DHS Shares August 26 H.R. 1 Webinar Recording and Medicaid Updates

On August 26, the Department of Human Services (DHS) hosted a webinar to provide updates on how the State will implement the upcoming changes to Medicaid as a result of H.R. 1. The webinar recording can be found here. In addition to the webinar, DHS has released a Medicaid Toolkit to assist in outreach and communication to help Pennsylvanians stay up-to-date with changes and help them maintain their healthcare coverage. The toolkit will be updated regularly, so Pennsylvanians are encouraged to check back often for new materials. If you have suggestions on what would be helpful, send them here.

Outreach for Medicaid Work Requirements:

As required by H.R. 1, DHS is beginning formal outreach on Medicaid work requirements for the Medicaid expansion population. This mailing will be sent to approximately 700,000 individuals and will be mailed in English, Spanish, Chinese, Vietnamese, Arabic, and Russian.

All mail is expected to have entered the mail-stream by September 21, 2026, for the first cohort of recipients eligible prior to August 21, 2026. Subsequent mailings for new Medicaid expansion recipients will occur monthly in October, November, December, and January. In 2027, “periodic” outreach will be sent to all expansion applicants and recipients at the time of application and renewal.

In order for the State to meet its federal obligations, automated calling and texting will accompany these mailings starting in mid-September. Timelines and examples of outreach can be found in the DHS Medicaid Toolkit.

Six-Month Renewals:

Section 71107 of H.R. 1 requires that, starting January 1, 2027, individuals eligible in categories MG90/91 (Medicaid expansion) will need to have their Medicaid eligibility checked by completing a renewal every six months instead of every year. 

This change will occur for applicants found eligible for Medicaid under the MG90/91 expansion categories on or after January 1, 2027. Similar to the provisions of Medicaid Work Requirements in Section 71119, the first renewal cohort for which this change will occur is the group of recipients with renewals due after January 1, 2027.

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.

Retroactive Coverage:

Section 71112 of H.R. 1 requires limitation of Medicaid retroactive coverage segments as of January 1, 2027. The current retroactive payment period for all MA categories is three months prior to the month of application. Because of H.R. 1, retroactive eligibility is now:

• One month: For categories MG90/91, also known as Medicaid expansion 
• Two months: All other Medicaid eligibility categories

This change will impact all new applications submitted on or after January 1, 2027. An application received prior to January 1, 2027, but not processed until after January 1, 2027, would still be entitled to three months of retro coverage. An application received on or after January 1, 2027, will be subject to the new retroactive coverage limits.

Recipients and their providers will, because of these new requirements, lose the ability to receive payment for services that they would have been paid for if not for the change. 

This change will not alter the reconsideration period. The reconsideration period for applications is 60 days and, if retroactive coverage is requested, the original application date is the date used when establishing the retroactive period. The reconsideration period for renewals is 90 days and, if eligible, a new eligibility period will be established from the date the missing information was received and that date will be used when establishing the retroactive period. The reconsideration period for other closures is 60 days and, if eligible, would be reopened back to the date of closure. 

Noncitizen MA Eligibility Changes:

Section 71109 of H.R. 1 requires that, effective October 1, 2026, States limit noncitizen eligibility for federally funded MA to:

• United States (U.S.) citizens;
• U.S. nationals;
• Lawfully permanent residents (after the five-year bar, unless they meet an exemption);
• Cuban/Haitian entrants;
• COFA migrants; and,
• Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) qualifying applicants and recipients;
• Lawfully present noncitizens who are under age 21; and
• Lawfully present noncitizens who are pregnant or in their 12-month postpartum period.

Individuals with the following noncitizen statuses will no longer be eligible for federally funded MA:

• Refugees;
• Asylees;
• Humanitarian parolees;
• Victims of domestic violence or trafficking;
• Noncitizens with deportation withheld; and,
• Noncitizens granted conditional entry.

As of the October 1, 2026, federal deadline, all current noncitizen recipients not otherwise eligible for federally funded MA will have their coverage closed. They will get advance notice about the changes and the opportunity to submit additional documentation. New applicants will also be subject to these restrictions after October 1, 2026.

DHS will continue federally funded MA beyond October 1, 2026, for newly noneligible, noncitizen recipients who appeal timely or meet the criteria to be afforded a Reasonable Opportunity Period (ROP) to the extent current appeal and ROP policy allow.

These new restrictions include all MA categories, except for the following categories:

• General Assistance Medical Assistance (state-funded);
• Medical Assistance for Workers with Disabilities, Workers with Job Success (state-funded);
• Office of Refugee Resettlement Medical Assistance; and,
• Emergency Medical Assistance.

All current noncitizen MA recipients that have their federally funded MA closed starting October 1, 2026, will be reviewed for eligibility in state-funded MA categories and opened if eligible. Pennsylvania statute 62 P.S. § 441.1(a)(1) requires that individuals shall be eligible for MA if they are eligible for a Social Security Income State Supplemental Payment, so this population of SSI recipients will remain eligible in state-funded MA.

Presumptive Eligibility (PE) Changes:

The Affordable Care Act established Presumptive Eligibility, which is an eligibility period conferred to applicants by qualifying submitters. These application submitters are primarily hospital providers who make presumptive eligibility determinations for individuals in MAGI categories and apply for temporary MA coverage. This coverage lasts from the date an eligibility determination for presumptive eligibility is made up to a month or up until ongoing eligibility is determined, whichever is earlier.

Changes to coverage for people eligible under Medicaid expansion (categories MG90/91) due to Sections 71109 (noncitizen MA) and 71119 (MA work requirements) will require changes to the presumptive eligibility application process. New questions will be added to the presumptive eligibility application effective October 1, 2026, and changes related to the MA Work Requirements will be incorporated for January 1, 2027.

RCPA will continue to share updates from DHS as relevant information is shared. Please contact your Policy Director with any questions or concerns.