Pennsylvania families who depend on Medicaid for long-term care face sweeping changes under the One Big Beautiful Bill Act (OBBBA). The legislation signed by President Trump on July 4, 2025 takes effect in 2026 and will continue rolling out through 2027. It marks the most dramatic overhaul of Medicaid since the program began.
Anyone currently receiving Medicaid or planning to apply for coverage in Pennsylvania needs to understand what's coming. Below, our Paoli Medicaid planning lawyers outline the new rules, including monthly work requirements, twice-yearly eligibility reviews, and nearly $1 trillion in federal funding cuts over the next decade.
Will I Still Be Eligible for Medicaid-Funded Long-Term Care?
Your Medicaid eligibility depends on several factors that didn't matter before. Age, work status, and health conditions now play bigger roles in determining who keeps coverage.
Work Requirements for Most Adults Under 65
Under the new rules in the One Big Beautiful Bill Act, adults under 65 must work at least 80 hours each month to keep their Medicaid benefits. Exceptions exist for pregnant women, people caring for young children, and those with qualifying disabilities.
Imagine Marie works part-time at a local diner in Philadelphia. She's 52 years old and has received Medicaid for three years. Under the old rules, her part-time schedule was fine. Now, she must track her hours every month and submit documentation proving she worked 80 hours. If she gets sick and misses too much work, she risks losing her health coverage entirely.
Eligibility Reviews Double in Frequency
Pennsylvania now checks your eligibility every six months instead of once a year. If you miss a deadline or forget to submit paperwork, you could lose Medicaid coverage even if you still qualify.
Higher Copays for Some Recipients
People with incomes above the federal poverty level now pay up to $35 per doctor visit. For someone with a chronic condition requiring frequent medical care, these costs add up quickly.
How Will Medicaid Benefits Change in Pennsylvania?
The state faces tough choices as federal Medicaid funding shrinks. Pennsylvania must decide which services to cut, which to maintain, and how to pay for them.
Restricted Revenue Options
Pennsylvania can no longer rely on provider taxes to fund its portion of Medicaid costs. This limitation forces the state to find other revenue sources or reduce services.
The change affects everyone applying for Medicaid, but hits long-term care services particularly hard. Home health aides, adult day programs, and supportive services that help people stay in their homes face potential cuts.
Home-Based Services Under Pressure
Services that allow seniors and disabled individuals to remain at home rather than enter nursing facilities face the biggest funding shortfall. These programs cost less than institutional care but may be eliminated first when budgets tighten.
Rural Areas Face Additional Challenges
Rural hospitals and clinics depend heavily on Medicaid payments. With reduced federal funding, some facilities may close or limit services. The legislation includes $50 billion in rural hospital funding, but some health policy experts say this won't offset the larger cuts.
What Steps Should I Take to Access the Long-Term Care I Need?
Smart Medicaid planning ahead of when the new rules take effect is crucial. Documentation, backup plans, and legal guidance help protect your access to long-term care.
Keep Detailed Records
The increased paperwork burden under the One Big Beautiful Bill Act means that good organization matters more than ever.
Keep copies of all income records, medical documentation, and correspondence with Pennsylvania's Medicaid office. Work records become particularly important for people subject to the 80-hour monthly requirement. Even if you're currently exempt due to age or disability, your status could change.
Prepare for Coverage Gaps
With more frequent eligibility reviews and stricter requirements, temporary coverage losses may happen even to people who ultimately qualify. Having a plan for accessing care during these gaps prevents medical emergencies.
Plan for Alternatives
Traditional Medicaid planning techniques may need updates given the new restrictions. Strategies that worked under the old rules might not provide the same protection now.
Suppose 48-year-old Tom has a disability that prevents him from working full-time. He currently receives Medicaid without work requirements. Under the new law, though, he must provide more documentation of his disability status every six months. Some supportive services he uses, like transportation to medical appointments, face funding cuts that could force him to find alternatives.
Professional Guidance Makes the Difference
The changes brought by the One Big Beautiful Bill Act create uncertainty for Pennsylvania families who rely on Medicaid for long-term care. These modifications to eligibility requirements, benefit structures, and funding mechanisms require careful consideration and strategic planning.
At Ruggiero Law Offices, our experienced Pennsylvania Medicaid planning attorneys understand how these changes affect your access to long-term care. We help families throughout the Delaware Valley and Lehigh Valley regions develop strategies that protect assets while maintaining access to essential care and benefits.