Gov. Josh Shapiro’s administration has exaggerated estimates of people losing Medicaid because of a new federal law, officials of a Harrisburg-based think tank say.
Officials of the conservative-leaning Commonwealth Foundation cast doubt on the state estimates during a briefing for reporters Thursday.
The state Department of Human Services projects President Donald Trump’s One Big Beautiful Bill Act will force 310,000 Medicaid recipients to lose coverage when new work and other requirements take effect on Jan. 1, 2029.
Elizabeth Stelle, the Commonwealth Foundation’s vice president for policy, said the department wrongly assumes many able-bodied adult Medicaid recipients without children won’t try to find work or other “community engagement” to keep benefits.
“The estimates of 300,000 Pennsylvanians losing their Medicaid is based largely on the assumption that these individuals will not go to work, they won't find volunteer opportunities, they refuse to pursue any sort of training,” Stelle said. “And we think that's a very misguided assumption.”
Keeping Medicaid benefits
Medicaid pays for health care coverage and a wide variety of other services for low-income people.
Under the act’s “community engagement requirement,” an able-bodied adult who wants to keep Medicaid benefits must have a job, perform community service or undergo job training for at least 80 hours a month or be enrolled in “an educational program.”
Foundation officials say they focused on “healthy, childless adults” because that’s where most of the expansion of Medicaid benefits among Pennsylvanians has come in the last decade.
Medicaid benefits in Pennsylvania
In the year ending June 30, 2014, 80,134 adults without dependents had Medicaid, according to the state’s proposed budget that year. For the year ending this June 30, that number ballooned to 1,078,209 who had become eligible for Medicaid, or almost 13.5 times higher.
That was because:
- The state sharply expanded Medicaid eligibility based on the Affordable Care Act after Gov. Tom Wolf took office in 2015.
- The federal government allowed states to add more people to Medicaid rolls during the pandemic and would not let them remove people.
Overall, about 3 million Pennsylvanians receive benefits through Medicaid.
The administration explains
In an email, state Department of Health spokesman Brandon Cwalina said the department’s estimate of 310,000 people losing Medicaid coverage includes:
- About 200,000 dropping off because of the work and other community engagement requirements.
- About 110,000 because recipients will have to apply to renew benefits every six months instead of once a year.
Each year, Cwalina said, about 55,000 people eligible under the benefits expanded by the Affordable Care Act do not reapply for benefits. The state assumes twice a year re-applying will mean twice that many won’t reapply, which produces the 110,000 estimate.
Without more financial support for programs to help people train for jobs, all of the 200,000 who face work requirements “are at risk of losing coverage,” Cwalina said.
What the CBO says
Last month, the Congressional Budget Office, which gauges the effect of federal legislation, estimated the One Big Beautiful Bill Act would mean 7.8 million fewer Medicaid beneficiaries in 2034.
That estimate includes:
- About 4.8 million able-bodied adults with no children or dependents who don’t meet work or other community engagement requirements.
- About 2.2 million who would drop off Medicaid rolls because of having to apply twice a year instead of once.
- About 1.4 million undocumented immigrants who are covered under current law in state-paid programs.
That adds up to 8.4 million people, but CBO says about 600,000 might be in more than one category, reducing the actual number affected.
The One Big Beautiful Bill Act also forbids Medicaid spending on non-citizens or undocumented immigrants altogether. Some states now use their own Medicaid money to avoid an existing federal ban.
Pennsylvania does not offer state-funded Medicaid to undocumented immigrants unless it’s an emergency.
