If you are interested in applying for Medicaid in Pennsylvania – or Medical Assistance (MA), you’ve come to the right place. In this post, we will provide information about Pennsylvania Medicaid eligibility criteria for children and family, pregnancy, the elderly, the blind, and the disabled.
We will explain in detail everything you need to know to successfully apply for Pennsylvania Medicaid.
In addition, we will show you the various ways you can apply, including how to log in to MyCOMPASS PA Portal, and how to contact Pennsylvania Medicaid.
Finally, we will answer some of the most frequently asked questions about Pennsylvania Medicaid Eligibility.
This article on Pennsylvania Medicaid eligibility will cover:
- What is Pennsylvania Medicaid?
- Who is Eligible for Medicaid in Pennsylvania?
- Pennsylvania Medicaid Eligibility Guidelines
- 2021 Pennsylvania Medicaid Income Limit
- How to Apply for Medicaid in Pennsylvania
- What does Medicaid Cover in Pennsylvania?
- Pennsylvania Medicaid Phone Number
- Medicaid Expansion in Pennsylvania
- Pennsylvania Medicaid Card
- FAQs about Medicaid in Pennsylvania
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
The Pennsylvania Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 3.2 million people.
This includes about 1.5 million children as shown by the image below.
The Pennsylvania Medicaid program is managed by the Department of Human Services (DHS)
Who is Eligible for Medicaid in Pennsylvania?
The following people may qualify for Pennsylvania Medicaid if they meet certain financial
- Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG)
- Individuals who are aged (age 65 and older), blind and disabled.
- Families with children under age 21
- Special Medical Assistance conditions
Pennsylvania Medicaid Eligibility Guidelines
To qualify for Medicaid in Pennsylvania, an individual must meet the eligibility requirements of the program.
There are several Medicaid programs that people in Pennsylvania can be eligible for. Each program has its own income and asset requirements.
However, all applicants must meet the general requirements below in order to qualify for Pennsylvania Medicaid.
Proof of Identity
Identity can be verified by a driver’s license, state identification card or another piece of identification.
Social Security Number (SSN)
An SSN must be provided for each person applying for Medicaid.
Your county Medicaid Office staff can help you apply for an SSN for anyone who does not have one.
Medicaid assistance is available to individuals who are residents of Pennsylvania if all other eligibility requirements are met.
There is no requirement regarding the length of time that a person must live in Pennsylvania in order to be eligible.
Medicaid is available to United States citizens, refugees, and certain lawfully admitted aliens. Other aliens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists.
Additionally, U.S. citizens, refugees and legal aliens must submit documentation proving U.S. citizenship or legal alien status.
County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance.
The income requirements for Pennsylvania Medicaid is perhaps the most important eligibility criteria. See below for details about Medicaid income limits by group. and household size.
2021 Pennsylvania Medicaid Income Limit
The PA Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in Pennsylvania who qualify for Medicaid.
Pennsylvania Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
|Pennsylvania Medicaid Income Limit – Children|
|Children Medicaid Ages 0-1||Children Medicaid Ages 1-5||Children Medicaid Ages 6-18||Children Separate CHIP|
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
Pennsylvania has expanded Medicaid to include adults without dependents.
Therefore, adults without dependents can apply for Medicaid in Pennsylvania.
For an update on the Medicaid expansion debate and timeline in Pennsylvania, see our Pennsylvania Expansion update below.
Pennsylvania Medicaid Income Limit for Adults
|Pennsylvania Medicaid Income Limit – Adults|
|Pregnant Women Medicaid||Adults (Medicaid) Parent/ Caretaker||Seniors & People w/ Disabilities (Medicaid)||Adults (Medicaid) Expansion to Adults|
How to Read the Pennsylvania Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 215% of the Federal Poverty Level – which for a family of two is $37,453 as shown in the chart above.
How to Apply for Pennsylvania Medicaid
There are 3 ways you can apply for Medicaid in Pennsylvania.
Option 1 – Apply online
You can apply online through the MyCOMPASS PA Portal – as shown in the image below.
If you have an account, you can log in or create your MyCOMPASS PA account. Click here to be taken to the website.
Option 2 – Apply at a County Assistance Office Near You
You can apply in person at the County Assistance Office (CAO) office near you. Click here to locate a CAO office.
Option 3 – Download Application
You can download an application, complete it, and mail it to your County Assistance Office (CAO) office or submit it in person.
Additionally, you can Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.