the PA COMPASS home page.
  • Upload photos of verification documents on the free myCOMPASS PA mobile app.
  • Call 866.550.4355 or call CHIP at 800.986.5437 and select option 2 to complete applications and renewals via phone.
  • Mail, fax, or drop off items in person to your local CAO.

Note: Please do not send any applications, renewals, or verification documents to your CHIP health insurance company or to the CHIP Office in Harrisburg after April 3, 2023. This may delay the processing of your application or renewal.

How do I report changes in my household after application and before renewal?

You can use COMPASS, the myCOMPASS PA mobile app, or call the Customer Service Center at 877.395.8930 or 215.560.7226 in Philadelphia to report changes such as household size, change in income, or a new address.

How do I find my local County Assistance Office?

You can find the address, phone number, and hours of operation of your local County Assistance Office by:

Will I still be able to contact my CHIP health insurance company?

Yes. You will still receive communications from your health insurance company and be able to contact them with questions about benefits, services, and premiums.

Who do I contact for issues or questions about my premium?

You will continue to contact your health insurance company about premiums. Contact information for each CHIP insurance company can be found on the CHIP Website.

You can find the CHIP health insurance rate information here.

COMPASS

What will be different about how CHIP families use COMPASS?

CHIP families will be able to do more on COMPASS such as:

  • Complete healthcare applications and renewals on the myCOMPASS PA mobile app.
  • Sign up for texts and electronic notices.
  • pload photos of verification documents using the myCOMPASS PA mobile app.
  • Access your renewal through myCOMPASS using either your social security number or a record number instead of a UFI or Unique Client Identifier (UCI).

How do I create a myCOMPASS account?

Creating a myCOMPASS account can be done in just a few minutes. Go to the PA COMPASS home page and select "Login/Register" from the navigation ribbon at the top of the screen. You will need to provide your name, contact information, and create a username and password. Follow the prompts to apply for or manage your benefits.

Who do I contact if I forget myCOMPASS login information or need other help with myCOMPASS?

If you have trouble logging into or using myCOMPASS, you can call the myCOMPASS helpline at 800.692.7462, option seven. A representative can help you reset your password or answer general questions about how to complete tasks on COMPASS. The helpline is available Monday - Friday 8:00 AM - 5:00 PM.

Renewals

How do I complete my renewal? Can I complete my renewal online or over the phone?

You can submit your renewal in several ways:

  • Online at PA COMPASS home page.
  • Over the phone by calling 866.550.4355 Monday—Friday between 8:00 AM and 5:00 PM
  • Mail, fax, or drop off in person to your local CAO.

The easiest way to complete your healthcare renewal is online at PA COMPASS home page. You can even submit required verification documents on the COMPASS website or through the myCOMPASS PA mobile app. You can download the myCOMPASS PA mobile app for free from the Apple App store or Google Play store.

How long do I have to complete and submit my renewal?

A due date will be listed on your renewal packet and in COMPASS with your MCA login. If you have difficulty completing your renewal or providing the required documents by the due date, contact your local county assistance office or the statewide Customer Service center at 877.395.8930 or 215.560.7226 in Philadelphia. These centers are available Monday - Friday 8:00 AM - 4:30 PM.

What if my renewal packet is not delivered or arrives late?

If you do not get your renewal packet or it arrives late, please call the statewide Customer Service center at 877.395.8930 or 215.560.7226 in Philadelphia Monday - Friday, 8:00 AM - 4:30 PM. They can send you a packet and help make sure you have enough time to submit your renewal and required documents. You can also complete your renewal online at PA COMPASS home page or by calling 866.550.4355 to complete your renewal over the phone with a representative.

What happens if I do not submit my renewal and/or required documents by the due date?

If you do not return your renewal or do not provide required documents by the due date, your healthcare coverage will stop. You will receive a notice of your coverage ending. The notice will include instructions on appealing the decision by asking for a fair hearing if you think we made a mistake. If you do not appeal, you can still provide your renewal and/or required documents up to 90 days after the ineligible date on your notice without the need for a new application. If you are still eligible for CHIP, your CHIP will reopen with no gap in coverage.

Note: During the COVID-19 Public Health Emergency members are not disenrolled for failure to provide a renewal packet or required documents at renewal. Self-attestation of information in the renewal packet is accepted with an electronic or handwritten signature.

What if I complete my renewal and I’m found ineligible for CHIP?

If you are found ineligible for CHIP when your renewal is processed, your family will be automatically reviewed for MA eligibility. You will get a notice in the mail telling you that your CHIP coverage will end, and the notice will indicate if you are eligible for MA or not.

If you are ineligible for MA, you may be referred to Pennie®, Pennsylvania's official health and dental insurance marketplace and source of financial assistance to lower the cost of coverage and care. You can find out more about Pennie® by visiting the Connect with Pennie® page or calling 844.844.8040.

You can appeal the decision if you think we made a mistake by asking for a fair hearing. Appeal and fair hearing rights and instructions for filing an appeal will be on your eligibility notice.

Hearings and appeals

If you do not agree with your CHIP eligibility decision, you will be able to appeal the decision and request a fair hearing that will be held by phone or, in some cases, face to face. The fair hearing form is included with your eligibility notice.

What does an eligibility notice include?

An eligibility notice is sent when DHS has made an eligibility determination and it will tell you if you are eligible to receive CHIP benefits. The notice includes the following:

  • Income used to make an eligibility and premium determination.
  • Household information like family size and relationships.
  • Date benefits begin or end.
  • Next review date.
  • Hearing and appeal information.

What if I do not agree with an eligibility decision at application, renewal, or during my eligibility period?

During the reconsideration period you can provide any information/verification to have your eligibility determined with updated material.

  • At application: an individual can request a reconsideration without a new application if requested verification is provided or a new application is requested within 60 days of denial date.
  • At renewal: an individual can request a reconsideration if requested verification/renewal packet is provided or a new application is requested within 90 days of closure date of benefits.
  • During eligibility period: an individual can request a reconsideration without a new application if requested verification is provided or a new application is requested within 60 days of the date benefits were closed.

What if I still do not agree with an eligibility decision and have sent the necessary information to the CAO for a reconsideration?

If you do not agree with the outcome of your reconsideration or any other eligibility decision you may request a fair hearing via written or verbal request.

How do I find information on how to request/complete an appeal?

Appeal information is provided with each eligibility notice that you will receive. This includes the form to complete to request a hearing along with instructions on where to provide the form or how to call to make a verbal request.

Important reminder

Due to the change in eligibility processing from the CHIP health insurance companies to DHS, there may be delays in processing applications and renewals in April 2023. Send all applications, renewals, or changes to DHS starting April 3, 2023.

To help ensure that your application or renewal is processed as timely as possible: If you apply or submit a renewal to your CHIP MCO in March 2023, make sure that you supply all documents needed to complete your application or renewal. CHIP health insurance companies are COMPASS community partners and information received by your insurance company will be transferred to DHS for processing.