Pennsylvania Medicaid (Medical Assistance) Application Guide

Pennsylvania Medicaid, also known as Medical Assistance (MA), pays for health care services for eligible individuals. In 2015, Pennsylvania adopted Medicaid expansion under the Affordable Care Act (ACA), allowing children and adults to qualify for coverage based solely on having limited income. HealthChoices is the name of Pennsylvania's managed care programs for Medicaid recipients, through which eligible individuals receive quality physical and behavioral medical care, as well as long-term supports.

Medicaid eligibility is based on factors such as a person's income, family size, age, and disability status. Medicaid is available to Pennsylvania residents regardless of how long they've been residents, and covers United States citizens, refugees, and lawfully admitted non-citizens. Other non-citizens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists. People do not have to apply for a specific category or program – the County Assistance Office (CAO) reviews all applications for eligibility through any of the available Medicaid categories and programs.

Medicaid covers a broad range of physical and behavioral health services, including doctor visits, preventive care like health screenings and vaccines, hospital stays, prescription medications, mental health and substance use disorder care. Medicaid is the only program that covers Long-Term Services and Supports (LTSS) at home or in a nursing facility or group home. The application process for Medicaid LTSS differs from applying for health care coverage.

The best way to find out if you or your loved one are eligible is to complete an application. You can apply online through the secure COMPASS website, in-person at your local county assistance office, by calling 1-866-550-4355, or by mail. For long-term care, additional forms are required including a Medical Evaluation Form (MA 51) from your physician and a Functional Eligibility Determination (FED) completed by the local Area Agency on Aging.