HARRISBURG \u2014 Key federal\u00a0Medicaid changes\u00a0will roll out next year, and Pennsylvania\u2019s governor will play a crucial role in how they\u2019re implemented or challenged.<\/p>\n
The sweeping 2025 federal budget law, President Donald Trump\u2019s signature piece of second-term legislation, is expected to\u00a0lead millions of people to lose coverage\u00a0and cut federal Medicaid spending by\u00a0hundreds of billions of dollars. Independent research shows it will create\u00a0administrative and financial complications for states,\u00a0leaving them with big decisions.<\/p>\n
One of the biggest changes is that working-age adults who don\u2019t fall into traditional Medicaid categories, such as those for people who are pregnant or have disabilities, will be subject to new work rules and have their eligibility checked more frequently.\u00a0Hundreds of thousands of such people\u00a0in Pennsylvania have coverage now because\u00a0former Democratic Gov. Tom Wolf\u00a0expanded eligibility, as allowed under the federal Affordable Care Act of 2010.<\/p>\n
The Medicaid issue offers a clear contrast in the race between Democratic Gov. Josh Shapiro and his Republican challenger, Treasurer Stacy Garrity, and it gives insight into how they would manage a massive program that provides healthcare for nearly 2.9 million Pennsylvanians. The federal government and states fund the program, which is administered by states operating under federal rules and guidelines.<\/p>\n
Shapiro has repeatedly criticized these changes, called the cuts in the bill an example of cruelty and joined a lawsuit challenging the rollout of work requirements.<\/p>\n
Meanwhile, Garrity has embraced the federal law, including the Medicaid changes. Her campaign promises she would work with the Trump administration to implement the law\u2019s \u201canti-fraud protections\u201d and that she would also demand independent performance audits of the state\u2019s Medicaid programs.<\/p>\n
The governor will face a\u00a0host of decisions about Medicaid\u00a0in the years ahead, and while some of those specific policy approaches are likely to get fleshed out in annual budget proposals and hashed out during negotiations, Shapiro and Garrity have made it clear where they stand on the state\u2019s overall approach.<\/p>\n
Shapiro\u2019s administration has highlighted its work to prevent people from losing coverage, including offering an FAQ hotline, a communications toolkit and other resources to help prepare for the changes. But, before the law passed, Shapiro warned Pennsylvania couldn\u2019t provide its own funding to make up for the lost revenue. During his primary night rally, he talked about the importance of other races on the ballot \u2014 flipping control of Congress \u2014 in order to roll back the Medicaid cuts.<\/p>\n
Garrity campaign spokesperson Matt Beynon told Spotlight PA that changes in the Medicaid program strengthen it \u201cby cracking down on fraud, waste, abuse, and improper enrollment.\u201d He highlighted changes in the law, saying that it \u201crequires more frequent eligibility reviews, improves data matching to prevent people from enrolling in multiple government health plans, and closes financing loopholes that allowed states to improperly draw down federal funding.\u201d<\/p>\n
These changes will \u201cprotect taxpayers while preserving Medicaid for the children, seniors, people with disabilities, and low-income families who depend on it most,\u201d Beynon added.<\/p>\n
Beyond the upcoming federal changes, the governor faces other choices for the Medicaid program, from abortion access to handling fraud.<\/p>\n
Here\u2019s where the candidates stand on the issues.<\/p>\n
Governor\u2019s power over Medicaid<\/p>\n
It costs tens of billions of dollars each year to provide benefits and administer the program in Pennsylvania. Nearly one in four Pennsylvania residents are enrolled.<\/p>\n
Governors can influence coverage both through executive and legislative action.<\/p>\n
For instance, in 2015, Wolf approved a\u00a0major expansion to Medicaid eligibility, which was allowed under the federal Affordable Care Act.<\/p>\n
And on a smaller scale, the governor\u2019s power over the program was on display late last year when the\u00a0Shapiro administration restricted access\u00a0to weight-loss drugs for Medicaid patients. The move was projected to save the state hundreds of millions of dollars, Spotlight PA previously reported. Shapiro has also talked about how\u00a0he\u2019s resisted\u00a0\u201cforces on the other side of the aisle that are pushing me every budget cycle to cut money out of Medicaid.\u201d<\/p>\n
As treasurer, Garrity has limited power over Medicaid. But during remarks to the\u00a0Pennsylvania Press Club, she talked about the importance of scrutinizing it and other state programs, saying \u201cthere is a lot of room for efficiency in government.\u201d She cited her work as treasurer. Her department released a report in July describing how it identified and prevented nearly\u00a0$820 million worth of improper payments for various agencies in a recent fiscal year.\u00a0That led to over $88.1 million in taxpayer savings, \u201cusing a fairly conservative definition,\u201d the report said.<\/p>\n
Federal Medicaid changes<\/p>\n
