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Medicaid Monitor
Friday, November 6, 2026 · Updated 1:03 PM MT · 37 stories today
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Around the States / Pennsylvania · 37 stories todayPRO
Around the States · Pennsylvania

Pennsylvania

8 stories this week from 3 sources

PA-15 Candidates Spar Over Medicaid Cuts, Rural Hospital Relief

In a News Lab at Penn State voter guide, Democrat Ray Bilger and Republican incumbent Glenn Thompson lay out contrasting responses to federal Medicaid funding cuts and expiring ACA subsidies affecting Pennsylvania's 15th Congressional District. Bilger calls for restoring cut funding as a stopgap toward a universal healthcare model with a private option, and proposes new birthing centers and a bill forcing insurers to divest from non-healthcare business lines.

Medicaid MonitorNov 2, 2026

Democrat Stelson Unseats Medicaid-Cuts Ally Perry in Pennsylvania

Democrat Janelle Stelson defeated seven-term Republican Rep. Scott Perry in Pennsylvania's 10th Congressional District, a rematch of their 2024 race which Stelson narrowly lost. Perry, former House Freedom Caucus chair and a staunch Trump ally, had backed the administration's sweeping Medicaid cuts and other controversial policies.

Medicaid MonitorNov 3, 2026
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    PA Senate Passes Resolution Studying Home Nursing Medicaid Rates

    The Pennsylvania Senate unanimously passed Senate Resolution 238, sponsored by Sen. Frank Farry, directing the Legislative Budget and Finance Committee to study how Medicaid reimbursement rates and nursing workforce shortages affect access to pediatric and adult shift nursing services. Shift nursing allows medically complex patients, including those needing ventilator care, feeding tubes or seizure management, to receive care at home rather than in facilities, but staffing shortages leave shifts unfilled, forcing parents to miss work or delaying hospital discharges. Home care providers including BAYADA Hearts for Home Care, Aveanna Healthcare and the Pennsylvania Homecare Association backed the measure, framing it as a step toward reimbursement reform. The resolution does not change rates itself but sets up an independent legislative review intended to inform future policy action.

    Why it mattersHome nursing providers and families relying on Medicaid-funded private duty nursing gain a formal legislative review that could lead to future rate increases addressing chronic workforce shortages.

  7. Published Oct 30

    CMS Clarifies Rules for Reviewing Critical Access Hospital Eligibility

    CMS issued updated guidance clarifying when it will review whether Critical Access Hospitals (CAHs) still meet Medicare rural status and distance requirements. Effective September 20, 2026, reviews will be triggered when a new acute care hospital seeks certification near an existing CAH, when CMS identifies a previously unconsidered nearby hospital, or when a facility seeks new CAH certification or conversion. Starting in 2033, CMS will also review all existing CAHs on a 10-year cycle, though it may review eligibility at any time. CAHs found ineligible generally get a set period to reclassify as rural, convert to an acute care hospital or Rural Emergency Hospital, or face Medicare termination; the guidance also recommends CAHs seek advance CMS review before adding provider-based locations and clarifies that recertification surveys can proceed without prior CMS confirmation of rural and distance eligibility.

    Why it mattersRural hospitals that lose CAH status face significant Medicare reimbursement cuts and must quickly pursue reclassification or conversion to avoid termination from the program, which also affects their standing as Medicaid-serving rural providers.

  8. Published Oct 29
  9. Published Oct 29

    States Scramble to Warn Enrollees About 2027 Medicaid Work Rules

    States and their partners are racing to inform roughly 20 million Medicaid enrollees about new work requirements taking effect in 2027, which will require many to prove they are working, volunteering, in school, or exempt. Hospitals, community clinics, advocacy groups and insurers are being enlisted as "trusted messengers" to reach affected populations, but experts say communications funding and staff time remain scarce. Complicated and still-evolving federal exemption rules, including unresolved medical exemption criteria, are complicating outreach, and nearly a dozen states have built self-screening tools to help people determine applicability. Drawing on Arkansas' 2018 work requirement experience, where automated exemptions still left the state losing roughly 80% of affected enrollment, researchers warn that despite these efforts many people will likely lose coverage due to paperwork and communication gaps.

