CHIP IT Transition
Starting April 17, 2023, CHIP families will work with a caseworker at a DHS County Assistance Office to apply for and manage their CHIP coverage.
Your CHIP insurance company will still be able to help you with premium payments and questions about your coverage.
Your CHIP coverage will not change, and you don’t have to do anything.
The only thing that changes is where you go to apply for and renew CHIP coverage, report changes, submit documents, and ask questions about your CHIP eligibility.
CHIP families will go through a DHS caseworker to:
Submit applications and renewals
Make changes to your case
Provide verification documents
A caseworker will handle your application, renewal, case updates, and eligibility questions instead of your CHIP health insurance company. This change will make it as easy as possible to apply for, renew, and manage your CHIP coverage.
Below are common questions or you can download:
CHIP Transition FAQ (English) |
CHIP Transition FAQ (Spanish)
Jump down to:
Why is this changing?
We want to make it as easy as possible for families to apply for, renew, and manage CHIP coverage.
With this change, CHIP families will be able to:
After the change on April 1, families will also be able to use COMPASS to upload verifications, leave messages for their caseworker, review notices sent to them, and choose paperless communications for future updates for their CHIP coverage.
More general FAQs:
Accordion [2]
Expand AllClick here for a more accessible versionCHIP 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).
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Questions about eligibility and application processing can be addressed by calling the Statewide Customer Service Center at 1-877-395-8930 or 1-215-560-7226 in Philadelphia.
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Communications about eligibility for CHIP and application processing will come from DHS, including but not limited to eligibility notices, renewal packets, and verification requests.
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A new appeal process for eligibility determinations and appeal communications will come from DHS.
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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.
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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.
- 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.
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.
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.
CHIP families will begin to receive communications from DHS in early 2023. You will receive a letter in late March 2023 with your new record number. CAOs will begin processing CHIP applications and renewals starting April 1,2023.
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.
Accordion [1]
Expand AllClick here for a more accessible versionYes. You will still receive communications from your health insurance company and be able to contact them with questions about benefits, services, and premiums.
Starting April 1, 2023, you will be able to submit applications, renewals, and verification documents in several ways:
- Online at dhs.pa.gov/COMPASS.
- Upload photos of verification documents on the free myCOMPASS PA mobile app.
- Call 1-866-550-4355 or call CHIP at 1-800-986-5437 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 March 20, 2023. This may delay the processing of your application or renewal.
You can use COMPASS, the myCOMPASS PA mobile app, or call the Customer Service Center at 1-877-395-8930 or 1-215-560-7226 in Philadelphia to report changes such as household size, change in income, or a new address.
You can find the address, phone number, and hours of operation of your local County Assistance Office by:
- Visiting the CAO contact page
- Calling the Customer Service Center at 1-877-395-8930.
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: https://www.dhs.pa.gov/CHIP/CHIP-Coverage/Pages/CHIP-Insurance-Companies.aspx
You can find CHIP health insurance rate information here: https://www.dhs.pa.gov/SiteAssets/CHIP%20Contractor%20Rate%20Information%20-%207-1-2022%20rev%2011232022.pdf
What’s next?
After this change occurs, you will receive your case record number in a mailing. You can use this number to set up a
My COMPASS Account to manage your benefits or reference your case. You will also sometimes get mail from DHS about your CHIP case. It is important to review and respond to these mailings by the date listed on them to make sure your children keep their CHIP coverage.
FAQs - COMPASS
Accordion [3]
Expand AllClick here for a more accessible versionCHIP 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.
- Upload photos of verification documents using the myCOMPASS PA mobile app.
- Access your renewal through My COMPASS using either your social security number or a record number instead of a UFI or Unique Client Identifier (UCI).
Creating a My COMPASS Account can be done in just a few minutes.
- Go to dhs.pa.gov/COMPASS 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.
If you have trouble logging into or using COMPASS, you can call the COMPASS Helpline at 1-800-692-7462, option 7. 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 a.m. – 5 p.m.
FAQs - Renewals
Accordion [4]
Expand AllClick here for a more accessible versionYou can submit your renewal in several ways:
- Online at COMPASS
- Over the phone by calling 1-866-550-4355 Monday – Friday between 8 a.m. and 5:00 p.m.
- Mail, fax, or drop off in person to your local CAO
The easiest way to complete your healthcare renewal is online at dhs.pa.gov/COMPASS. 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.
A due date will be listed on your renewal packet and in COMPASS with your My Compass Account (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 1-877-395-8930 or 215-560-7226 in Philadelphia. These centers are available Monday – Friday 8 a.m. - 4:30 p.m.
If you do not get your renewal packet or it arrives late, please call the Statewide Customer Service Center at 1-877-395-8930 or 215-560-7226 in Philadelphia Monday – Friday, 8 a.m. - 4:30 p.m. 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 dhs.pa.gov/COMPASS or by calling 1-866-550-4355 to complete your renewal over the phone with a representative.
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.
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 pennie.com/connect or calling 1-844-844-8040.
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.
FAQs - Hearing and Appeals
Accordion [5]
Expand AllClick here for a more accessible versionIf 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.
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.
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.
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.
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.