An 11th-hour amendment to state Medicaid expansion language could affect health care coverage for hundreds of thousands of Pennsylvanians.

On Monday evening, House Democrats got a copy of amended language for HB-59, which extends a string of state expansions to Medicaid coverage. But the new language adds work requirements to coverage as well as other restrictions designed to shrink the number of people covered under state law, health advocates say. 

The House will vote on the new language Tuesday afternoon.

The PA Health Access Network called it a “sneak attack” on Medicaid. Lawyers from Community Legal Services, a legal aid society in Philadelphia, said the work requirements appeared to be intended to act as a stumbling block to coverage.

“We’re not worried because we think most people would be affected by the work requirements. Three-quarters are already in households that are working,” said Kristen Dama, an attorney at CLS. “But you’re requiring the state to set up a new apparatus to determine the ability to work for 1.6 million people. That’s a huge number of people for an office is already overworked.”

The requirements would mainly apply to higher earners enrolled in Medicaid, but Dama said those requirements would result in people losing coverage largely for bureaucratic reasons, rather than lack of compliance.

“You’ll have a lot of people losing coverage not because they don’t qualify but because the bureaucracy isn’t there to support it,” she said. “People’s paperwork gets lost, people can’t get into the office to give that extra piece of paper to state offices.”

In March, the Trump administration invited states to reintroduce previously rejected “waivers” to Medicare and Medicaid coverage. These waivers have historically been used to expand coverage beyond the original scope of federal health programs, but in recent years conservative groups had sought to use waivers to do the opposite. Many of these attempts were rejected by the Obama administration. The amendments to HB-59 largely mimic earlier Republican efforts to add restrictive language to PA’s existing waivers.

Dama said she had heard that the language had come directly from House Republican leadership, and was quickly voted out of a nighttime session of the Appropriations Committee. Sources within the GOP caucus said that several moderate members had spoken against the amendment, criticizing the work requirements and the lack of short-term savings as critical budget talks wind on in the capital.

A spokesperson for Speaker Mike Turzai did not immediately comment on the amended bill. 

The evening introduction of the amendments reportedly sent House Democrats scrambling. 

“The GOP didn't share its language with Democrats until late yesterday, so we are still trying to learn what it does,” said Bill Patton, a Democratic spokesperson.

Gov. Tom Wolf has opposed past attempts to curtail Medicaid expansion. His office said he would release a statement on the amended language later today.