Since October 1, some lawfully present immigrants no longer qualify for Medicaid.

A federal change under H.R. 1 ended Medicaid and CHIP eligibility for many people who are in the United States legally — including refugees and people granted asylum who don't yet have a green card, humanitarian parolees, survivors of trafficking, and people with Temporary Protected Status. Emergency Medicaid still covers emergency care and childbirth. People who remain eligible include US citizens, green-card holders who meet the five-year rule, Cuban and Haitian entrants, and COFA citizens of the Marshall Islands, Micronesia and Palau. If this may affect you or someone in your household, open any letter your state sends and ask about a community health center near you — they charge on a sliding scale regardless of immigration status. Read the full explainer →

New Medicaid work rules start in 92 days What you have to do →

All states Pennsylvania

Pennsylvania

Pennsylvania Medicaid and the new work rules

Medical Assistance (MA) is run by Pennsylvania Department of Human Services (DHS). Pennsylvania expanded Medicaid on January 1, 2015, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 2,875,106 enrolled 750,000 in the expansion group
Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 750,000 people in Pennsylvania. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

DHS says it will first try to verify compliance and exemptions automatically from existing wage, SNAP, TANF and medical-claims records. If it cannot confirm someone's status that way, it will contact the enrollee directly before taking any coverage action.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

310,000 people

That is the state's own estimate of how many will lose coverage.

Pennsylvania DHS/Shapiro administration estimate of Medical Assistance coverage loss from H.R. 1 (P.L. 119-21) provisions, announced in 2025 and reported by WITF and other outlets. This is separate from an additional, less precisely sourced estimate of Pennie marketplace enrollees who may lose coverage as enhanced ACA subsidies expire; a frequently cited combined Medicaid-plus-Pennie figure near 570,000–600,000 could not be traced to a single official document and is not used here.

Most of that is expected to be paperwork rather than people becoming ineligible. Which is the whole reason to sort out your address and your proof now rather than at the last minute.

February 2026 · already happened
DHS began CER planning and stakeholder workgroup meetings with its Medical Assistance Advisory Committee (MAAC)
June 1, 2026 · already happened
CMS published the interim final rule implementing the federal work requirement
August–September 2026 · already happened
DHS began mailing initial outreach letters (Form CM-710) to Medical Assistance enrollees likely in the expansion group
January 1, 2027
The work requirement takes effect and six-month renewals begin for the expansion group

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Parents or caretakers of a child under 14, or of someone with a disability
Pregnant, or receiving postpartum coverage through Medicaid
Members of American Indian or Alaska Native tribes
Veterans with a VA-determined total disability
In treatment for alcohol or substance use disorder
In prison or jail within the last 4 months
Former foster care youth under age 26
Already meeting TANF work requirements
Receiving SNAP and already subject to SNAP work requirements
Medically frail or with special medical needs — blindness or disability, substance use disorder, a disabling mental disorder, a significant physical, intellectual or developmental disability, or a serious or complex medical condition
Temporary hardship: a recent stay in a hospital, nursing facility, assisted living facility, personal care home, psychiatric facility, or other residential care facility
Temporary hardship: travel outside your community to get medical treatment for yourself or a dependent
Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64138% of the poverty line

1 person
$1,835.50
2 people
$2,489.20
3 people
$3,141.85
4 people
$3,795.50
5 people
$4,449.20
6 people
$5,101.85

Parents and caretakers138% of the poverty line

1 person
$1,835.50
2 people
$2,489.20
3 people
$3,141.85
4 people
$3,795.50
5 people
$4,449.20
6 people
$5,101.85

Pregnant215% of the poverty line

1 person
$2,860
2 people
$3,878
3 people
$4,895
4 people
$5,913
5 people
$6,931
6 people
$7,948

