What are the changes to Medicaid?

There are three major changes coming that will affect some Medicaid applicants and 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.

Work and Community Engagement

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