Major Pennsylvania Medicaid Changes Are Coming in 2027: What Recipients and HCBS Providers Need to Know

Beginning January 1, 2027, major changes to Pennsylvania’s Medicaid program—also known as Medical Assistance—will affect many adults between the ages of 19 and 64.

The Pennsylvania Department of Human Services (PA DHS) is contacting potentially affected Medicaid recipients by mail, automated phone calls and text messages. The outreach is intended to help people understand the new requirements and what they may need to report to keep their healthcare coverage. The most important message for recipients, families and providers is simple: Do not ignore communications or renewal notices from PA DHS.

Who may be affected?

The new work and community-engagement requirements primarily apply to certain adults ages 19 through 64 who receive Medicaid through Pennsylvania’s Affordable Care Act Medicaid-expansion program.

As of August 14, 2026, approximately 709,000 Pennsylvanians were enrolled in HealthChoices through Medicaid expansion. However, not everyone in this group will be required to work. Many recipients may qualify for an exemption based on caregiving responsibilities, disability, medical needs or other circumstances.

Medicaid coverage will not automatically end on January 1, 2027. Current recipients will generally have their compliance with the new requirements reviewed at their next scheduled renewal in 2027.

Three major Medicaid changes beginning in 2027

1. Medicaid renewals may occur every six months

Some adults ages 19 through 64 will need to renew their Medicaid eligibility every six months instead of once a year.

For current recipients, the change generally begins after they complete their next scheduled renewal in or after February 2027. For example, someone who renews in March 2027 may need to renew again in September 2027.

Missing a renewal or failing to provide requested information could result in a loss of coverage.

2. New work and community-engagement requirements

Beginning January 1, 2027, certain Medicaid applicants and recipients ages 19 through 64 who do not have a dependent child under age 14 must demonstrate that they meet the work requirement or qualify for an exemption.

People subject to the requirement can generally satisfy it by completing at least 80 hours per month through one or a combination of the following:

• Employment or self-employment
• Volunteer work or community service
• An approved work or job-training program
• School or another qualifying educational program

PA DHS also states that some recipients may meet the requirement when their countable household income is at least $580 per month before taxes. Seasonal workers may qualify based on average monthly household income over the preceding six months.

Recipients should not assume PA DHS already has all the necessary information. They may still need to report their qualifying activities or exemption during an application or renewal.

3. Retroactive Medicaid coverage will be shortened

Pennsylvania is also changing the period during which new applicants may receive Medicaid coverage for qualifying medical expenses incurred before their application.

Beginning January 1, 2027:

• Medicaid-expansion adults may receive up to one month of retroactive coverage.
• Other Medicaid recipients may receive up to two months of retroactive coverage.

Previously, retroactive Medicaid coverage could generally extend for as many as three months before the application month.

This makes it especially important for potentially eligible individuals to apply promptly instead of waiting until significant medical expenses have accumulated.

Who may qualify for an exemption?

PA DHS identifies several possible exemptions from the work requirement. A person may qualify if they are:

• A parent, caretaker or caregiver of a child under age 14
• Caring for an individual with a disability
• Pregnant or receiving postpartum Medicaid coverage
• Medically frail or living with special medical needs
• Blind or living with a qualifying disability
• Living with a serious or complex medical condition
• Living with a significant physical, intellectual, developmental or mental health condition that interferes with daily activities
• Participating in alcohol or substance-use treatment
• A member of a recognized American Indian or Alaska Native tribe
• A veteran with a total disability rating from the Department of Veterans Affairs
• A former foster-care participant under age 26
• Meeting Temporary Assistance for Needy Families work requirements
• Receiving SNAP and subject to SNAP work requirements
• Currently incarcerated or recently released from incarceration

Temporary hardship exemptions may also be available following certain institutional stays or when a person must travel outside the community to obtain treatment for a serious medical condition.

Because individual circumstances differ, recipients should confirm their eligibility directly with PA DHS.

Why these changes matter to the HCBS community

Many people receiving home and community-based services live with disabilities, complex medical conditions or functional limitations that may qualify them for an exemption.

However, qualifying for an exemption and successfully reporting that exemption are not necessarily the same thing.

A recipient could experience a preventable interruption in coverage if PA DHS requests documentation and the request is missed, misunderstood or not completed on time. Coverage interruptions can affect access to medications, behavioral-health treatment, direct-support services, medical appointments and other essential care.

HCBS providers, supports coordinators, caregivers and family members can help by encouraging recipients to:

• Open and review every notice from PA DHS
• Keep their mailing address, phone number and email address current
• Know their next Medicaid renewal date
• Identify whether a work requirement or exemption may apply
• Gather supporting documents before they are requested
• Respond to PA DHS by the deadline stated in the notice
• Keep copies of submitted documents and confirmation information

Providers should offer education and administrative support while protecting recipients’ privacy and avoiding legal or eligibility determinations outside the provider’s role.

How recipients can submit information

If PA DHS needs additional information, the recipient will generally receive a notice and have 30 days to respond.

Information may be submitted through:

• The COMPASS website
• The myCOMPASS PA mobile application
• A local County Assistance Office
• The PA DHS Statewide Customer Service Center at 877-395-8930
• The Philadelphia Customer Service Center at 215-560-7226

Questions specifically concerning the 2027 Medicaid changes can be directed to the PA DHS HR1 FAQ Line at 877-883-6383.

Be alert for Medicaid-related scams

Major benefit changes can create opportunities for scammers.

According to PA DHS:

• Legitimate DHS text messages come from 69217.
• Automated DHS calls may come from 877-839-4782 or display “PA DHS.”
• PA DHS will not request sensitive information such as an Social Security number, EBT PIN or COMPASS password through an unsolicited text or automated call.
• Legitimate links should lead to recognized government, educational or nonprofit websites.

Recipients should avoid clicking unfamiliar links or providing personal information in response to threatening or suspicious messages. When uncertain, they should contact PA DHS through a verified telephone number or visit the official website directly.

What recipients should do now

Recipients do not need to wait until their next renewal to prepare.

They can take the following steps now:

1. Verify their mailing address and contact information through COMPASS or the myCOMPASS PA app.
2. Update their address separately with the United States Postal Service if they have moved.
3. Watch for letters, calls and text messages from PA DHS.
4. Review the available exemption categories.
5. Begin keeping records of employment, school, training or volunteer activities if the work requirement may apply.
6. Ask PA DHS or a qualified benefits counselor for assistance when anything is unclear.

The Bottom Line

From our perspective at HCBS Provider, the biggest concern is not simply whether someone meets the new requirements. It is whether participants and families understand what must be reported, receive their notices on time, and submit the right information before a deadline. For individuals receiving ongoing home and community-based services, an administrative oversight can have consequences that extend well beyond insurance paperwork.

Pennsylvania’s 2027 Medicaid changes introduce more frequent renewals, new reporting responsibilities for certain adults and shorter retroactive-coverage periods.

Many people in the HCBS community may qualify for exemptions, but no one should assume the process will happen automatically. Early preparation, accurate documentation and timely responses will be essential to preventing avoidable gaps in healthcare coverage.

HCBS providers can play an important role by educating staff, alerting participants and families, monitoring renewal deadlines and directing recipients to official PA DHS resources.

For the latest information, visit the Pennsylvania Department of Human Services Medicaid Changes page.

This article is provided for general informational purposes and does not constitute legal advice or an individual Medicaid eligibility determination. Medicaid recipients should rely on their official PA DHS notice and contact PA DHS regarding their individual circumstances.