Letters are arriving at the homes of nearly 700,000 Pennsylvanians on Medicaid, warning that adults on the expansion program will have to show 80 hours a month of work or similar activity. The rule begins in January 2027. People who do not meet it, and do not report an exemption, can lose coverage.
The state Department of Human Services announced the mailings on September 10, 2026. Automated calls and text messages follow the letters.
Which adults the letter is about
The requirement reaches adults ages 19 to 64 who get Medicaid through the state’s expansion program and do not have a dependent child under 14, according to the department’s FAQ. It applies to new applicants and to people already enrolled. Medicaid recipients outside that group, including children and most older adults, are not the target of this letter.
A first renewal in 2027 is where the rule bites for current enrollees. At that renewal, an adult has to report either that the requirement was met or that an exemption applies, and the renewal schedule changes after it.
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What 80 hours a month means
The department says the 80 hours can come from work, volunteering or community service, a job training program, or school at least half-time, or from any combination of those. Households with monthly income of at least $580 can also meet the requirement, and seasonal workers can use their average monthly income, the Medicaid changes page says.
DHS Secretary Dr. Val Arkoosh said the department wants Pennsylvanians to stay covered, and that the process to keep coverage is now more difficult and creates confusion. Only adults covered through Medicaid expansion who are eligible based on income get the work-requirement letter.
The first letter is available in English, Spanish, Arabic, Chinese, Russian and Vietnamese. It explains how to meet the requirement, which situations may create an exemption, who in the household is affected, when the changes take effect and how to report information to the department. Current recipients were mailed the letter in four waves from late August through September, and people who became eligible later receive it monthly through the end of 2026, the department’s toolkit says.
Who may be exempt
The state lists a long set of exemptions. They include parents or caretakers of a child under 14 or of a person with a disability, people who are pregnant or on postpartum coverage, and people in treatment for alcohol or substance use disorder. Veterans with a total disability rating from the VA, members of federally recognized tribes and former foster youth under 26 are also exempt.
People who meet a TANF work requirement, or who receive SNAP and are subject to its work rules, are exempt too, as are the medically frail and anyone with a temporary hardship such as a recent hospital stay. DHS plans to use data such as recent medical claims to spot likely exemptions. Even so, the department’s toolkit says that recipients must report the exemption and provide information.
How to report, and what happens if nothing is sent
Information can go in on the application or renewal form. It can also be uploaded through the state’s COMPASS portal and the myCOMPASS PA app, or mailed or brought to a County Assistance Office. The Customer Service Center takes calls at 877-395-8930.
DHS will first check records it already holds. If more is needed, a letter gives 30 days to respond. Paid work has to be backed up with proof such as a pay stub in 2027, while most other activities and exemptions can be self-reported that year. From 2028, documentation will be required, according to the FAQ.
An adult who fails to report may lose Medicaid or be found ineligible, and the department says it will send a notice before coverage changes. Reapplying is possible at any time, but the applicant then has to show compliance for the month before applying.
Other changes that arrive the same month
Some adults 19 to 64 will move from yearly renewals to renewals every six months. Current recipients switch after the first renewal in or after February 2027. A March 2027 renewal, for example, would be followed by one in September 2027.
The look-back for coverage before an application also shrinks. It is now up to three months and becomes one month for expansion adults 19 to 64, and two months for other recipients.
The letters and the follow-up calls and texts are the state’s own. Automated calls come from 877-839-4782 and texts from the short code 69217. Anyone unsure whether a call is real can phone the department’s HelpLine at 1-800-692-7462 instead of replying to the message.
The open question for each household is whether a given adult meets the hours, the $580 income test or an exemption, and whether DHS has current contact information to reach that person. Letters that go to an old address are a common way to miss a deadline. Contact details can be updated through COMPASS, and a change of address can be filed with the Postal Service.
Is an adult in the household exempt from Pennsylvania’s Medicaid work rule?
The exemptions are not applied automatically in every case. An adult who qualifies as medically frail or as a caretaker still has to report it at the first 2027 renewal, and a missed or misfiled report can turn into a lost card.
The SNAP & Medicaid Renewal Organizer covers the new Medicaid work requirement and who is exempt, alongside a renewal document checklist and a renewal and reporting calendar. It also includes state packs for all 51 states and a section on the 90-day window after coverage is dropped.
Get the Medicaid work-rule exemption guide and renewal checklist for Pennsylvania →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
