Cuts to Healthcare Are On The Horizon: Will Pennsylvania Be Ready?

Mental Health Partnership participants Shawn Anderson, Elizabeth Anderson and Quadira Purfoyi at a press conference celebrating the 60th anniversary of Medicare and Medicaid on August 1, 2025  (above image)

For Hannah, who juggles work at a nonprofit, a small business, and seasonal jobs, Medicaid is what allows her to get routine physical, mental, and dental care. But with new federal work requirements, she worries her fluctuating hours will make it nearly impossible to keep her coverage. 

“Reporting any different for that kind of work in order to qualify for Medicaid would just make it impossible,” she says.

Hannah is just one of the Pennsylvanians who shared their stories with the Pennsylvania Health Access Network (PHAN), which has been gathering video testimonials to highlight what’s at stake as the 2025 Budget Reconciliation Law, or the “One Big Beautiful Bill Act”, reshapes health care, among other essential services. The law, passed in early July, is projected to cut $859 billion from Medicaid nationally, alongside hundreds of billions in reductions to Medicare and Marketplace coverage. In Pennsylvania, the loss of nearly $4 billion in annual federal funding could mean fewer resources for maternity care, nursing homes, and hospitals.

People with disabilities are among the most vulnerable under this bill. “The proposed healthcare cuts in the 2025 Budget Reconciliation Law will devastate not only people with disabilities but also their caregivers, many of whom are unpaid family members already surviving on very low incomes and relying on Medicaid,” explains Steven Mack, director of communications at Liberty Resources Inc., a Center for Independent Living serving Philadelphia, Chester, Delaware, and Montgomery counties. “These caregivers will now be forced to ‘prove’ they are working, even though they are already working around the clock, exhausted and stretched thin.”

With nearly one in four Pennsylvanians depending on Medicaid, including 42% of Philadelphia residents, the challenge of limiting the negative effects of these cuts is immense. More than 300,000 eligible Pennsylvanians are at risk of losing coverage. Yet even as the safety net is reduced significantly, health care organizations, advocacy groups, and policymakers are developing strategies to help people maintain access to care. 

The Medicaid Works Coalition

Joanna Rosenhein with the Pennsylvania Health Access Network speaking at a rally in partnership with fellow Medicaid Works Coalition members: the American Cancer Society Action Network PA, Children First, Philadelphia Unemployment Project, The Arc of Philadelphia, and the Philadelphia Medical Society, May 28, 2025.

Last fall, after election results came in, the Pennsylvania Health Access Network (PHAN) –a consumer-driven organization advocating for affordable health care – began convening providers and advocates across the state to prepare for potential cuts. As the 2025 Budget Reconciliation Law took shape, their initial focus was on blocking the bill. “We basically built upon that organizing,” says Shana Jalbert, PHAN’s Director of Communications.

That groundwork evolved into the Medicaid Works Coalition, which brought together 150 organizations, from direct service providers to statewide advocacy groups, with a strong base in Philadelphia, to oppose the cuts. Now that the law has passed, the coalition is shifting its focus to how to best reduce harm.

Jalbert is frank about the limits: “There’s nothing we can really do to fully mitigate the harm.” Still, she says the coalition’s priority is ensuring people don’t lose coverage unnecessarily. Much of the current work centers on helping eligible Pennsylvanians navigate the paperwork so they don’t get lost in red tape.

“Many people don’t even know they’re on Medicaid”

When thinking back a few months to when the 2025 Budget Reconciliation Law was passed, Julie Platt, Director of Policy & External Affairs at Mental Health Partnerships (MHP), who is part of the Medicaid Works Coalition, remembers how scared people were. According to Platt, some community members worried their Medicaid coverage would disappear immediately. 

“To be honest with you, people are so scared right now,” she says. “And it does feel like it’s right around the corner, but we do have time, and people will have time to get their documents in order.” For Platt, part of the challenge now is helping people manage that fear — preventing panic and replacing it with clear information and support.

On the other end of the spectrum are people who may not even realize the bill affects them directly. Advocates worry that many Pennsylvanians don’t know they’re on Medicaid at all, because the program goes by different names. 

“A lot of people don’t know they’re on Medicaid,” explains Platt. “We call it different things in Philadelphia such as Keystone First, AmeriHealth Caritas, Health Partners Plans, and people may not know these are Medicaid programs through a Managed Care Organization.”

