{"id":627018,"date":"2024-02-28T13:39:21","date_gmt":"2024-02-28T18:39:21","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627018"},"modified":"2025-12-15T17:47:34","modified_gmt":"2025-12-15T22:47:34","slug":"pennsylvania-medicaid-guide","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/pennsylvania-medicaid-guide\/","title":{"rendered":"Guide to Medicaid in Pennsylvania"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">In 2015, Pennsylvania became one of 41 states to adopt the <\/span><span style=\"font-weight: 400;\">Affordable Care Act<\/span><span style=\"font-weight: 400;\"> (ACA) Medicaid expansion. This currently provides healthcare coverage to nearly <\/span><span style=\"font-weight: 400;\">3.2 million Pennsylvania residents<\/span><span style=\"font-weight: 400;\">. In addition to pregnant women and children, the Medicaid health insurance plan in Pennsylvania, also called Medical Assistance (MA), is available to low-income adults, disabled persons, and seniors who meet certain requirements.\u00a0<\/span><\/p>\n<h2 id=\"eligibility-for-pennsylvania-medicaid\"><b>Eligibility for Pennsylvania Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Since adopting the ACA Medicaid expansion in 2015, Pennsylvania has implemented targeted enrollment strategies to help eligible Pennsylvanians gain coverage. To qualify for Medicaid in Pennsylvania, residents must meet certain income, age, disability designation, citizenship status, and\/or healthcare needs requirements.<\/span><\/p>\n<h3 id=\"income-requirements\"><b>Income requirements<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">In some cases, Medicaid eligibility in Pennsylvania is based on an applicant\u2019s modified adjusted gross income (MAGI), which has a built-in <\/span><a href=\"http:\/\/services.dpw.state.pa.us\/oimpolicymanuals\/ma\/312_ACA\/312.6_Income_Deductions_and_Disregard.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">5% income disregard<\/span><\/a><span style=\"font-weight: 400;\">. However, this does not apply to all applicants, as the state separates eligibility for medical assistance by MAGI and non-MAGI groups.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">MAGI-eligible applicants include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Children aged 18 and younger<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pregnant women<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Parents and caretakers of children younger than 21<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Adults aged 19 to 64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Individuals in need of family planning services<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For these groups, DHS determines Pennsylvania Medicaid eligibility using the MAGI deduction.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Non-MAGI eligible applicants include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Individuals aged 65 and older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Individuals who are blind and\/or disabled<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Individuals applying for Medical Assistance for Workers with Disabilities (MAWD)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Individuals seeking long-term care (LTC) or home and community-based services (HCBS)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For these groups, DHS determines Pennsylvania Medicaid eligibility without the MAGI 5% income disregard.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To be eligible for Pennsylvania Medicaid based on your income, your MAGI or non-MAGI income must not exceed the percentage of the federal poverty level (FPL) established for your eligibility group. The <\/span><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/stateprofile.html?state=pennsylvania\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicaid income limits in Pennsylvania<\/span><\/a><span style=\"font-weight: 400;\"> for each eligibility group are as follows:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">215% for children aged 0 to 1<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">157% for children aged 1 to 5<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">133% for children aged 6 to 18<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">314% for children under the separate CHIP program<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">215% for pregnant women<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">33% for parents\/caretakers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">133% for adults eligible under the ACA expansion<\/span><\/li>\n<\/ul>\n<h3 id=\"age-requirements\"><b>Age requirements<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Pennsylvania Medicaid is open to residents of all ages, including those 65 and older, who qualify based on their income.<\/span><\/p>\n<h3 id=\"disability-requirements\"><b>Disability requirements<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Individuals who are blind and\/or disabled can receive Medicaid in Pennsylvania if they meet certain income and resource requirements. Disabled persons who are employed and have a salary that exceeds the Medicaid income limits in Pennsylvania may be eligible for the <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Pages\/MA-for-Disabled-Workers.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medical Assistance for Workers with Disabilities<\/span><\/a><span style=\"font-weight: 400;\"> (MAWD) program, which requires a small monthly premium.\u00a0<\/span><\/p>\n<h3 id=\"citizenship-or-immigration-status\"><b>Citizenship or immigration status<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Pennsylvania Medicaid is available to United States citizens and certain lawfully admitted non-citizens. Other non-citizens may qualify for limited Medicaid benefits if they have an emergency medical condition. When applying for Medicaid in Pennsylvania, applicants must submit documentation to prove their U.S. citizenship, refugee, or lawful non-citizen status and must be an official resident of Pennsylvania.<\/span><\/p>\n<h2 id=\"pennsylvania-medicaid-benefits\"><b>Pennsylvania Medicaid benefits<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Pennsylvania Medicaid provides a <\/span><a href=\"https:\/\/www.dhs.pa.gov\/docs\/For-Providers\/Documents\/Regulations%20Handbooks%20Guides%20Manuals\/c_268952.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">full scope of health benefits<\/span><\/a><span style=\"font-weight: 400;\"> to enrollees, including medical, dental, vision, prescription drugs, and some long-term care services.\u00a0<\/span><\/p>\n<h3 id=\"medical-services-covered\"><b>Medical services covered<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Health services covered by Pennsylvania Medicaid vary slightly between eligibility groups, with children receiving the most comprehensive benefit package.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For adults aged 21 and older, the <\/span><a href=\"https:\/\/www.dhs.pa.gov\/HealthChoices\/HC-Services\/Documents\/Adults%20Benefits%20Package.