Source: PA DHS, Federal Poverty Income Guidelines page (pa.gov/agencies/dhs/resources/data-reports/federal-poverty-income-guidelines) and the 2026 Presumptive Eligibility Income Limits chart, both effective January 13, 2026. A note on precision: DHS's general eligibility page states adults 19–64 qualify 'at or below 133 percent' of the FPIG, publishing that as a monthly table. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months Starting January 1, 2027, the roughly 750,000 Pennsylvanians in the Medicaid expansion group move from annual to six-month eligibility renewals.
Back-dated coverage is changing on January 1 One month for adults in the expansion group; two months for children, people 65 and older, and people with disabilities. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details COMPASS Free, and open all year The state's own work-rules page Read Pennsylvania's guidance Updated as rules are finalized Talk to a person 1-866-550-4355 DHS Consumer Service Center — apply for Medical Assistance (including long-term care and home/community-based services) by phone COMPASS online help line, Mon–Fri 8:30am–4:30pm 1-800-692-7462

About the phone numbers: COMPASS's address changed to www.compass.dhs.pa.gov. Older bookmarks and some search results still point to www.compass.state.pa.us, which may not resolve.

Deaf, hard of hearing or speech-impaired: 1-800-451-5886.

EnglishSpanishArabicCambodianChineseFrenchHaitian CreolePortugueseRussianUkrainianVietnamese

Pennsylvania's general benefits application is published in English, Spanish, Arabic, Cambodian, Chinese, French, Haitian Creole, Portuguese, Russian, Ukrainian and Vietnamese, and county assistance offices can arrange interpretation for other languages on request. The specific Medical Assistance health care application (PA 600 HC) is only published in English and Spanish, so someone applying in another language should use the general PA 600 application form instead.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

71% of the coverage losses recorded in Pennsylvania were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. From January 1, 2027 that matters more, not less.

Pennsylvania Department of Human Services (DHS) · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

1
The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.
2
"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 1-866-550-4355.
3
Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.
4
You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.
Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

Procedural disenrollment · CMS
71%

Of people who lost coverage here, this share lost it over paperwork rather than eligibility. That is among the highest rates in the country.

Open every letter. Keep your address current with the agency.

Payment error rate · CMS
0.26%

Records here are relatively accurate, so treat a notice as real rather than assuming a mistake.

Quintile 1 of 5.

How care is delivered
Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Pennsylvania?
They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 750,000 people in Pennsylvania. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.
How many hours a month do I have to work?
80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.
Who is exempt from the work requirement in Pennsylvania?
Exemptions include: Parents or caretakers of a child under 14, or of someone with a disability; Pregnant, or receiving postpartum coverage through Medicaid; Members of American Indian or Alaska Native tribes; Veterans with a VA-determined total disability; In treatment for alcohol or substance use disorder; In prison or jail within the last 4 months; Former foster care youth under age 26; Already meeting TANF work requirements.
When do the Pennsylvania work rules start?
January 1, 2027. Starting January 1, 2027, the roughly 750,000 Pennsylvanians in the Medicaid expansion group move from annual to six-month eligibility renewals. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.
What is the income limit for Pennsylvania Medicaid?
For adults 19 to 64, about $1,835.50 a month for one person and $5,101.85 for a household of 6.
How do I apply for Medical Assistance (MA)?
Online at COMPASS, or by phone on 1-866-550-4355. It is free and there is no open-enrollment window — you can apply at any time of year.
How often do I have to renew Pennsylvania Medicaid?
Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.
Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

DelawareThe new work rules MarylandThe new work rules New JerseyThe new work rules New YorkThe new work rules OhioThe new work rules West VirginiaThe new work rules

See all 50 states and Washington, D.C. on the map →

If you're a Medical Assistance enrollee between 19 and 64, the new 80-hour-a-month work requirement takes effect January 1, 2027, and Pennsylvania's tracking system goes live October 31, 2026.

Update your address in COMPASS now and check whether you fall into one of the exemption categories — including caretaker, pregnant, or medically frail — before the letters and your first six-month renewal arrive.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to COMPASS →