What’s changing with Medicaid (Medical Assistance) in Pennsylvania?

Changes are coming to Pennsylvania Medicaid, also called Medical Assistance, that will affect some people who are applying to or getting Medicaid.

Starting in January 2027, some Medicaid applicants and recipients, known as the Medicaid expansion group, will have to meet work requirements (or, if you’re exempt, report that to the Pennsylvania Department of Human Services).

If you don’t, you could be ineligible or lose coverage for Medicaid. Most of these changes go into effect in January 2027, so it’s important to stay on top of the new rules in Pennsylvania.

The state started outreach in August 2026 to any current Medicaid expansion recipients who will need to meet the new rules through mail, text messages, and automated calls. If these new rules apply to you, you should get information from PA DHS, so be on the lookout.

The best way to stay up-to-date is to make sure that the U.S. Postal Service and PA DHS have your current mailing address and contact information—the state is required to send a notice in the mail when there are changes with your case and if PA DHS needs more information from you, you’ll get a letter in the mail with a due date to provide whatever is requested.

Never miss a Medicaid notice. Update your contact information online with the US Postal Service and with PA DHS online through the COMPASS benefits portal, the myCOMPASS PA mobile app, or by calling or visiting your local county assistance office (CAO).

What changes are coming to Medicaid in Pennsylvania?#what-changes-are-coming-to-medicaid-in-pennsylvania

There are three changes coming to Medicaid in Pennsylvania in 2027, including:

• New work requirements for some adults: Also called “work rules” or “community engagement requirements,” this new rule requires some adults aged 19-64, who do not have a dependent under 14 ,to work or complete other qualifying activities to keep their benefits (unless they’re exempt).
• More frequent Medicaid renewals for some adults: This new rule requires some adults aged 19-64 with Medicaid to renew every six months instead of once per year.
• Changes to eligibility rules for some immigrants: Under new rules, some lawfully-present immigrants no longer qualify for federally funded Medicaid based on their immigration status as of October 2026. Pennsylvania has other coverage pathways that may be available to some affected people.
• Less retroactive Medicaid coverage: Under new rules, Medicaid will cover fewer months of eligible medical bills from before the start of your eligibility. Exact coverage depends on your eligibility category, but this makes it even more important to submit all the required information for your application as quickly as possible and to do your renewals on time.

There were also some changes to immigrant eligibility that went into effect in October 2026.

Rule changes do not apply to everyone who has Medicaid. If you have questions about how upcoming changes might affect you, reach out to your caseworker or local county assistance office.

Who will be affected by the Medicaid changes in Pennsylvania?#who-will-be-affected-by-the-medicaid-changes-in-pennsylvania

Not every Medicaid change will affect everyone in Pennsylvania. Many of the biggest changes affect adults ages 19 to 64 who qualify through Medicaid expansion.

This generally includes adults with low incomes who qualify based on income, rather than through another Medicaid group such as pregnancy, disability, or older age.

Other changes specifically affect people with certain immigration statuses. Starting in October 2026, some noncitizen refugees, asylees, humanitarian parolees, survivors of domestic violence or trafficking, and other noncitizens may lose eligibility for federally funded Medicaid if they do not have another qualifying immigration status.

Some changes, however, like shorter retroactive coverage periods, affect everyone applying for or renewing their Medicaid coverage.

Who is exempt from Medicaid work requirements?#who-is-exempt-from-medicaid-work-requirements

If you’re already subject to SNAP work requirements or meeting TANF work requirements you should be exempt from the Medicaid ones.

Other people who may be exempt from Medicaid work requirements include people who are:

• Pregnant or receiving postpartum Medicaid
• Caring for a child under age 14 or a person with a disability
• An American Indian or Alaska Native
• A veteran with a VA-determined total disability
• Under age 26 and formerly in foster care
• Receiving treatment for a substance use disorder
• Medically frail or have certain serious medical, mental health, intellectual, developmental, or physical conditions
• Recently released from jail or prison
• Experiencing certain temporary hardships, such as a recent stay in a hospital or residential care facility

Your local county assistance office may contact you if they need more information to determine whether you are meeting work requirements or qualify for an exemption.

What are the new work requirements for Medicaid in Pennsylvania?#what-are-the-new-work-requirements-for-medicaid-in-pennsylvania

Starting January 1, 2027, Medicaid expansion adults enrolled in Pennsylvania Medicaid, also called Medical Assistance, will need to meet new work requirements, also called community engagement requirements, to qualify for or keep their health coverage.

Generally, affected adults that are not exempt will need to either:

• Show they’re earning at least $580 per month, including seasonal work that averages to $580 a month over the last six months
• Go to school at least half-time
• Complete at least 80 hours per month of one or a combo of qualifying activities, which can include:
  • Working
  • Attending school
  • Volunteering or doing community service
  • Participate in a job training program

If you are required to meet work requirements for Medicaid, you will need to provide information at your next application or renewal to show you met the requirement or qualify for an exemption.

PA DHS will first try to verify your eligibility using information it already has. If they need more information from you, they’ll send you a notice, and you'll have 30 days to provide the requested information.

You can provide any requested information by calling your state at 877-395-8930 (or 215-560-7226 in Philadelphia), uploading documents through your COMPASS benefits portal, the myCOMPASS PA mobile app, or mailing or bringing documents to your local County Assistance Office.