The 2025 federal budget law, called the \u201cOne Big Beautiful Bill\u201d by Trump\u2019s White House, included $4.5 trillion in tax breaks, plus more than $1 trillion in cuts from federal healthcare and food assistance over a decade, the Associated Press reported.<\/p>\n
Some of the law\u2019s provisions will have a big impact for people receiving coverage under Medicaid expansion. With some exceptions, it imposes new work or community engagement requirements on non-disabled adults, according to an analysis from\u00a0RAND Health, while also requiring adults covered under Medicaid expansion to have their eligibility checked every six months, instead of every year.<\/p>\n
Responding to administrative changes under the law will be the heaviest lift in the short term for states, according to an analysis from government relations firm\u00a0MultiState, and will likely \u201crequire increased administrative personnel to accommodate the increased onus on agencies.\u201d Otherwise, the report says, enrollees could lose coverage not because they aren\u2019t eligible \u201cbut because of paperwork or administrative issues.\u201d<\/p>\n
In Pennsylvania, state officials face a number of challenges as they prepare for the change, including not having a budget for paid advertisements to spread the word,\u00a0WESA recently detailed.<\/p>\n
In response to questions from Spotlight PA, a Pennsylvania Department of Human Services spokesperson described a number of ways the administration has shared information to help \u201cMedicaid recipients affected by these dangerous changes navigate the new rules and bureaucracy to stay covered.\u201d The recent state budget included funding to fill nearly 400 positions at County Assistance Offices \u201cto support the additional workload created by\u201d the federal law\u2019s \u201cunfunded mandates,\u201d according to the spokesperson, Brandon Cwalina.<\/p>\n
The administration estimates more than 310,000 people will lose Medicaid coverage in Pennsylvania not because they\u2019re ineligible, but because of \u201cbureaucratic hurdles,\u201d Cwalina said.<\/p>\n
During the campaign, Shapiro has highlighted Garrity\u2019s support for the federal law, including in a\u00a0recent ad\u00a0and in his\u00a0primary night speech.<\/p>\n
Shapiro, in his capacity as governor, joined two dozen other states, as well as Washington, D.C., to sue the Centers for Medicare & Medicaid Services over the agency\u2019s interpretation of exceptions to the work requirements under the federal law.\u00a0They argue\u00a0the agency\u2019s exceptions are too narrow and will \u201cforce medically frail individuals in need of healthcare to jump through unnecessary administrative hoops to get and retain life-saving healthcare coverage.\u201d<\/p>\n
Beynon, the Garrity campaign spokesperson, criticized the governor in general for the lawsuits against Trump.<\/p>\n
Shapiro had\u00a0sued\u00a0the Trump administration more than two dozen times over the past year and a half,\u00a0Spotlight PA previously reported. The governor has challenged the president on a range of issues, including the loss of federal funding, rollbacks of environmental protections, and student loan limits. He\u2019s highlighted\u00a0that record.<\/p>\n
Garrity\u00a0has said Shapiro\u00a0\u201cblames President Trump for all of our problems.\u201d<\/p>\n
Beynon told Spotlight PA that Garrity would work with the Trump administration to implement the 2025 federal budget law\u2019s \u201canti-fraud protections, strengthen provider screening, use modern data analysis to identify impossible and duplicate claims, and demand independent performance audits of Pennsylvania\u2019s Medicaid programs.\u201d He also said that the federal government provides a higher reimbursement rate for Medicaid expansion enrollees than traditional recipients and said Garrity wants \u201ca fairer federal funding formula.\u201d<\/p>\n
If elected, Garrity would also use\u00a0rural health funding\u00a0as part of the federal budget bill to address a number of issues, Beynon said, including by deploying telehealth platforms across rural systems, expanding broadband, and prioritizing specialty services, such as mental health, cardiology, and orthopedics. Her administration would \u201cestablish rural diagnostic and lab offices so telehealth providers can send patients for follow-up care close to home,\u201d the spokesperson said.<\/p>\n
Fighting over fraud<\/p>\n
Both candidates have portrayed themselves as tough on fraud.<\/p>\n
Garrity\u2019s\u00a0issues\u00a0page appears to reference a statement Shapiro made as attorney general in which he estimated Pennsylvania\u00a0likely loses $3 billion a year due to fraud and improper billing in the state\u2019s Medicaid program. He made those remarks following a\u00a02019 statewide grand jury report\u00a0released by his office. The report said\u00a0\u201cstate regulators and law enforcement lack the tools to effectively oversee and investigate fraud\u201d in the Medicaid program.<\/p>\n
Shapiro joined with lawmakers to support changes following that grand jury report, including creating a \u201cfalse claims\u201d law that would financially incentivize whistleblowers to come forward,\u00a0Spotlight PA previously reported.\u00a0Whistleblowers could receive a share of money that\u2019s recovered through litigation.<\/p>\n
