Medicaid in Pennsylvania, also known as Medical Assistance (MA), is a state and federally-funded program providing healthcare coverage to eligible low-income residents, including children, pregnant women, elderly adults, and individuals with disabilities. It covers many services, such as hospital stays, doctor visits, prescriptions, and mental health services. Eligibility is based on income, family size, and other factors. Pennsylvania residents can apply for Medicaid through various methods, including online, by phone, in person, or by mail.

Pennsylvania Medicaid, known as Medical Assistance, offers its beneficiaries a wide range of covered services. Here's a summary of the covered services:

Medical Assistance Covered Services

1. Ambulance Services: Transportation for medical emergencies.
2. Ambulatory Surgical Center (ASC): Outpatient surgical services.
3. Case Management: Assistance in coordinating care and services.
4. Chiropractic Services: Treatment involving manipulation of the spine.
5. Clinic Services: Various healthcare services are provided in a clinic setting.
6. Dental Services: Oral health care and treatments.
7. Drug and Alcohol Services: Treatment for substance abuse.
8. Durable Medical Equipment: Includes orthotics and prosthetics.
9. Family Planning Services and Supplies: Contraception and related services.
10. Hospice Services: Care for terminally ill patients.
11. Laboratory Tests: Various medical testing services.
12. Maternity Services: Care during pregnancy, including visits to physicians, nurse midwives, birth centers, and home visits by nurses.
13. Medical Supplies: Various healthcare supplies.
14. Mental Health Services: Psychological and psychiatric services.
15. Optometrist Services: Eye care and vision services.
16. Podiatrist Services: Foot and ankle care.
17. Prescription Drugs: Medications prescribed by a healthcare provider.
18. Radiology Services: Imaging services, including X-rays, MRIs, and CT scans.
19. Renal Dialysis Services: Kidney dialysis treatments.
20. Nursing Facility Services: Care provided in nursing facilities.
21. Non-Emergency Medical Transportation: Transportation to and from covered medical services.

Important Notes

• ACCESS Card: Always carry your ACCESS card and show it along with any other insurance cards when accessing health care services.
• Presumptive Eligibility for Pregnant Women: A specific benefit package for pregnant women.
• Exclusions: Inpatient services are not covered under specific benefit packages like "Presumptive Eligibility for Pregnant Women."

The scope of services and eligibility may vary depending on individual circumstances and specific Medicaid programs. Beneficiaries should always check with their healthcare provider and the Pennsylvania Medicaid office to confirm coverage details.

Eligibility for Medicaid in Pennsylvania involves several criteria, categorized under Modified Adjusted Gross Income (MAGI) and Non-MAGI groups. Here's a summary:

MAGI-Based Eligibility

Target Groups

1. Children under 19.
2. Pregnant women.
3. Parents/caretakers of children under 21.
4. Adults aged 19-64 with incomes ≤133% of the Federal Income Poverty Guidelines (FPIG).
5. Family planning services recipients.

Income Considerations

• Includes wages, interest, dividends, Social Security, Veterans' Benefits, pensions, and spouse's income if cohabitating.
• Excludes TANF, SSI, SNAP, LIHEAP benefits, foster care payments, certain housing/utility subsidies, weatherization payments, and child support payments for MAGI MA only.

Non-MAGI-Based Eligibility

Target Groups

1. Individuals ≥65 years.
2. Blind/disabled individuals.
3. Medical Assistance for Workers with Disabilities (MAWD) participants.
4. Recipients of long-term care or home/community-based services.

Resources

• Includes cash, bank accounts, stocks, bonds, some trust funds, life insurance, vehicles, revocable burial funds, and non-resident property.
• Excludes primary residence, certain burial reserves, spaces, and one motor vehicle.

Resource limits

• Non-MAGI: $2,000 for one person, $3,000 for two.
• Medically-Needy Only: $2,400 for one person, $3,200 for two, plus $300 for each additional person.
• Medicare Buy-In Programs: $9,090 for one person, $13,630 for two.
• MAWD: $10,000 for any household size.

Other Eligibility Criteria

• Identity Verification: Via driver's license, state ID, or other IDs.
• Social Security Number: Required for each applicant.
• Residency: Must be a Pennsylvania resident.
• Citizenship: Open to U.S. citizens, refugees, and certain lawfully admitted non-citizens. Some non-citizens may qualify for limited benefits in emergencies.

Special Notes

• No resource limits for pregnant women, children under 21, or families with children under 21 in MAGI MA, except for Medicare Buy-In programs and MAWD.
• The County Assistance Office assesses household composition to determine mandatory or optional budget group members.

For specific income limits for each group, it is advised to refer to Pennsylvania's Medical Assistance Eligibility Handbook.

Applying for Medicaid in Pennsylvania (known as Medical Assistance or MA) can be done through several methods, and you can use it even if you're unsure of your eligibility. Here's a summary of the application options:

• ‍Online: Use the COMPASS website to apply for MA and other services.
• ‍Telephone: Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355 for assistance.
• ‍In-Person: Visit your local county assistance office (CAO).
• ‍On Paper: Download and fill out the application form, then send it to your local CAO.

Application forms are available for download:

• ‍Application for cash assistance, SNAP, and Medical Assistance benefits (PDF)
• ‍Solicitud para recibir beneficios (Spanish PDF)

Before applying, remember to gather necessary documentation about your income, residency, citizenship, and other relevant information. If you need assistance or have specific questions, it's advisable to contact the Consumer Service Center or your local CAO.

Renewing your state health coverage in Pennsylvania is crucial to maintaining your Medicaid or CHIP benefits. Here's a summary of the renewal process:

You will receive a renewal packet by mail when it's time to renew your health coverage. It's essential to complete and return your renewal by the due date. This applies whether your circumstances (like income or household size) have changed or remained the same.

If you're no longer eligible for Medicaid or CHIP, DHS can connect you to other affordable health coverage options, like those available through Pennie®.

Ways to Complete and Submit Your Renewal

• ‍By Mail: Complete the forms and mail them back using the provided envelope.
• ‍Online: Use the COMPASS website to complete your renewal.
• ‍Telephone: Call 1-866-550-4355 to speak with a customer service representative.
• ‍In-Person: Visit and complete your renewal at any local county assistance office (CAO).

DHS will assess if you are still eligible for Medicaid or CHIP. If eligible, your coverage will continue. You'll be referred to Pennie® for other health coverage options if you are no longer eligible.