About three million Pennsylvania residents have health care insurance through Medicaid, also known as Medical Assistance. With the passage of The Reconciliation Bill (One Big Beautiful Bill Act) on July 4, 2025, it is projected that there will be more than $1 trillion in nationwide cuts to the program over the next 10 years.

Governor Josh Shapiro believes that around 300,000 Pennsylvanians could lose coverage. Shapiro's administration said the loss of Medicaid-funded health care services will likely result in higher costs, more uncovered care, and delays in getting treatment. 

The changes to Medical Assistance are not taking place as soon as the changes to the Supplemental Nutrition Assistance Program (SNAP). But it is still important to understand what is coming next. The SNAP changes requiring proof of work requirements or eligible exemptions began rolling out in Pennsylvania on September 1, 2025.

Those who get Medical Assistance are usually enrolled with a Managed Care Organization (MCO). The most popular MCOs in NPLS’s counties are AmeriHealth and Geisinger. Highmark is also a popular choice in Northampton and Lehigh counties.

You can also apply for Medical Assistance with your County Assistance Office (CAO). You can also apply online on the Compass website.

Pennsylvanians can also sign up for Medical Assistance with Pennie. Pennie is Pennsylvania's online insurance marketplace. Open enrollment takes place from November 1-Janurary 15.

The first set of major changes takes place on December 31, 2026. Adults between the ages of 19-64 will lose coverage if they do not report that they are working 80 hours a month. This does not apply to adults in this age range who are receiving job training or going to school. Adults with dependents under age 13 do not need to meet the work requirement.

Also on December 31, 2026, proof of work and eligibility (known as eligibility redeterminations) will be required every six months. If enrollers do not send in the right paperwork, they will be at risk of losing Medical Assistance.

The new law also imposes new guidelines on cost-sharing. This will likely lead to more people on Medical Assistance paying out-of-pocket charges. These charges will include deductibles, copayments, or coinsurance. The change will take place on October 1, 2028, for adults over 100% of the Federal Poverty Line ($15,650+ for a household of 1).

There are some limits on these charges, and they do not apply to primary care, mental health, or substance use care. The limits are no more than $35 per service or 5% of their income.

Another change to Medical Assistance is in eligibility for groups of noncitizens. Starting October 1, 2026, the law says that U.S. citizens and immigrants with permanent resident status can get Medical Assistance. Refugees and asylum-seekers will not be eligible.

The spending cuts will not only result in changes to eligibility and cost. The changes will also affect the places where some receive care. To make up for the Medical Assistance cuts, $50 billion in relief funding was provided for rural hospitals. Even with relief funding, many rural hospitals are at risk of closing. Where it is already difficult to find services, it may become much harder in these areas to get treatment.

A change already in place is a hold on Medical Assistance funding to providers of family planning services. This applies to providers “primarily engaged in family planning services, reproductive health, and related medical care; and provides for abortions” that received more than $800,000 of funding in 2023. Though the hold only lasts until July 4, 2026, it will likely make it more difficult to access family planning services until then. There are currently lawsuits by Planned Parenthood and some states related to this provision. Though currently in effect, active litigation surrounding this provision makes its future uncertain.

Starting on January 1, 2027, payments for bills from the months before the patient becomes eligible for MA will be lowered from three to one month (retroactive coverage). This means that if you apply for Medical Assistance, it will only help pay medical bills up to a month before you start getting benefits.

To see more changes, visit this link from the National Consumer Law Center.