Such a measure passed out of the\u00a0state House in 2025, but has not come up for a vote in the state Senate.\u00a0During his latest budget address, Shapiro urged the legislature to act on the issue, and a campaign spokesperson cited the governor\u2019s support in a response to questions from Spotlight PA.<\/p>\n
Garrity\u2019s campaign website\u00a0criticizes Shapiro on the issue, saying, \u201cInstead of addressing fraud as Attorney General, he focused on increasing state spending as Governor \u2013 raising the risk of even more waste. Taxpayers deserve better.\u201d Her campaign website describes rooting out fraud, waste, and abuse in state government as a priority. Savings would be used \u201cto reduce the deficit and lower the burden on taxpayers,\u201d the website says.<\/p>\n
Beynon, the Garrity campaign spokesperson, said her administration would create a fraud task force, and the initiative would strengthen the state\u2019s inspector general, empower the attorney general to address the issue, and require the auditor general to conduct performance audits of state health care programs.<\/p>\n
The latter would be an expansion of requirements for the Department of the Auditor General, which an agency spokesperson said must perform audits of how tobacco settlement money is used by hospitals. The department has discretion\u00a0over auditing\u00a0how state agencies\u00a0oversee health care plans\u00a0and programs.<\/p>\n
Shapiro and his administration have said increased state spending in Pennsylvania budgets has gone to worthy efforts, such as schools, law enforcement, and economic development.<\/p>\n
State officials under Shapiro have highlighted their own oversight work, saying the governor \u201cmade fighting public assistance fraud a cornerstone\u201d of his administration.<\/p>\n
In 2025,\u00a0the administration\u00a0cited a federal report that found Pennsylvania ranked first for the number of Medicaid fraud indictments and third for Medicaid fraud convictions. (The rankings were not adjusted for population size.) His administration credited the cases to \u201cthe hard work of the dedicated staff at\u201d Pennsylvania\u2019s Department of Human Services.<\/p>\n
In July,\u00a0an administration news release said that, since Shapiro took office, two agencies under him have worked together to investigate over 62,000 applications for public assistance for suspected fraud, preventing nearly $179 million worth of benefits from being distributed to people who weren\u2019t entitled to the assistance. The same news release also highlighted his work as attorney general on the issue.<\/p>\n
Another part of Beynon\u2019s response specifically called for an audit of Pennie, Pennsylvania\u2019s health insurance marketplace. A spokesperson for Pennie told Spotlight PA that it \u201chas long-established effective processes for rescinding policies that are fraudulent, has robust processes to verify eligibility, and has responded quickly to fraud concerns.\u201d Under state law, the governor and legislative leaders appoint members to\u00a0the board overseeing\u00a0Pennie, which operates as a state-affiliated agency.<\/p>\n
Medicaid coverage for abortion<\/p>\n
The two candidates disagree about a Medicaid case that has reached the Pennsylvania Supreme Court.<\/p>\n
As governor, Shapiro chose not to defend a ban on Medicaid covering abortion. He celebrated a\u00a0Commonwealth Court ruling overturning the restriction, saying \u201ca woman\u2019s ability to access reproductive care should never be determined by her income.\u201d<\/p>\n
Garrity criticized\u00a0both the court decision and how the Shapiro administration handled the case. She called the ruling \u201cimmoral\u201d and \u201ccallous,\u201d and said the Shapiro administration\u2019s choice to not defend the ban was \u201cdeeply concerning.\u201d<\/p>\n
Attorney General Dave Sunday, a Republican, has taken up the case, which is currently before\u00a0the Pennsylvania Supreme Court.<\/p>\n
Spotlight PA\u00a0is an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.\u00a0Sign up for our free newsletters.<\/p>\n
BEFORE YOU GO\u2026\u00a0If you learned something from this article, pay it forward and contribute to Spotlight PA at\u00a0spotlightpa.org\/donate. Spotlight PA is funded by\u00a0foundations and readers like you\u00a0who are committed to accountability journalism that gets results.<\/p>\n","protected":false},"excerpt":{"rendered":"HARRISBURG \u2014 Key federal\u00a0Medicaid changes\u00a0will roll out next year, and Pennsylvania\u2019s governor will play a crucial role in…\n","protected":false},"author":2,"featured_media":275671,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[836,182,139,28,30,29,50,181],"class_list":["post-275670","post","type-post","status-publish","format-standard","has-post-thumbnail","category-pennsylvania","tag-election","tag-local-news","tag-news","tag-pennsylvania","tag-pennsylvania-headlines","tag-pennsylvania-news","tag-politics","tag-top-stories-stt"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/275670","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/comments?post=275670"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/275670\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media\/275671"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media?parent=275670"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/categories?post=275670"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/tags?post=275670"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}