Big changes to Pennsylvania Medicaid start January 1, 2027. Here is what you need to know, in plain words.
Who do the new work rules affect?
Adults ages 19 to 64 who get Medicaid through expansion and do not have a child under 14 at home.
What do I have to do?
Do 80 hours a month of any of these:
- Work
- Volunteering
- School
- Job training
Some people don’t have to do this. This is called an exemption.
Do I need proof?
- In 2027: you tell DHS your hours yourself. This is called self-attestation.
- Paid work: DHS checks state wage records. They may ask for proof, like a pay stub.
- Starting in 2028: you will need proof.
Important: Self-attestation does not mean you can skip it. You still have to answer DHS, or you could lose coverage.
What else is changing?
- Renewals every 6 months, not once a year, for some adults.
- Less back coverage. Medicaid will pay for older bills from only 1 month before you apply (expansion adults) or 2 months (everyone else).
How do I keep my Medicaid?
- Keep your address and phone number up to date with DHS.
- Watch your mail.
- Look for texts from 69217. That is DHS.
- Answer DHS by the date they give you.
Who can help me?
- At our centers: our Patient Financial Counselors can help you in person.
- By phone: PointCare at 215-600-3182.
- DHS help line: 1-877-883-6383.
- Spectrum Health Services: 215-471-2761, or make an appointment.
No insurance? You can still get care. We offer a sliding fee scale based on income.
Could the rules change?
Yes. The state is still working out details. We will update this page when we learn more.
Sources: PA DHS: Medicaid Changes and PA DHS: Medicaid Changes FAQ.