Major changes to Medicaid are on the horizon, potentially impacting millions of Americans who rely on the program for essential healthcare services. As these changes approach, individuals like Grace Robinson, a psychology student with significant health challenges, express concerns over the new requirements and their implications.
Grace Robinson, a 31-year-old student at Northampton Community College, aspires to become a behavioral therapist. Residing in Cresco, Monroe County, she has been battling mitochondrial disease, which has severely affected her organ systems. “In 2015, I became critically ill. I started spending large chunks of time in the hospital. I would go into metabolic crisis often. I’ve had brain lesions, strokes. My GI tract failed. I ended up depending on a central line and getting nutrition through my chest. I spent years in a wheelchair. My heart failed, and I’ve had dozens of surgeries over the years,” shared Robinson. She is on a regimen of over 20 medications daily, with Medicaid covering most of her healthcare expenses.
Robinson is one of nearly 3 million Pennsylvanians and over 66 million Americans enrolled in Medicaid, who will soon face alterations to the program. Set to begin on January 1, 2027, these changes arise from the One Big Beautiful Bill Act, part of President Donald Trump’s 2025 budget. Under the new rules, Medicaid beneficiaries will need to meet an 80-hour-per-month work requirement, achievable through work, volunteering, schooling, or a work training program.
The Upcoming Medicaid Modifications
U.S. Rep. Rob Bresnahan, a Republican from Luzerne County who supported the One Big Beautiful Bill Act, assured that individuals rightfully enrolled in Medicaid will maintain their coverage. There are specific exemptions for certain groups, including caregivers of young children, pregnant individuals, veterans with disabilities, and those with special medical needs. Additionally, the frequency of eligibility checks will increase to every six months.
The Congressional Budget Office (CBO) projects that these changes will reduce federal Medicaid spending by over $900 billion in the next decade, with work requirements contributing approximately $326 billion to these savings. However, the number of uninsured individuals is expected to rise by 10 million by 2034, with Medicaid work requirements accounting for more than half of this increase.
State-Level Preparations and Concerns
Dr. Val Arkoosh, Pennsylvania’s Human Services Secretary, stated that the state is actively updating its Medicaid system to accommodate the upcoming changes. Despite some federal support for IT enhancements, most administrative expenses will rely on Pennsylvania taxpayers.
“We are spending just hundreds of hours and millions of dollars on creating paperwork programs to make sure that folks don’t get disconnected from their benefits because of some bureaucratic red tape,” said Arkoosh. The state is striving to make the transition as seamless as possible for residents, with assistance available from various agencies and nonprofits.
Outreach efforts began in August, with communications sent via mail, text, and calls to inform recipients about the changes and how to comply with the new requirements. Arkoosh emphasized the importance of recipients staying informed by engaging with these communications.
Personal Stories and Concerns
Robinson, who relies on Medicaid, voiced her concerns regarding the increased eligibility checks, fearing she might “fall through the cracks.” Given her health challenges, she worries about how she will manage during periods of severe illness.
Another Medicaid recipient, Krysten Xanthis from Scranton, shares similar anxieties. Earning $13 an hour as a home health aide while caring for her mother and dealing with her health issues, Xanthis fears the stigma associated with Medicaid and the potential for losing benefits. “I’m trying to get people to understand that, like you know, being on Medicaid doesn’t mean that the people are not working,” she said.
The state aims to ensure that individuals like Robinson and Xanthis retain their benefits amidst these changes. “I want Pennsylvanians to know that we are doing everything in our power to keep people connected to their healthcare through Medicaid, but we need their partnership in this work, and so first and foremost, we need everybody to read their mail,” Arkoosh urged.