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Pennsylvania Medicaid \u2018Adult\u2019 benefit package<\/span><\/a><span style=\"font-weight: 400;\"> may include the following:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Primary care provider (PCP) services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certified registered nurse practitioner services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chiropractic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Podiatrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Crisis services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Durable medical equipment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Emergency room\/ambulance services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family planning services and supplies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Federally qualified health center services\/rural health clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Home health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hospice services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">ICF\/IID and ICF\/ORC (requires an institutional level of care)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient drug and alcohol services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient hospital services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient mental health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medical supplies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Methadone maintenance<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mobile mental health treatment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Non-emergency medical transportation (only to and from covered services)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nursing facility services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nutritional supplements<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Optometrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient drug and alcohol services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient hospital services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Partial psychiatric hospitalization<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Peer support services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prosthetics and orthotics (orthopedic shoes and hearing aids are not covered)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Psychiatric clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiology services (X-rays, MRIs, CTs)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Renal dialysis services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Targeted case management services \u2014 behavioral health is limited to individuals with SMI only and other than behavioral health is limited to individuals in the target group<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Therapy (physical, occupational, speech)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Habilitative and rehabilitative (only when provided by a hospital, outpatient clinic, or home health provider)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tobacco cessation<\/span><\/li>\n<\/ul>\n<h3 id=\"prescription-drug-coverage\"><b>Prescription drug coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Pennsylvania Medicaid covers a substantial portion of prescription drug costs, but it may require some recipients to <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Pages\/Copay-Help.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pay a small copayment<\/span><\/a><span style=\"font-weight: 400;\">:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">$1 for each prescription and refill for generic drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">$3 for each prescription and refill for brand-name drugs<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some medications to treat certain medical conditions may not have a copayment.<\/span><\/p>\n<h3 id=\"dental-coverage\"><b>Dental coverage<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Medicaid recipients in Pennsylvania receive comprehensive dental service coverage. Some of the <\/span><a href=\"http:\/\/services.dpw.state.pa.us\/oimpolicymanuals\/ma\/index.htm#t=338_Medical_Assistance_Benefits%2F338_Appendix_F.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">dental services Pennsylvania Medicaid covers<\/span><\/a><span style=\"font-weight: 400;\"> include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oral examinations, limited to one per year<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prophylaxis (cleaning), limited to one per year<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Root canals, with certain exceptions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Crowns, with certain exceptions\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Full dentures, limited to one in each arch every seven years<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Partial dentures to replace two front teeth or four back teeth, excluding third molars, limited to one in each arch every seven years<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Relining of dentures, limited to one in each arch every two years<\/span><\/li>\n<\/ul>\n<h3 id=\"vision-coverage\"><b>Vision coverage<\/b><\/h3>\n<p><a href=\"http:\/\/services.dpw.state.pa.us\/oimpolicymanuals\/ma\/health_care_benefit_packages.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Vision coverage<\/span><\/a><span style=\"font-weight: 400;\"> under Pennsylvania Medicaid includes the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Optometrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Contact lenses (limited to individuals with aphakia)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Eyeglass frames and lenses (limited to individuals with aphakia)<\/span><\/li>\n<\/ul>\n<h3 id=\"long-term-care-services\"><b>Long-term care services<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">In Pennsylvania, long-term care is sometimes referred to as long-term living. Under Pennsylvania Medicaid, <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Disabilities-Aging\/Pages\/Long-Term-Care-Services.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">long-term care<\/span><\/a><span style=\"font-weight: 400;\"> includes a wide range of assistive services provided to recipients based on their specific needs. Included services can range from getting assistance with activities of daily living at home to receiving advanced medical care in a nursing facility.<\/span><\/p>\n<h3 id=\"services-for-children-and-pregnant-women\"><b>Services for children and pregnant women<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Medicaid in Pennsylvania provides a full range of medical benefits for children and pregnant women.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Pages\/Pregnancy-and-Family-Planning.