If this rule applies to you and you don't meet the work requirements or show that you qualify for an exemption, you could be ineligible or lose your Medicaid coverage.

If other people in your household do not have to meet requirements, they can still get Medicaid as long as their renewal is completed and they’re still eligible, even if you don’t meet the work requirement.

How are Medicaid renewals changing in Pennsylvania?#how-are-medicaid-renewals-changing-in-pennsylvania

Starting January 1, 2027, some Medicaid expansion adults enrolled in Medicaid will need to renew their eligibility every six months instead of every twelve months to keep their health coverage.

This change affects all Medicaid expansion group recipients. You get Medicaid coverage through Medicaid expansion if you are ages 19-64 and qualify because of your income and not because of your health, age, or a disability.

People who qualify through another Medicaid eligibility category, like parents or caretaker relatives and former foster youth, are not subject to the new six-month renewal requirement. American Indians and Alaska Natives will also continue to renew every 12 months.

The timing of the new rules depends on when you applied or last renewed:

• If you newly enroll in Medicaid after January 1, 2027, you will have your first eligibility check six months after you applied and will continue completing renewals every six months.
• If you already had Medicaid before January 1, 2027, you will keep your next scheduled twelve-month date, and then any future renewals will be every six months. For example, if you renew your benefits in October 2026, your next renewal will be in October 2027 and your first six month renewal will be April 2028.

How did Medicaid eligibility change for immigrants in Pennsylvania?#how-did-medicaid-eligibility-change-for-immigrants-in-pennsylvania

Starting October 1, 2026, new federal rules changed which noncitizens can qualify for federally funded Medicaid in Pennsylvania.

Some people who previously qualified based on their immigration status lost eligibility, but Pennsylvania has other coverage options that may help some affected residents.

• Some immigrants lost Medicaid coverage: Starting October 1, 2026, refugees, asylees, humanitarian parolees, victims of domestic violence or trafficking, and people who have had deportation withheld no longer qualify for federally funded Medicaid based on those statuses unless they have become lawful permanent residents (LPRs).
• Some noncitizens remain eligible: Lawful permanent residents (green card holders), Cuban/Haitian entrants, and migrants from the Marshall Islands, Micronesia, and Palau under the Compacts of Free Association can continue to qualify if they meet the other Medicaid requirements. Lawfully present people who are under age 21 or are pregnant or who were recently pregnant can also remain eligible.
• Pennsylvania may provide state-funded Medicaid to some people who lose federal eligibility: Pennsylvania has a program called General Assistance-related Medical Assistance (GA-related MA) that provides state-funded Medicaid to some noncitizens who don't qualify through another Medicaid category. You must meet income and resource limits and another eligibility requirement, such as being age 59 or older, having a disability, needing health-sustaining medication, caring for certain children or people with disabilities, or meeting another qualifying condition.
• Emergency Medical Assistance is still available for qualifying emergencies: Non-citizens who don't qualify for regular Medicaid may be able to receive Emergency Medical Assistance (EMA) if they meet Medicaid income and resource limits and have an emergency medical condition verified by a medical professional. There is no five-year waiting period for EMA.
• CHIP also has additional protections: New federal immigration changes will not close CHIP coverage for eligible lawfully residing children and pregnant people. Pennsylvania uses a policy option known as CHIPRA that allows it to continue this coverage as long as the person meets the other CHIP eligibility requirements.

How is retroactive coverage for Medicaid changing in Pennsylvania?#how-is-retroactive-coverage-for-medicaid-changing-in-pennsylvania

Starting January 1, 2027, Pennsylvania Medicaid will cover fewer months of eligible medical expenses from before you applied for coverage.

Under the old rule, retroactive Medicaid could cover eligible medical expenses for up to three months before the month you applied, as long as you were eligible for Medicaid during those months.

That meant that after you were approved for Medicaid, it could cover outstanding medical bills from the months before.

Starting January 1, 2027, retroactive coverage will be limited to:

• One month before application for Medicaid expansion adults ages 19 to 64
• Two months before application for all other Medicaid recipients

This change makes it especially important to apply for Medicaid as soon as you think you may qualify, particularly if you have unpaid medical bills. Make sure your application is as complete as possible and, if PA DHS asks for more information, you respond quickly to avoid delays.

When do the Medicaid changes start in Pennsylvania?#when-do-the-medicaid-changes-start-in-pennsylvania

What if I lose Medical Assistance in Pennsylvania because of the new rules?#what-if-i-lose-medical-assistance-in-pennsylvania-because-of-the-new-rules

If you lose Medicaid because of the new rules, you may have other options for health coverage. What you should do next depends on why your coverage ended and whether you qualify for another program.

Depending on your situation, you may be able to:

• Reapply for Medicaid if you become eligible again or provide missing information
• Appeal the Medicaid decision if you believe your coverage was ended incorrectly
• Get coverage through Pennie, Pennsylvania's Health Insurance Marketplace, and see if you qualify for financial help that lowers your monthly premium or other costs
• Enroll in Medicare if you qualify based on your age, disability, or other status

Be sure to read any notices you receive from PA DHS or your local county assistance office. Your notice should explain why your Medicaid coverage is changing, when the change takes effect, and what options you have to keep or replace your health coverage.

Learn more about changes to Medicaid from PA DHS here on the DHS website.