More than 300,000 Pennsylvanians could lose Medicaid. Some don’t even know they’re on it.

Looming federal Medicaid cuts enacted under President Donald Trump’s signature tax and spending legislation could strip care from an estimated 300,000 Pennsylvanians. But many may be unaware the changes to the publicly funded healthcare program will affect them.

The confusion stems in part, experts say, from the state’s distribution of public healthcare funds through private insurers under alternate program names.

For example, Pennsylvania calls its Medicaid program “medical assistance,” while other states have also adopted different names for their Medicaid coverage. Nearly 97% of Pennsylvanians who receive publicly funded healthcare receive it through managed care organizations, or MCOs, according to the Pennsylvania Department of Human Services. DHS contracts with private insurance companies to operate most MCOs throughout the state, meaning many participants obtain a commercial insurance card while continuing to receive care through public funds.

» READ MORE: The ‘big, beautiful bill’ is poised to cut Medicaid. Here’s what’s at stake for five Philly-area families.

MCOs operating in southeastern Pennsylvania include Geisinger Health Plan, Health Partners Plan, Keystone First, UnitedHealthcare Community Plan, and UPMC For You Inc. Philadelphia is home to 22% of the state’s Medicaid enrollment, according to DHS’ most recent enrollment data.

In June, DHS provided a message template to its MCOs to share with their recipients that the proposed changes to Medicaid could affect them and to urge people to stay up-to-date on Medicaid changes.

Going forward, “DHS will continue work with our MCOs and other partners across the Commonwealth to help Pennsylvanians understand and prepare for changes mandated by the federal Republican Budget Bill so that those who need and qualify for benefits will still receive them,” DHS spokesperson Ali Fogarty wrote in a statement to The Inquirer.

But even with those warnings, Matt Yarnell, president of SEIU Healthcare Pennsylvania, said the puzzling patchwork of names for the state’s Medicaid system is “part of why folks don’t understand the impact of what the cuts are going to do to people.”

Trump’s spending package, signed into law on July 4, will cut $1 trillion from the federal health spending over a decade, resulting in nearly 12 million people removed from insurance nationwide by 2034, according to Congressional Budget Office estimates. As part of those cuts, enrollees will be required to file paperwork for work requirements to prove they are working a minimum of 80 hours per month, which could mean the end of coverage for millions of people who will fail to meet new standards.

The projected cuts could have vast implications for healthcare systems throughout the state, requiring many hospitals to provide additional uncompensated care in an already fraught environment for those facing closure because of financial difficulties. State lawmakers are also grappling with how to fund the rising costs of caring for an older and sicker population under Pennsylvania’s ballooning Medicaid program.

Though the federal work requirements for Medicaid eligibility will not go into effect until January 2027, “now is the time when we need to start preparing for those cuts to ensure that nothing falls through the cracks, and to ensure that we don’t exacerbate an access-to-care crisis across the Commonwealth,” said Zach Shamberg, president of the Pennsylvania Health Care Association, which represents long-term care facilities.

Rep. Dan Frankel (D., Allegheny), chair of the House Health Committee, is preparing legislation directing DHS to collaborate with the state’s nonprofit healthcare community to help Medicaid recipients navigate the program’s new requirements and administrative hurdles.

“We need to have a vigorous outreach program in the state to basically make sure that people are aware that they have to go through this process, what they’re going to have to provide, and to walk them through the requalification application so that they don’t miss a box,” he said.

But, he said, the healthcare industry faces an additional basic challenge: communicating to Medicaid recipients who have grown used to understanding themselves as privately insured individuals, or who never understood themselves to be receiving public funds in the first place.

Pennsylvania adopted a new system in 2017 for its Community HealthChoices Medicaid program, requiring participants to enroll in MCOs to receive their coverage. Mandatory managed care for the state’s physical health Medicaid programs began in the late 1980s, according to Fogarty.

This shift prompted a “public destigmatization campaign” around Medicaid and public benefits, said Danna Casserly, the co-executive director at the Pennsylvania Health Law Project.

As a result, people started referring to their insurance by the name of the commercial companies operating under state MCOs, instead of saying they were on Medicaid, she said.

Some of them never stopped.

“People generally don’t think about it as medical assistance all the time. They think about it as, you know, ‘I have my Keystone First card, or I have my Health Partners card,’” said Lydia Gottesfeld, managing attorney of the Health and Independence Unit at Community Legal Services of Philadelphia.

While some people apply for Medicaid themselves through Compass, the state’s online portal for health benefits, many hospitals or clinics help uninsured people apply for Medicaid. As a result, some patients do not understand they are connected to Medicaid because health systems will tell them they are connected to a private insurer through an MCO, according to Aditi Vasan, a Children’s Hospital of Philadelphia pediatrician and Medicaid expert.

In clinical practices, Vasan and her colleagues are not usually talking to patients in detail about their type of insurance, she explained. “But, I think that this can be concerning, particularly around coverage loss, because you could have someone who has lost Medicaid coverage and only finds out when they go to access care,” Vasan said.

Experts say the elderly, people with mental health issues, and people without easy access to technology, are particularly vulnerable to inadequate information about their Medicaid coverage.

Shamberg called the system “extremely convoluted,” explaining that many nursing home residents require around-the-clock care and struggle to use technology without assistance, “so a lot of this messaging is going to have to be done to not only residents, but their family members as well,” Shamberg said.

Even those well acquainted with the state’s healthcare system can easily misunderstand their coverage.

Lolita Owens is a home care worker in Philadelphia, whose clients rely on state-funded healthcare. But Owens learned only last week that she herself receives Medicaid, relying on the Health Partners MCO.

Owens originally thought she had purchased coverage through Pennie, Pennsylvania’s health insurance marketplace, which provides federally subsidized rates for private insurance to eligible individuals.

She was grateful to learn she received Medicaid, but was also concerned about her own status’ added uncertainty, given new coverage hurdles.

“My fears are even more heightened, just because I need to protect my own health insurance,” she said.