That confusion extends beyond Medicaid. Jalbert warns that people who buy health insurance through the marketplace are also at risk, often without realizing it. At the end of 2025, the premium tax credits introduced under the American Rescue Plan are set to expire. Premiums are already projected to rise significantly: Governor Shapiro recently announced that average rates in Pennsylvania are expected to increase by 19% in 2026, up from an increase of 6% last year. Without the tax credits to offset those hikes, consumers will bear the full cost, leaving self-employed workers and small business owners especially vulnerable.

“We expect that open enrollment for the marketplace this year is going to be really tough for people,” Jalbert says. “Unless Congress extends those tax credits, we’re really expecting premiums to go up very significantly.” She notes one potential solution: “The state could put some subsidies forward to reduce the cost of marketplace plans even though the federal subsidies will be gone.” 

For both Platt and Jalbert, the immediate focus is on education: making sure people understand whether they’ll be affected by the new law, and what those changes could mean for their coverage.

Healthcare navigators: guiding people through uncharted waters 

From left to right: Luis Quiles, Chatline Certified Peer Support Specialist; Andrea Boffice, Learning and Content Development Specialist & Robert Dennis, Advocate with Mental Health Partnerships delivering letters written by people dependent on Medicaid to members of Congress. June 25, 2025

The idea of healthcare navigation isn’t new. In the 1990s, a Harlem hospital pioneered the concept to help underserved cancer patients overcome barriers to care. The goal was to reduce late-stage diagnoses and high mortality rates among low-income Black women with breast cancer. Since then, the “patient navigator” model has evolved, most notably under the Affordable Care Act of 2010, which expanded the role of “insurance navigators” to help people understand and enroll in health coverage.

Today, with the reshaping of Medicaid, Medicare, and the health insurance marketplace, advocates say navigators are once again essential to helping people adapt. To prepare, PHAN is investing heavily in training. 

“What we’re hoping to do is train as many people as possible about how they can comply with work requirements, fill out the paperwork, and make sure they’re on top of it,” says Jalbert. The organization has used a similar approach before, most recently during the COVID-19 pandemic, and plans to expand its “train the trainer” model this fall, equipping community leaders to help their neighbors navigate the new rules. “We can train people to not get caught up in the red tape so that they can keep their coverage,” Jalbert explains.

Platt points to another form of navigation: certified peer specialists. These workers act as bridges between the health system and the people it serves, with a key difference from other navigators: lived experience is a requirement for the job. “They can really speak to individuals in a way that no one else in the healthcare ecosystem can,” says Platt. While they don’t replace social workers, nurses, or doctors, peer specialists provide vital support that helps people make informed decisions about their care.

The role also has potential beyond navigation. As demand for certified peer specialists grows, it offers a pathway for people on Medicaid to meet new work requirements while serving their communities. “Certified peer specialists are a potential opportunity for people who want to fulfill their work requirements, but who also want to help others,” Platt notes.

The ripple effects of expected bureaucratic bottlenecks 

Michael Anderson (left) and Sean Janick from The Arc of Philadelphia at the 2025 Disability Policy Seminar, held April 7-9, 2025.  

Advocates know that educating people on how to meet Medicaid’s requirements is only part of the battle. The other challenge lies in the bureaucracy: the county and state offices responsible for processing paperwork on time. 

“There are so many ways that could go wrong with paperwork, with bureaucracy, with the data that they’re using not being correct,” says Platt. “They are already completely understaffed at our community benefit agencies and our county welfare offices.” 

People who aren’t technically impacted by the law may still face delays. That includes Pennsylvanians with intellectual and developmental disabilities (IDD), who require 24/7 assistance, unlike some individuals with physical or sensory disabilities. As such, people with IDD aren’t directly targeted by the bill’s changes. However, they could still be hit hard by the ripple effects.

“The same county offices that process our paperwork to renew the Medicaid funding for our home health aides, those same county offices are now also going to be receiving four times the amount of paperwork and applications from the other expansion groups,” says Shane Janick, executive director with The Arc of Philadelphia, which advocates for people with IDD. 

His colleague Michael Anderson, legislative advocate at the organization, shares the very real personal stakes of these cuts. Anderson has IDD and relies on his aging parents for care. 

“Caregivers are aging out. What do you do when parents are gone? I don’t want people to live in institutions, I want people to live where they want to live,” he says.

As caregivers age and community-based providers remain limited, the crisis is compounded by the cuts to Medicaid, putting even more pressure on an already vulnerable system.

