Shapiro Admin helps Pa. residents prepare for Medicaid changes

HARRISBURG — Late this week, the Pennsylvania Department of Human Services (PA DHS) announced that nearly 700,000 Pennsylvanians who are on Medicaid will begin receiving letters to inform them of federally-mandated changes to the program that are scheduled to begin in January 2027, according to a release.

This letter is the first in a series of communications from PA DHS to notify Pennsylvanians about changes to Medicaid at the federal level and what they need to do to keep their coverage. A copy of the letter is available on PA DHS' website (visit https://bit.ly/Medi-Letter). The letter will be followed by automated calls and text messages starting in mid-September.

Under the federal budget bill passed by Congressional Republicans and signed into law by President Trump in July 2025, beginning January 2027, some Medicaid recipients and applicants ages 19-64 who do not have a dependent child under 14 years old will need to meet work requirements or show they meet an exemption to keep their coverage. Work requirements will be checked when a Pennsylvanian applies for Medicaid and at renewal for current Medicaid recipients. The mailing to affected Medicaid recipients outlines how to meet work requirements, details exemptions to these requirements and what recipients must do to stay covered. Also beginning in 2027, Medicaid renewals for these recipients will take place every six months instead of every year.

"For the first time ever, some Pennsylvania Medicaid recipients will need to verify they are working to receive health coverage," said PA DHS Secretary Dr. Val Arkoosh. "We have seen that when Medicaid work requirements have been enacted in other states, it adds more red tape, resulting in people losing their healthcare, not because they are not eligible but because the process to keep coverage is more difficult and creates confusion. PA DHS is doing everything we can to ensure Pennsylvanians stay covered. Since HR 1 became law last year, we have been preparing for these changes to the Medicaid program, including improving our technological capabilities and hiring staff. We are working alongside community organizations, health systems, managed care organizations, and others, to share information about these changes and to make sure Pennsylvanians who are eligible for Medicaid keep their coverage."

These changes affect only Pennsylvanians who are eligible for Medicaid under the Affordable Care Act's Medicaid expansion, which expanded coverage to adults ages 19-64 who are eligible based on their income, not based on disability or health status. Only adults who receive Medicaid because of Medicaid expansion will receive the letter outlining steps they must take to meet work requirements.

To meet the new work requirements, Medicaid applicants or recipients must do one or a combination of these activities for at least 80 hours a month:

Work.

Volunteer or do community service.

Participate in a job training program and/or

Attend school at least half-time.

Applicants and recipients whose household monthly income is at least $580 may not need to meet the new work requirements.

Medicaid applicants and recipients may be exempt from these rules depending on their health status or other circumstances. For example, parents or caretakers who meet certain criteria, those who are currently or recently pregnant, those subject to a SNAP (Supplemental Nutrition Assistance Program) or TANF (Temporary Assistance for Needy Families) work requirement, and those with certain health statuses or medical needs may be exempt.

PA DHS is working to simplify the exemption process as much as possible by using available data like recent medical claims to help identify if someone may be exempt. More information about exemptions, including a full list, is available at https://bit.ly/4r7LJma.

These new federal rules will start for applications received beginning in January 2027 and renewals due after January 2027. After current recipients' first renewal in 2027, they must begin renewing every six months instead of every year. If a Pennsylvanian must meet the work requirement but does not comply with the new requirements and report that they have complied to PA DHS, they will lose Medicaid coverage.

PA DHS has also launched a Medicaid Changes Communications Toolkit with shareable and customizable content to help everyone spread the word about these upcoming changes. Visit https://bit.ly/Medi-Tool.

The Toolkit includes resources such as flyers, social media posts, newsletter content, FAQs and more. The toolkit also includes the communications PA DHS will send to Medicaid recipients including text messages and phone call scripts. Automated phone calls will come from PA DHS 877-839-4782 and text messages will come from PA DHS 69217. The first letter Medicaid recipients will receive is also available online in English, Spanish, Arabic, Chinese, Russian and Vietnamese.

More information on changes to Medicaid is available on the PA DHS website at dhs.pa.gov/MedicaidChanges.

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