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Important changes are coming to the Medicaid program, also known as Medical Assistance, in Pennsylvania.
In July 2025, Republicans in Congress passed a bill that makes changes to the Medicaid program. President Trump signed that bill into law. Because of this new federal law, some Medicaid recipients will be required to renew their Medicaid every six months instead of every year. Additionally, some Medicaid applicants and recipients will need to meet work requirements or meet an exemption and report to PA DHS. If they do not report, they could lose coverage or be ineligible for Medicaid.
Keep reading to learn more about these changes, how they will affect Medicaid recipients, and how to meet the new work requirements or an exemption.
Important Dates
PA DHS will start reaching out to Medicaid recipients affected by these changes. That outreach will include mail, calls, and texts.
Work requirements go into effect for adult Medicaid recipients ages 19-64 who do not have a dependent child under 14 years old and do not meet an exemption.
Medicaid applicants and recipients must report they are meeting the work requirements or an exemption when they apply for or renew Medicaid coverage. If they do not report, they could lose coverage or be ineligible for Medicaid.
Medicaid coverage will not automatically change on January 1. Current Medicaid recipients will need to report they are meeting the new requirements or an exemption at their next renewal date in 2027. PA DHS will send a notice if there are changes to benefits.
Some adults ages 19 to 64 years old will have to renew their Medicaid every six months instead of every year. Current Medicaid recipients will switch to six months renewals after completing their next Medicaid renewal in or after February 2027. Renewals must be completed and returned to PA DHS to stay covered by Medicaid.
The timeframe will change for new Medicaid applicants who apply for retroactive coverage to cover medical expenses that occurred prior to the start of their Medicaid. Retroactive coverage can currently be approved for up to three months prior. As of January 1, retroactive coverage windows will change as follows:
- One month for Medicaid expansion adults (age 19-64)
- Two months for all other recipients
Renewing Medicaid Every Six Months
Starting January 1, 2027, some adults ages 19-64 will need to have their Medicaid eligibility checked by completing a renewal every six months instead of every year.
For example, if they apply for Medicaid on or after January 1, 2027, they will have to renew their Medicaid in six months. If their coverage begins in January 2027, they will complete a Medicaid renewal in July 2027.
If they are currently on Medicaid, the current renewal date will not be shortened until after their next renewal. For example, if their next Medicaid renewal is due in March 2027, they will renew again in September 2027.
Medicaid Work Requirements
Starting January 1, 2027, some adults ages 19-64 who do not have a dependent child under 14 years old must show that they are meeting work requirements. This will be reviewed during application, renewal, and when an individual becomes eligible for Medicaid expansion between renewals. If they must meet the requirement but do not follow the new rules or report to PA DHS, they will lose Medicaid coverage.
Some people may be exempt from the requirement. Read more about potential exemptions.
Retroactive Medicaid
Starting January 1, 2027, retroactive Medicaid coverage timeframes will decrease for Medicaid applicants. Retroactive coverage is for medical expenses that occurred prior to the month of application. Retroactive coverage can currently be approved for up to three months prior to the month of application for Medicaid.
As of January 1, retroactive coverage windows will shorten to the following:
- One month for Medicaid expansion adults (age 19-64)
- Two months for all other Medicaid recipients
Work
Volunteer or do community service
Participate in a work training program
Go to school at least half time
Going to school at least half time meets the full work requirement. When attending less than half time, hours can be combined with other activities to meet the 80-hour requirement. Each school determines whether their students are enrolled full time, half time, or less than half time.
Applicants and recipients may also meet the requirement based on their household’s monthly income if it is at least $580 each month. Seasonal workers may also meet work requirements based on their household’s average monthly income. Your caseworker can help you calculate if your income meets this option.
Remember: Applicants and recipients must report to PA DHS that they are meeting work requirements or an exemption during their application, renewal or if they become eligible for Medicaid expansion between renewals.
If they do not tell PA DHS, they may lose their Medicaid coverage.
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Are aged 19-64 years old;
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Do not have a dependent/child under 14 years old.
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Parents/caretakers of a child under 14 OR an individual with a disability
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Pregnant or receiving postpartum coverage through Medicaid;
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Members of American Indian or Alaska Native tribes;
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Veteran with a VA-determined total disability;
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In treatment for alcohol or substance use disorder;
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In prison or jail in the last 4 months;
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Former foster care under the age of 26;
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Meeting TANF work requirements;
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Receiving SNAP and subject to SNAP work requirements; OR
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Medically frail or have special medical needs, including:blindness or disability, substance use disorder/addiction, disabling mental disorder, other significant physical, intellectual, or developmental disabilities that make it hard to do daily activities, or serious and/or complex medical condition that makes it difficult to meet work requirements.
Exemptions are also available for temporary hardship situations, like:
- Recent stay in a hospital, nursing facility, assisted living facility, personal care home, psychiatric, or another residential care facility.
- Travel to receive medical treatment for a serious health condition for self or dependent.
How do people report their work requirements or exemption?
Applicants and recipients must report that they meet work requirements or an exemption at the time of application and at each renewal starting in 2027.
PA DHS will try to use information already on hand to verify work requirements and exemptions. If DHS needs more information, they will send a letter and individuals will have 30 days to provide the information.
Individuals can provide information in three ways:
- Call PA DHS to report at 877-395-8930 (or 215-560-7226 in Philadelphia).
- Upload documents through the COMPASS website or the myCOMPASS PA mobile app.
- Mail or bring documents to their local County Assistance Office.
Individuals who do not report that they meet the work requirements or are exempt may lose their Medicaid benefits.
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1
Update their address.
Log in to COMPASS at dhs.pa.gov/COMPASS or the myCOMPASS PA mobile app to check and update an address and other contact information.
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2
Report address changes to the US Postal Service
If they updated their address in COMPASS, they also need to report address changes to the US Postal Service to ensure they receive mail from us. Visit USPS.com/move to update an address.
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3
Sign up for texts and emails from DHS
Visit dhs.pa.gov/text to sign up for texts and emails to get even faster notifications about benefits.