Janick also points to a broader risk: funding. With Pennsylvania set to lose an estimated $3.9 billion annually in federal health care dollars, he fears the state will eventually cut home and community–based services to people with IDD who rely on them to fill the gap. The stakes are already high: more than 7,600 adults with IDD are currently on the waiting list for these services in the state, even though their applications have been approved and their need for intensive care recognized.

Before the bill passed, the goal was to shrink the waitlist. Now, the strategy has shifted toward simply holding on to existing services. 

“The solution isn’t to even address the problem anymore. The solution is like, can we at least keep our baseline where it’s at, which we’re not happy about, but we’ll have to accept, you know, at the end of the day,” says Janick. He adds, “Basically our job now is to keep on our state budgets and legislature to say, please don’t start making up these losses from our disability line items.”

Mack, with Liberty Resources Inc., also emphasizes the importance of pressing policymakers to protect home and community-based care. 

“Here in Pennsylvania, that includes supporting legislation like the modernization of Act 139, which would add transition services as a core offering for Centers for Independent Living, enabling more individuals to move out of nursing homes and back into the community,” he says.

Legislation that brings a sense of hope 

Because Medicaid is a federal–state partnership, much of the solution to mitigating the bill’s cuts lies at the state level. On July 29, 2025, State Representative Dan Frankel (D–Allegheny, 23rd District) issued a co-sponsorship memo for the Protect Pennsylvanians’ Medicaid Access Act. Frankel, who also serves as Democratic chair of the House Health Committee, says he is focused on using legislation to respond to what he calls “alarming trends in healthcare.”

“This is really a crisis for patients. It’s a crisis for providers. It’s a crisis for our hospitals and healthcare systems across Pennsylvania. And the repercussions are really daunting and distressing,” he says.

The legislation he’s proposing has three main components:

• Create a grant program to support community organizations assisting with Medicaid applications and outreach.
• Require proactive outreach by the state Department of Human Services.
• Streamline access to Medicaid systems so that community organizations can efficiently submit applications and documentation on behalf of clients.

“What the state can most readily do is address the challenge of re-enrolling individuals into Medicaid programs and dealing with the hurdles the federal government is placing on those individuals and on the states,” Frankel explains. He stresses that community organizations must be central to this effort and properly resourced: “We must make sure that they’re properly resourced in order to be able to assist this very vulnerable population, which in many cases may not have access to computers, may have certain disabilities, which make it more of a challenge to do the paperwork and to deal with a system that is designed to keep as many people off of Medicaid as possible.”

One challenge remains beyond legislation: the loss of federal dollars. “States are in a very tough spot with respect to trying to replace the loss of federal dollars,” Frankel says. “We need to find potentially other sources of revenue, you know, if at all possible, to try and maintain the viability of Medicaid expansion and make sure that we don’t disenfranchise.”

Still, he sees an opportunity to act before the worst impacts hit. “We have over a year to prepare, and the sooner we start preparing, the better,” he says. “You don’t want to do this at the last minute. That’s why we put this out for co-sponsorship, and why we’re going to engage with DHS and the administration in Harrisburg to work out something that makes sense.”

For now, the framework is just beginning to take shape. The next steps include gathering input from community health organizations and the Department of Human Services. “We have time to do this in a way that is inclusive and responsive,” Frankel says. “But that process is only just starting.”

Organizations are there to support 

Health advocates emphasize that while the looming cuts pose serious risks, the organizations supporting people navigating the healthcare system bring decades of experience, some dating back to before Medicaid was even created.

“I hope that the general population starts to learn about organizations like ours so that when these changes gradually roll out, they know there’s a free resource available to them,” says Janick. Anderson adds that he wishes their work were better known: “My ultimate goal is that we don’t have to explain what The Arc of Philadelphia does.”

As these organizations gain visibility, advocates say maintaining momentum by making Medicaid access an ongoing public conversation is crucial. 

“That means holding rallies, sending letters to your representatives, and sharing stories about how Medicaid has helped people,” says Platt.

Jalbert agrees that storytelling is central to the strategy. “Storytelling is the way that we understand the real-world impacts of a complex program like Medicaid,” she says, adding that real-life testimonials help combat myths about the program. Platt echoes this point: “Stories really show people that Medicaid is not just a handout. It’s a hand up, and it helps people become stable and get the healthcare they need and deserve.”