Looking Ahead to HR1: Medicaid Work Requirements Coming January 1
In September, many Pennsylvania Medicaid recipients began receiving communications from PA DHS about the new Medicaid work requirements that start in January 2027. These letters, as well as robocalls and texts messages, provide an overview of work requirements and exemptions from those requirements. Below is key information to understand about the new Medicaid work requirements.
Only Medicaid Expansion Adults Are Affected
Medicaid work requirements only apply to adults aged 19-64 who are in the “Medicaid Expansion” category and many of those people will easily comply or be exempt.
Medicaid Expansion is a pathway to Medicaid coverage created by the Affordable Care Act and adopted in Pennsylvania in 2015. Prior to that, only children, people with disabilities, adults age 65+, pregnant people, and very low-income parents and caregivers could get Medicaid. Medicaid Expansion gave Medicaid coverage to childless adults and parents ages 19-64 with incomes up to 138% of the federal poverty level. This population, Medicaid Expansion adults, must meet work requirements unless they are exempt.
The groups listed in the table below are not subject to the new work requirements:
| People who are NOT on Medicaid Expansion | |
|---|---|
|
|
$580 in Monthly Household Income Counts
Many people in the Medicaid Expansion group will comply with work requirements by having household income of $580 in a month. This income does not have to come from work. Both earned and unearned income count, such as a pension or unemployment income. Some income does not count, such as workers' compensation, SSI, and VA benefits.
The $580 also does not need to belong to the person trying to meet the work requirement. It can belong to anyone in the household, or to a combination of people. "Household" means the Medicaid household:
- For tax filers and their spouses: the tax filer, their spouse who lives with them, and their tax dependents.
- For adults who do not file taxes: the applicant or recipient, their spouse who lives with them, and their children under 19 who live with them.
Parents of Children Under 18 Shouldn't Need to Worry
Parents living with their children under 18 should not have to worry about work requirements. These parents are automatically exempt, already compliant, or not in Medicaid Expansion at all, which means the work rules don't apply to them:
- Parents with dependent children under 14 are exempt from work requirements.
- Parents with household income of $580 or more in a month are compliant.
- Parents living with children under 18 with household income less than $580 are in a pre-ACA Medicaid category, not in Medicaid Expansion.
Many Others Can Be Exempt, Too
There are many more ways to be exempt from work requirements even for non-parents. All of the following individuals should be exempt from Medicaid work requirements, but they may have to take steps to let the County Assistance Office (CAO) know they should be exempt:
- People who are pregnant or receiving postpartum Medicaid coverage
- People who have a disability or medical condition that makes it hard to work
- People who live with and care for someone with a disability
- Related caregivers of someone with a disability
- Substance use treatment program participants
- And others
New Medicaid Applicants: Work Requirements Start January 1, 2027
Individuals who apply for Medicaid on or after January 1, 2027 and are reviewed for the type of Medicaid that has work requirements, will need to show they were either compliant with or exempt from work requirements in the month before they applied or that they are exempt at the time of application.
Current Medicaid Recipients: Work Requirements Start at First Renewal After January 2027
Current Medicaid recipients will not have to show work requirement compliance or an exemption until their first renewal that happens after January 2027.
The first recipients affected will be those with renewals due in February 2027. They will have to show they were compliant with or exempt from work requirements in any one month since their last renewal.
What to do now
- People on Medicaid should make sure their address is up to date with the County Assistance Office (CAO) and the U.S. Postal Service, so they don't miss renewals and other important information.
- People who get electronic notices about their Medicaid should check their email regularly for notifications from COMPASS.