Take a breath: Medicaid hasn’t changed yet | Expert Opinion
But change is coming to the federal insurance plan, which (along with the state plan CHIP) covers two in five Pennsylvania children. Here’s what you can do to prepare.
“Another month without insurance,” our patient’s mother sighed. She had brought her 18-month old to all his doctor’s appointments in his first year. Then his Medicaid coverage was cut off, and she had no idea why.
She tried multiple times to contact Medicaid, but couldn’t get through, and assumed incorrectly that this must be due to changes in the state-federal insurance program she had heard about on the news. She spent a week’s wages on care so her baby would not fall behind on his recommended visits, but wondered if she could afford future appointments. What would happen if he needed emergency care?
As pediatricians, we worry about kids not getting the care they need. Health insurance, particularly Medicaid and CHIP (Children’s Health Insurance Program), is essential to children receiving recommended care. Navigating insurance coverage is confusing on a good day. We know it’s about to become even more challenging for children to get and stay covered because of changes coming to the Medicaid program.
Fortunately, there was positive news to share with our patient that we wanted to share with everyone: Medicaid has not changed yet. Plus, there are things families can do to prepare for upcoming changes.
Medicaid is the federal and state insurance program that covers two in five Pennsylvanian children and over half of children nationally.
What has happened, and what can you expect?
January 2026: Premium tax credits expired. These tax credits helped low- and middle-income people without affordable employer insurance pay for Affordable Care Act marketplace coverage, based on a sliding scale.
October 2026: Many legally residing immigrants previously eligible for Medicaid will lose coverage, including refugees, asylum-seekers, and victims of trafficking.
January 2027: Certain adults will have work requirements and need to prove Medicaid eligibility every six months rather than annually. This will apply to adults who are not pregnant, disabled, or the parents or caregiver for a child under 14 or foster youth under age 26. Six month redetermination will also apply to moderate-income Pennsylvanians who became eligible under Medicaid expansion a few years ago.
What does this mean for families?
If you have private insurance with ACA tax credits, you may pay more for coverage.
Even if your own Medicaid eligibility changes, your child will likely remain eligible, and you must show they’re eligible annually, not every six months. .This is important as research shows that children are less likely to stay enrolled when parents lose coverage.
How can Pennsylvania families prepare?
If your child loses coverage, they can still receive healthcare at community and city health centers regardless of ability to pay.
If your child is on Medicaid or CHIP, make sure your address and contact information are up to date with the County Assistance Office or COMPASS. Open messages right away to avoid administrative loss of coverage.
Be prepared for longer wait times. If you have trouble reaching your caseworker, you can ask for a supervisor or contact the Customer Service Center (1-866-550-4355) or DHS Helpline (1-800-692-7462).
Help is available! PA Navigate, the Pennsylvania Health Access Network (877-570-3642), PA Health Law Project (1-800-274-3258), and Children First PA (1-800-986-KIDS) can assist families facing barriers to enrollment.
In this changing policy landscape, pediatricians aren’t just clinicians — we’re essential partners in keeping children covered and cared for. We will always want to hear from you. So, tell your pediatrician about any insurance struggles. If you have questions or are confused by information you hear, visit Pediatric Health Chat and tell CHOP what topics you’d like to learn more about. Because we will always advocate for health insurance that covers all children and gives them a healthy future.
Elizabeth Salazar and Diana Montoya-Williams are attending neonatologists at the Children’s Hospital of Philadelphia (CHOP), Assistant Professors of Pediatrics at the University of Pennsylvania, and health services researchers at CHOP PolicyLab and the Penn Leonard Davis Institute of Health Economics.