About 100,000 people have dropped off Pennsylvania’s Medicaid over the past year, but the health program’s costs have continued to climb during that period, according to state analysts.
The program, which provides health coverage for low-income Americans, is one of the biggest expenses in the Pennsylvania budget, costing the commonwealth about $15.5 billion in the 2025-2026 fiscal year.
That’s an increase of about $1.1 billion, or 7.8%, over the previous year, according to an Independent Fiscal Office report released in June.
Spending climbed despite the fact enrollment saw an “unanticipated decline” from about 3.05 million people to 2.95 million, as the average cost per person spiked by about 13%, the analysis showed.
The drop has taken place even before the rollout of federal requirements — adopted through President Donald Trump’s “big beautiful” tax bill — that are projected to push as many as 310,000 people out of the program. The changes slated to start in January 2027 include new work requirements for many enrollees and more frequent checks to determine eligibility.
Who left the Pa. Medicaid program?
The number of disabled and older people depending on Medicaid, the populations that represent more than three-quarters of the program’s costs, increased from about 884,000 to 890,000 between the two years, the fiscal analysis showed.
At the same time, the number of enrollees from low-income families fell from about 1.33 million to 1.26 million. The population covered through the Affordable Care Act expansion dropped from 836,000 to 797,000.
Why did Pa. Medicaid enrollment fall?
The fiscal analysis points to a couple recent federal changes as possible reasons for the enrollment drops:
- Work requirements kicked in in 2025 for many recipients of federal nutrition assistance programs. About 236,000 people have left the Supplemental Nutrition Assistance Program in Pennsylvania since these new rules took effect, the analysis shows. If the work mandates have pushed more people into the labor force, some of these recipients might no longer qualify for Medicaid coverage, according to the report.
- Trump’s aggressive immigration enforcement tactics might be dissuading some mixed-status families from applying for Medicaid coverage, the analysis said.
