A Penn State rural health expert on the impact of coming Medicaid changes

WPSU | By Anne Danahy

Published July 30, 2026 at 8:58 PM EDT

In this file photo, workers at a Medicaid call center in Jefferson City, Mo., field questions and review information regarding eligibility determinations on Aug. 16, 2023.

As states and people who get their health coverage from Medicaid get ready to meet new requirements that take effect Jan. 1, 2027, a Penn State expert on rural health said the new rules will impact healthcare providers and hospitals too.

Lisa Davis, director of the Pennsylvania Office of Rural Health and an outreach associate professor of health policy and administration at Penn State, said 70% of Pennsylvanians on Medicaid are working. And the rest may be caretakers or have a disability or be in school.

“It is a misnomer, I think, to say that those who are on Medicaid are not interested in wanting to work," Davis said. "I think that the data show that they absolutely do want to work. But the kinds of positions that they are taking are not positions that offer health insurance benefits.”

Under H.R. 1 — the Big Beautiful Bill — people on Medicaid will have to renew their eligibility every six months. And, they’ll have to work or do community service or go to school 80 hours a month. There are some exceptions, including caring for a child.

H.R. 1 also means that the state will have to have tracking systems to comply. Another question is how "medical frailty," which can exempt someone from work requirements, will be defined.

Lisa Davis, director of the Pennsylvania Office of Rural Health and an outreach associate professor in health policy and administration at Penn State.

Davis said even if someone doesn’t have a way to pay for healthcare, they’ll still get sick at some point.

“What we have seen with those who have challenges with insurance is that they will avoid care," she said. "They will extend the time that they don't go to get care. So by the time they show up at, say for instance, the emergency department, they will require more extensive care, which is more expensive care.”

Non-profit hospitals have to provide care. And, Davis said many rural hospitals are already struggling to maintain services.

“They're the anchor of health care in their community," she said. "As they begin to see more uncompensated care come in, my guess is that they will even struggle more.”

According to the state, more than 300,000 Pennsylvanians could lose their coverage because of the changes to Medicaid.