    Why it mattersState Medicaid agencies and health plans face significant coverage-loss and administrative risk if outreach and automated verification systems fail to reach enrollees before the 2027 work requirement deadlines take effect.

  10. Published Oct 29
  11. Published Oct 29

    Four Pennsylvania House Races Tilt Toward Democrats Before Midterms

    WHYY News reports that four contested Pennsylvania congressional races, more than in any other state, have shifted toward Democratic challengers as Election Day approaches. Republican incumbents Brian Fitzpatrick, Ryan Mackenzie, Rob Bresnahan and Scott Perry face well-funded Democratic opponents amid tightening polls and forecaster rating changes from Cook Political Report and Sabato's Crystal Ball. Issues cited include affordability, health care, tariffs, and in Perry's race specifically his Medicaid vote, which Democratic challenger Janelle Stelson has used in attack ads. Outcomes in these races will help determine House control in the midterms.

    Why it mattersControl of the House majority resulting from these races will shape whether Congress revisits recent Medicaid eligibility and funding changes in future legislation.

  12. Published Oct 28
  13. Published Oct 28

    Pennsylvania Senate Passes Bill Expanding EMS Transport Destinations

    The Pennsylvania Senate unanimously approved Senate Bill 1403, sponsored by Sen. Frank Farry, which lets EMS providers transport patients to a broader set of authorized receiving facilities beyond hospital emergency departments, including crisis centers and nonhospital drug and alcohol detoxification or rehabilitation facilities. The bill also establishes reimbursement protocols requiring insurers, Medical Assistance managed care plans and CHIP managed care plans to pay applicable emergency services payments for EMS agencies that treat and transport patients to these alternate destinations. Supporters, including the Hospital and Healthsystem Association of Pennsylvania and a local EMS chief, say the change will speed behavioral health crisis care and ease emergency department congestion. The bill passed the Senate and would need further action to become law.

    Why it mattersMedical Assistance and CHIP managed care plans would face new mandatory reimbursement obligations for EMS transports to non-hospital destinations, requiring updates to payment policies and provider agreements.

  14. Published Oct 27
  15. Published Oct 27

    Pennsylvania Launches First State Doula Apprenticeship Program

    Pennsylvania has launched the Pennsylvania Statewide Registered Doula Apprenticeship Program, described by state officials as the nation's first apprenticeship program for doula training. The year-long program, run through Lancaster-based Patients R Waiting with applications opened this month, combines eight weeks of online instruction, a 16-module doula school, two days of in-person training and a subscription to continuing-education resources. Doulas who complete the program will be certified to receive Medicaid reimbursement for their services, which state officials and advocates say could expand doula access in low-income and rural communities. State health and workforce officials frame the program as part of a broader effort to build a structured maternal health workforce pipeline and address maternal mortality and disparities in birth outcomes.

    Why it mattersThe program creates a formal credentialing pathway tied to Medicaid reimbursement, giving Pennsylvania's Medicaid agency and managed care plans a larger, state-certified doula workforce to cover under maternal health benefits.

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    Broad + Liberty Editors Argue Medicaid Home Care Oversight Is Failing

    In an editorial, Broad + Liberty's editors argue that weak government oversight, not just individual criminals, is to blame for a wave of Medicaid home health care fraud. They cite reporting on Delco official Mohammed "Danny" Sayduzzaman's company, which collected $84.8 million in Medicaid payments despite spotty paperwork and liens against its owners, alongside other recent cases including a Montgomery County prison sentence, a $5.76 million Philadelphia fraud charge, Minnesota's $90 million scandal, and a New York guilty plea over $65 million in fraud. The editors contend that pandemic-era federal spending expanded without adequate verification, and argue government should be able to confirm who receives payments, whether they comply with law, and whether services are actually delivered, not just prosecute fraud after funds are gone.

