Pennsylvania has started mailing formal notices to more than 700,000 Medicaid expansion enrollees statewide, warning them that many will soon need to prove they work or volunteer at least 80 hours a month to keep their health insurance. Philadelphia alone has about 183,000 people in that Medicaid expansion group, and city and state officials are urging residents not to toss the letters aside.
The notices, sent by the Pennsylvania Department of Human Services, instruct recipients to update their contact information through the myCOMPASS PA app or by phone, and to check whether they qualify for an exemption from the new work rules. According to WHYY News, the letters also list household members currently enrolled in a Medicaid plan who may be affected by the changes. The new federal eligibility rules were signed into law by President Donald Trump in 2025 after passing Congress, and they apply to the Medicaid expansion population — adults ages 19 to 64 with low incomes who don't have children, disabilities, or a pregnancy.
Brandon Cwalina, speaking for the state, said the Shapiro administration is committed to protecting health care access and helping affected Medicaid recipients stay covered, per the same report. Medicaid — known in Pennsylvania as Medical Assistance or HealthChoices — is jointly funded by the state and federal governments and managed by state agencies, though the scale of the coming shift is enormous. In fiscal year 2024, roughly 3.14 million Pennsylvanians, or 24.1% of the state's population, were enrolled in Medicaid, with about 750,000 of them covered under the expansion program, according to USAFacts.
Philadelphia's Outsized Stake in the Rollout
Philadelphia County accounts for roughly 23% of Pennsylvania's total Medicaid enrollment, with about 670,000 residents relying on the program, according to the Philadelphia Inquirer. That concentration helps explain why city leaders have moved to set up their own infrastructure around the rollout. Philadelphia has established working groups to prepare for and respond to the federal changes, with those groups analyzing potential financial impacts on city departments if residents lose Medicaid and developing pathways for people to meet the 80-hour work or volunteer requirement.
Crystal Yates-Gale said Philadelphia aims to use its platforms and connections to inform residents about the coming changes, and she urged Philadelphians to open their mail, download the Compass app, and keep their address current. The working groups are also focused on identifying eligible people and helping with enrollment or eligibility paperwork, which recipients will need to handle every six months. Community Legal Services and BenePhilly are partnering to help residents navigate the documentation requirements and connect with social services.
What Happens If Coverage Lapses
City officials are already thinking about the downstream effects. Medicaid coverage losses could increase demand on Philadelphia's emergency services, mental health agencies, and public health centers, and several city agencies are preparing to step in. The Philadelphia Department of Public Health, the Department of Behavioral Health and Intellectual Disability Services, and Community Behavioral Health will all help patients understand what they must do to retain their coverage. Philadelphia's public health centers treat people regardless of insurance status, and the city is also directing residents to online finders for community resources, food and meals, and primary care providers.
Philadelphia officials are partnering with local nonprofits, health care providers, and other agencies to deliver Medicaid resources and information as the 2027 compliance deadline approaches. The federal work requirements stem from H.R. 1, the One Big Beautiful Bill Act, which the Centers for Medicare & Medicaid Services followed up with an interim final rule on June 1, 2026, establishing compliance guidelines for states, according to the National Alliance for Direct Support Professionals.
What Other States Have Learned the Hard Way
Pennsylvania is not the first state to attempt this. When Arkansas became the first state to enforce Medicaid work requirements in 2018, more than 18,000 adults lost coverage within four months, and a 2020 Harvard study concluded the rule failed to increase employment while significantly increasing medical debt and delayed care, according to Health Affairs. Federal courts eventually halted Arkansas's program before the Biden administration revoked its waiver.
Georgia offers a more recent cautionary example. Its Pathways to Coverage program, which requires 80 hours of work or qualifying activities per month, saw only 5% of more than 110,000 eligible applicants successfully complete enrollment in its first years, largely due to complex reporting requirements, per research published in PubMed Central. Georgia remains the only state currently operating an active 80-hour Medicaid work condition program. A policy analysis by the Urban Institute estimated that between 174,000 and 198,000 Pennsylvanians could lose Medicaid coverage under the new 80-hour monthly requirement, with researchers noting that administrative reporting hurdles, rather than non-employment, drive most coverage losses in states that have tried this before.
The Fiscal and Legal Backdrop
The financial stakes for Pennsylvania are significant. The federal government funds 90% of the cost for adults enrolled under ACA Medicaid expansion, compared to a standard 56% federal matching rate for traditional Medicaid enrollees in the state, per the Commonwealth Foundation. Pennsylvania formally expanded Medicaid under the Affordable Care Act in 2015 under Governor Tom Wolf, extending coverage to more than 2.5 million residents over the following decade. Nationally, Congressional Budget Office estimates from 2025 projected that implementing federal Medicaid work requirements would cut federal Medicaid spending by $326 billion over ten years, a figure reported by KFF.
Meanwhile, the rules themselves remain contested. In July 2026, Michigan's Attorney General led a multi-state federal lawsuit challenging federal Medicaid work rules that narrowed the eligibility definition for the medically frail exemption, with state officials arguing the tightened federal definitions put vulnerable enrollees at risk. That litigation could still reshape how Pennsylvania and other states process exemptions before the 2027 deadline takes full effect, leaving open how much flexibility Philadelphia's working groups will ultimately have as they try to keep eligible residents covered.