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medical Assistance for Children and Pregnant Women<\/span><\/a><span style=\"font-weight: 400;\"> benefit package includes the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Children\u2019s health services (any kind of medically necessary care, including yearly checkups)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Complete health and physical examinations, including checks on the child\u2019s physical and mental development<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Immunizations<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory tests, including testing of the level of lead in the child\u2019s blood<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dental, vision, and hearing screenings<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Health education<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Services provided by school-based service providers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ambulance services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certified registered nurse practitioner services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chiropractic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physical therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Podiatrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Preventive services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dental services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diagnostic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Eyeglasses<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family planning services and supplies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Home health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hospice services\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient hospital services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient and outpatient behavioral health services (mental health or substance abuse treatment)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory tests<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nursing facility services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Occupational therapy services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Optometrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient hospital services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prosthetic devices<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiology services (X-rays, MRIs, CTs)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Rehabilitative services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Renal dialysis services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Screening services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Speech, hearing, and language therapy services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Targeted case management services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Transportation help<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">These services are available in facilities across the state of Pennsylvania, including in hospitals, clinics, federally qualified health centers, rural health clinics, community health centers, physician offices, and certified registered nurse practitioner offices.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Pennsylvania Medicaid \u2018Children\u2019s\u2019 package also includes the <\/span><a href=\"http:\/\/services.dpw.state.pa.us\/oimpolicymanuals\/ma\/338_Medical_Assistance_Benefits\/338_6_Special_MA_Services.htm#338.61_Early_and_Periodic_Screening__Diagnosis_and_Treatment__EPSDT_\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Early and Periodic Screening, Diagnosis, and Treatment Program<\/span><\/a><span style=\"font-weight: 400;\"> (EPSDT). The EPSDT is a federally-funded care program with a focus on primary care. It is the most important part of Pennsylvania Medicaid and is free to all children younger than age 21 who receive Medicaid. EPSDT provides regular checkups for children enrolled in Medicaid and fully covers the cost of medical services, treatments, and follow-up care.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Children who do not qualify for Pennsylvania Medicaid may be eligible for the <\/span><a href=\"https:\/\/www.dhs.pa.gov\/chip\/Pages\/CHIP.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Children\u2019s Health Insurance Program<\/span><\/a><span style=\"font-weight: 400;\"> (CHIP). CHIP is available statewide and provides free or low-cost insurance for uninsured children up to age 19. Free CHIP is open to children in families whose income is below 208% of the FPL. Low-cost CHIP is open to children whose family income is 208% to 314% of the FPL.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For pregnant women, the Pennsylvania Medicaid \u2018<\/span><a href=\"http:\/\/services.dpw.state.pa.us\/oimpolicymanuals\/ma\/312_ACA\/312.9__Authorizing_Presumptive_Eligibility.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Presumptive Eligibility for Pregnant Women<\/span><\/a><span style=\"font-weight: 400;\">\u2019 benefit package includes the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Maternity services from physicians, certified nurse midwives, and birth centers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Home visits from a nurse<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family planning services and supplies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ambulance services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ambulatory surgical center (ASC) services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Non-emergency medical transportation (only to and from covered services)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Case management<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mental health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chiropractic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dental services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drug and alcohol services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Durable medical equipment (includes orthotics and prosthetics)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hospice services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory tests<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medical supplies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Optometrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Podiatrist services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiology services (X-rays, MRIs, CTs)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Renal dialysis services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nursing facility services<\/span><\/li>\n<\/ul>\n<h2 id=\"how-to-apply-for-pennsylvania-medicaid\"><b>How to apply for Pennsylvania Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">To apply for Medicaid, Pennsylvania residents can apply online, by mail, or in person.