750,000 – that is the number of residents within the state of Pennsylvania that the state is estimating will be kicked off of their Medicaid plans on January 1st, 2027. In an effort to “decrease fraud, waste and abuse”, the Trump administration rolled out H.R.1 in 2025, which introduced new measures to public benefits across the country and, more importantly, who could access them.
While each state has their own rules and regulations when it comes to services like Medicaid and Food Stamps, the Federal Government implements the specific guidelines (or terms) the states must follow in order to see who qualifies. There are some grey areas – called Medicaid expansion – that allows a broader audience to partake in these benefits, if they meet specific guidelines.
To better understand the changes coming for Pennsylvanians, see below for our helpful insights and tricks, for understanding a congested system that was, in fact, never really meant to be understood.
What is changing in 2027?
According to H.R.1, which was introduced to Congress in 2025, it introduced new Medicaid eligibility requirements for certain adults enrolled through what is called Medicaid expansion. Beginning no later than January 1st, 2027, adults ages 19-64 who don’t qualify for an exemption will be required to regularly demonstrate participation in work or other community engagement to maintain eligibility.
What are the exemptions?
Certain Medicaid members may qualify for what’s called a Medicaid Exemption if they fall into one or more of the following categories:
- Individuals under 19 or 65
- Pregnant or postpartum individuals
- People who are eligible for Medicare
- Certain caregivers
- Individuals meeting SNAP or TANF work requirements
- Individuals who meet applicable medical frailty or disability-related criteria
- People participating in qualifying substance use disorder (SUD) treatment programs
- Former inmates of a public institution during the last 3 months
- Native Americans and certain other groups
- Other individuals identified through federal and state guidance
What are the work requirements, as mentioned?
Prior to this upcoming January 1st, Medicaid recipients who were unemployed and did not have a “qualifying” medical condition were able to obtain Medicaid normally as other members. Now, the Federal and State governments must verify compliance.
Members who do not have a qualifying exemption must be completing their work requirements, such as:
- Enrollees must complete at least 80 hours per month of qualifying activities – such as working a part time job, or volunteering. If neither of these, applicants must be enrolled in an educational program at least half time.
- Individuals may combine activities to meet 80-hour work requirements, or meet it by earning at least 80 times the Federal hourly minimum wage, or $580 per month in 2026.
Are there medical exceptions to this?
Yes, the Pennsylvania Department of Human Services explains that H.R.1 exempts certain people from the work requirement including:
- An individual who is medically frail or other has special medical needs, including people who are or have a:
- Blind or Disabled
- Substance Use Disorder
- Disabling Mental Disorder
- Physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living
- Serious or complex medical condition
- *H.R.1 also allows for short-term hardship exemptions, such as a recent hospital admission
What about SNAP/ EBT Benefits? Were there changes to this as well?
Yes, certain SNAP recipients in Pennsylvania now must meet work requirements, while also reporting whether they are meeting these requirements to the PA Department of Human Services. If a SNAP recipient does not meet these requirements, they can only receive three months of SNAP benefits in a three-year period.
My friend is a noncitizen; do they still have access to these benefits?
Depending upon their citizenship status, the eligibility for noncitizens has changed. HR 1 changes which noncitizens can get federally-funded Medicaid coverage starting October 1, 2026. The following individuals will still be eligible for Medicaid:
- Lawful Permanent Residents (LPRs)
- Cuban/ Haitian Entrants
- Compact of Free Association Migrants (those from the Marshall Islands, Micronesia, and Palau)
- Lawfully present* individuals who are under age 21 or are recently pregnant
- * Lawfully present is a broad term that includes almost everyone who is permitted to be in the United States and includes both short-term and long-term stays.
The following individuals will NOT be eligible for Medicaid starting Oct. 1st, 2026:
- Refugees who do not have LPR status
- Asylees who do not have LPR status
- Humanitarian parolees who do not have LPR status
- Victims of domestic violence or trafficking who do not have LPR status
- Individuals who have their deportation withheld
What is the easiest way to find out if my benefits are changing?
The fastest way to discuss any changes to your PA Medicaid or SNAP benefits is to contact COMPASS. COMPASS is the DHS’s application website for residents to apply for services such as Medicaid, Food Stamps, LIHEAP, and so forth.
There are numerous ways to apply, whether you want to apply online, submit a paper application or apply in-person or on the phone, there are options to help with any type of circumstance.
What cannot be stressed enough, is the communication you will have between yourself and the PA DHS/ COMPASS team. Ensure they have all of your updated information in their system, including contact information, mailing address and work verification documents. If you fail to provide any of these, you are subject to losing your benefits.
How often do I have to recertify my benefits?
Unlike past years, starting Jan. 1st, 2027, all applications that are processed from that day forward, will have to recertify every 6 months; be on the lookout for large pink packets in the mail from the DHS that will contain your renewal packets.
These will contain your record ID, recertification due date, among other things. Be sure to keep these safe, as these hold valuable information moving forward.
I think I may need some extra help with my application – what can I do?
Do not hesitate to reach out to a COMPASS representative, or if you are working with a local case manager at a neighborhood clinic, there are numerous ways to get aid while applying for benefits.
To contact COMPASS, please utilize the following contact information: 1 (800) 692-7462
These changes are a shock to the entire community, as well as healthcare as a whole. Patients and providers are more anxious than ever, as many of us (including myself) face life-threatening diseases that need to be addressed on a daily basis, whether it is through treatment, prevention, or overall maintenance of our health.
It is important that we all remain focused, pay close attention to updates regarding these changes, and above all, remain happy and healthy.
