Shapiro Seeks Funding for Medicaid Pilot Programs Despite GOP Objections

The Pennsylvania governor is requesting $2.8 million for initiatives including medication for those leaving prison, housing assistance for the homeless, and specialized meal delivery.

Published on Feb. 24, 2026

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Pennsylvania Gov. Josh Shapiro is asking the state legislature to fund a trial run of extra Medicaid benefits, including programs to provide medication for those leaving prison, housing assistance for the homeless, and specialized meal delivery for diet-sensitive patients. The state's share of the cost would be $2.8 million, with federal funds roughly tripling that amount. Despite Republican opposition, the Trump administration has indicated it will allow the programs to run their course.

Why it matters

The pilot Medicaid programs are politically contentious, with Republicans fearing the extra benefits will be too expensive to maintain and exacerbate the state's budget deficit. However, Shapiro believes the initiatives have the potential to save the state millions of dollars in the long run by addressing issues like addiction, diet-related health problems, and homelessness earlier on.

The details

The benefits, created under a Section 1115 Medicaid waiver, include a program to enroll people about to leave incarceration and provide them with addiction-treatment medication, a program to deliver custom meals to patients with dietary conditions, and one to provide case management and rental/moving assistance to homeless patients transitioning into housing. The goal is to treat problems earlier and prevent more costly treatment down the road.

  • In December 2024, Pennsylvania received approval for two waivers covering four separate initiatives.
  • In a letter to states last summer, Trump's CMS said it would not be approving any new continuous eligibility waivers, or extending existing ones, effectively rendering Pennsylvania's program moot.

The players

Josh Shapiro

The governor of Pennsylvania who is requesting $2.8 million in state funding for the Medicaid pilot programs.

Mehmet Oz

Trump's head of the Centers for Medicare & Medicaid Services (CMS), who has tied healthy eating into what he's described as a push for the nation to spend its healthcare dollars more wisely.

Robert F. Kennedy, Jr.

Trump's Secretary of Health and Human Services, who has stressed his belief that much of America's healthcare woes could be solved by changes in lifestyle and living conditions, particularly with regard to diet, instead of costlier medical procedures.

Becky Ludwick

Vice President of Public Policy at the Pennsylvania Partnerships for Children, who said it was "disappointing" that the Trump administration would not approve or extend continuous eligibility waivers for children's Medicaid coverage.

Republican state Senate leadership

Wrote a letter to the Trump administration urging CMS to reconsider the Medicaid waivers, saying they were "potentially exposing state and federal taxpayers to new cost burdens that total billions of dollars" and would be an expansion of Medicaid that "goes well beyond the scope of the program and jeopardizes our ability to balance our state budget."

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What they’re saying

“even Dr. Oz supports our initiative.”

— Josh Shapiro, Governor of Pennsylvania (pennlive.com)

“our pilot has the potential to save our commonwealth millions of dollars, and the best part is, the upfront cost is very little.”

— Josh Shapiro, Governor of Pennsylvania (pennlive.com)

“It's disappointing, from our perspective, that that change was made. There were multiple states, including Pennsylvania, that were prepared to move forward with continuous eligibility for children.”

— Becky Ludwick, Vice President of Public Policy, Pennsylvania Partnerships for Children (pennlive.com)

What’s next

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The takeaway

This case highlights growing concerns in the community about repeat offenders released on bail, raising questions about bail reform, public safety on SF streets, and if any special laws to govern autonomous vehicles in residential and commercial areas.