    Why it mattersState Medicaid agencies and program integrity units face mounting pressure to tighten upfront verification and enrollment screening for home health providers as fraud cases accumulate nationally.

  22. Published Oct 21
  23. Published Oct 20

    Pennsylvania Finalizes 2027 ACA Marketplace Rate Increases

    The Pennsylvania Insurance Department has finalized 2027 premium rates for insurers selling plans on Pennie, the state's ACA marketplace. Rates will rise across all participating insurers, though the approved increases are lower than what carriers initially proposed. The announcement affects individuals and families who purchase coverage through Pennie rather than employer-sponsored or Medicaid coverage. New rates take effect for the 2027 plan year.

    Why it mattersHigher marketplace premiums could push more low-income Pennsylvanians who lose or forgo exchange coverage toward Medicaid eligibility determinations, increasing churn and enrollment pressure on the state agency.

  24. Published Oct 20

    PA Home Care Firm Tied to Ex-Official Drew $85M in Medicaid Pay

    New Hope Home Care, an Upper Darby, Pennsylvania agency linked to former township treasurer Mohammed "Danny" Sayduzzaman, received roughly $84.8 million in payments from Pennsylvania Medicaid managed care organizations between 2020 and mid-2026, growing more than tenfold over five years, according to state records obtained by Broad + Liberty. The payments are almost entirely for agency-directed personal assistance services billed to Medicaid MCOs, with no fee-for-service claims on record. Upper Darby Township has been unable to locate a business registration for the company, and all three listed shareholders face federal tax liens totaling about $357,000. No agency has alleged improper billing, but the reporting follows an unrelated August case in which federal and state prosecutors charged 18 people in Philadelphia with billing Medicaid for home care visits that never occurred.

    Why it mattersThe rapid, unverified growth in Medicaid managed care billing alongside missing business registration and unpaid federal taxes among the company's principals signals the kind of program integrity red flags that state Medicaid agencies and MCOs are expected to screen for in home and community-based services billing.

  25. Published Oct 18

    Community Care Behavioral Health Expands OurHAIR Program to Kingston

    Community Care Behavioral Health Organization has extended its OurHAIR initiative, which trains barbers and hairstylists on basic mental health awareness and referral pathways, to Kingston. The program teaches hair professionals to recognize signs of mental health struggles among clients and connect them with appropriate services beyond informal conversations in the chair. Community Care, a behavioral health organization, developed the initiative to reduce stigma around mental health, particularly in communities where barbershops and salons serve as trusted gathering spaces. No specific funding mechanism or regulatory action is described in the source.

    Why it mattersFor behavioral health-focused Medicaid managed care organizations, community-based outreach models like this illustrate alternative, non-clinical referral channels that can extend engagement with underserved populations.

  26. Published Oct 16

    PA Poll Finds Broad Support for Medicaid Work Requirements

    In its roundup "Elephant in the Room," Broad + Liberty covers several Pennsylvania election-season developments, including a Commonwealth Foundation-commissioned poll of 800 Pennsylvania voters conducted by Public Opinion Strategies. The poll found 77 percent of respondents support Medicaid and SNAP work requirements, including those set to take effect at the end of the year. The roundup also covers gubernatorial candidate Stacy Garrity's NFIB endorsement, new campaign ads, and a Meta social-media settlement, none of which involve Medicaid. The poll results arrive as Pennsylvania's political campaigns intensify ahead of the Nov. 3 election.

    Why it mattersPublic polling showing strong voter support for Medicaid work requirements could shape Pennsylvania legislative and gubernatorial positioning on implementation as the federal requirement deadline approaches.

  27. Published Oct 15
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