Changes in Medical Assistance (MA) Eligibility Requirements

Effective January 1, 2027, a new federal law will change Medical Assistance eligibility requirements. Some Medicaid recipients will have to meet work requirements AND renew their coverage every six months instead of every 12 months. This change creates new rules and additional reporting requirements that could cause people who would usually qualify for Medicaid to lose coverage if they do not report properly and on time.

Practice Impact:

  • Patients’ inability to pay for care.
  • Reimbursement for services you provide to recipients who have lost their Medical Assistance coverage will end.

Patient Impact:

  • New reporting requirements and renewal frequency.
  • Loss of coverage will impact your patient’s ability to access care, medications, and testing.

Action is Needed!

What your office can do to prevent your patients from losing their medical coverage:

  1. Ensure your patients with Medical Assistance are aware of the upcoming requirements starting in 2027.
    1. Educate them about exemptions to these rules so they understand what they must do to show they are exempt from work requirements.
    2. Share information about ways they can meet the work requirements.
      1. For more details on the upcoming work and exemption requirements, important dates, frequently asked questions, and PA DHS’ Medicaid changes communications toolkit, visit: https://www.pa.gov/agencies/dhs/resources/medicaid/medicaid-changes
  2. Help patients receive important updates from PA DHS by advising them to:
    1. Confirm their address is current. If it has changed, direct patients to contact PA DHS:
      1. Online: Visit www.dhs.pa.gov/COMPASS or use the MyCOMPASS PA mobile app
      2. By Phone: Call the Customer Service Center at 877-395-8930
      3. By Mail/In Person: Submit to your local County Assistance Office
  3. Remind patients to look for PA DHS mailings beginning in September.
  4. Encourage patients to return all requested information on time.

To assist providers, we have added a new data element to our PCP member roster to identify the renewal date for each assigned Medicaid member.

To access your member roster, sign in to our provider portal at JeffersonHealthPlans.com/ProviderPortal. From the Office Management dropdown, select “Document Manager” and search keyword “member roster” in the Name search field.

Resources:

Thank you for your support in preparing our members for these upcoming changes so they can stay covered.