\u00a0<\/span><\/p>\n<h3 id=\"required-documents-for-application\"><b>Required documents for application<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">When you apply for Pennsylvania Medicaid, you must submit documentation proving your U.S. citizenship, refugee, or lawful non-citizen status. All applicants who have one must provide their SSN on the Medicaid Pennsylvania application.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The application also asks for documents to prove your income, such as pay stubs, tax returns, or bank statements.<\/span><\/p>\n<h3 id=\"online-application-process\"><b>Online application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To submit a Pennsylvania Medicaid application online, go to the <\/span><a href=\"https:\/\/www.compass.state.pa.us\/compass.web\/Public\/CMPHome\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">COMPASS<\/span><\/a><span style=\"font-weight: 400;\"> website. You will need to create a COMPASS account to access and complete the online application for Pennsylvania Medicaid.\u00a0<\/span><\/p>\n<h3 id=\"paper-application-process\"><b>Paper application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To submit a <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Documents\/Benefits%20Applications\/PA-0600-8-23-Final-uf.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">paper application for Pennsylvania Medicaid<\/span><\/a><span style=\"font-weight: 400;\">, download, print, and complete the application, then mail it to <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Pages\/CAO-Contact.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">your local county assistance office (CAO)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"in-person-application-process\"><b>In-person application process<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To apply for Pennsylvania Medicaid in person, <\/span><a href=\"https:\/\/www.dhs.pa.gov\/Services\/Assistance\/Pages\/CAO-Contact.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">find your local county assistance office (COA)<\/span><\/a><span style=\"font-weight: 400;\"> and make a visit during its listed office hours.<\/span><\/p>\n<h2 id=\"cost-of-pennsylvania-medicaid\"><b>Cost of Pennsylvania Medicaid<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">There is no monthly premium for Pennsylvania Medicaid. However, some covered services may require recipients to pay a small copayment (e.g., some prescription drugs cost $1 or $3 per prescription\/refill).\u00a0<\/span><\/p>\n<h2 id=\"additional-pennsylvania-medicaid-resources\"><b>Additional Pennsylvania Medicaid resources<\/b><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.compass.state.pa.us\/compass.web\/Public\/CMPHome\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">https:\/\/www.compass.state.pa.us\/compass.web\/Public\/CMPHome<\/span><\/a>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Use this link to apply for and manage your Medicaid benefits. You can also find out if you qualify for Medicaid here.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/pennie.com\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">https:\/\/pennie.com\/<\/span><\/a>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">If you don\u2019t qualify for Medicaid, use this link to shop the ACA Marketplace and find a health insurance plan with a monthly premium that suits your budget.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2 id=\"pennsylvania-medicaid-faq\"><b>Pennsylvania Medicaid FAQ<\/b><\/h2>\n<h3 id=\"how-can-i-find-a-doctor-who-accepts-medicaid\"><b>How can I find a doctor who accepts Medicaid?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To find a doctor who accepts Medicaid in Pennsylvania, use the <\/span><a href=\"https:\/\/www.humanservices.state.pa.us\/HUMAN_SERVICE_PROVIDER_DIRECTORY\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">online DHS Provider Service Directory<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3 id=\"how-do-i-renew-my-medicaid-coverage\"><b>How do I renew my Medicaid coverage?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To renew your Pennsylvania Medicaid coverage online, visit <\/span><a href=\"http:\/\/www.dhs.pa.gov\/COMPASS\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">www.dhs.pa.gov\/COMPASS<\/span><\/a><span style=\"font-weight: 400;\"> and log in to your account. Alternatively, you can call 1-866-550-4355 to complete your renewal over the phone with a representative.<\/span><\/p>\n<h3 id=\"how-do-i-appeal-a-denied-claim\"><b>How do I appeal a denied claim?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">If your application for Medicaid is denied or your existing benefits are reduced, suspended, or terminated, you can <\/span><a href=\"https:\/\/www.dhs.pa.gov\/about\/DHS-Information\/Pages\/Hearing-and-Appeals-Process.aspx\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">appeal the decision by requesting a fair hearing<\/span><\/a><span style=\"font-weight: 400;\">. You must file appeals for a denied Pennsylvania Medicaid claim in writing, and they must be adjudicated by the Bureau of Hearings and Appeals (BHA).\u00a0\u00a0<\/span><\/p>\n<h3 id=\"how-do-i-report-medicaid-fraud\"><b>How do I report Medicaid fraud?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">To report Medicaid fraud by a provider, fill out an online <\/span><a href=\"https:\/\/forms.dhs.pa.gov\/dhs-ma-provider-compliance\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">MA Provider Compliance Response Form<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To report Medicaid fraud by a recipient, fill out an online MA Compliance Response Form or call the Fraud Hotline at 1-844-DHS-TIPS.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also report Medicaid fraud in Pennsylvania by writing to DHS at:<\/span><\/p>\n<p style=\"padding-left: 40px;\"><b>Department of Human Services<br \/>\n<\/b><span style=\"font-weight: 400;\">Office of Administration<br \/>\n<\/span><span style=\"font-weight: 400;\">Bureau of Program Integrity<br \/>\n<\/span><span style=\"font-weight: 400;\">P.O. Box 2675<br \/>\n<\/span><span style=\"font-weight: 400;\">Harrisburg, PA 17105-2675<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In 2015, Pennsylvania became one of 41 states to adopt the Affordable Care Act (ACA) Medicaid expansion. This currently provides healthcare coverage to nearly 3.2 million Pennsylvania residents. In addition to pregnant women and children, the Medicaid health insurance plan in Pennsylvania, also called Medical Assistance (MA), is available to low-income adults, disabled persons, and [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":627020,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[16],"coauthors":[8861],"class_list":["post-627018","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Guide to Medicaid in Pennsylvania<\/title>\n<meta name=\"description\" content=\"Everything you need to know to receive free or low-cost health services from Pennsylvania Medicaid, including how to apply, 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