While we are not affiliated with the government in any way, our private company engaged writers to research the Unemployment Insurance program and compiled a guide and the following answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.
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Medicaid is a federal U.S. health insurance program that provides health coverage to millions of Americans. The program primarily covers low-income adults, children, pregnant women, elderly adults and people with disabilities.
Federal guidelines for the Medicaid program are established by the Centers for Medicare and Medicaid Services (CMS). Learn more about Medicaid at a national level on the CMS website here.
The Pennsylvania Medicaid program is administered by the Pennsylvania Department of Human Services. Learn more about Medicaid in Pennsylvania on the Department of Human Services website here.
Through Medicaid, people gain access to health care services that may not be affordable without it. Additionally, some programs and benefits include special protections—such as provider networks and payment methods—that help ensure services are accessible. Medicaid also provides preventive care and other services to help people stay healthy and avoid costlier care.
Medicaid covers medical and health care services such as:
Medicaid does not cover the following types of medical services:
Medicaid recipients in Pennsylvania may need to pay a monthly premium, which is a monthly fee for enrollment in the program. Premium amounts are based on the recipient’s annual income.
Recipients may sometimes need to pay a small out-of-pocket cost for treatments, which are known as copayments. Copayment amounts depend on the recipient’s age, household income and what the state pays for the specific service.
Each Medicaid participant through the Pennsylvania Department of Human Services has their own individual health care plan. Some participants may be required to pay fees, and some recipients may not be required to pay fees, i.e., are exempt.
Medicaid participants who fall into one of the below categories are exempt from copayment fees:
To learn more about Medicaid copayments, click here.
To qualify for Medicaid in Pennsylvania, you must meet all of the following:
Income limits vary depending on household size, medical status and other factors and are subject to change annually. Find the current Medicaid income limits based on household size in Pennsylvania here.
Learn what documents you can submit to prove your citizenship and identity here.
Find further information on Pennsylvania Medicaid eligibility here.
To apply for Medicaid in Pennsylvania, complete the following three steps:
Learn what documents you need here.
To apply for Medicaid online, click here to access the COMPASS.
To apply for Medicaid by mail, click here to access the application form, fill it out, and mail it with the necessary documents to your local County Assistance Office.
To apply for Medicaid in person, click here to find your nearest County Assistance Office.
To apply for Medicaid by phone, call the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
To apply for Medicaid by fax, click here to access the application form, fill it out, and fax it with the necessary documents to your local County Assistance Office.
If you have questions about the application process or require assistance, call the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
Or, contact your nearest local Pennsylvania County Assistance Office. Find contact information for local offices in Pennsylvania here.
Pennsylvania Medicaid recipients must report changes that can influence their eligibility status.
You can report a change in the following ways:
You can check the status of your Medicaid application online or by phone:
The Pennsylvania Department of Human Services will review your application to verify if you are eligible for Medicaid. In some cases, the state may ask for additional information before approving your application. Pennsylvania will mail applicants a letter detailing if their Medicaid application was approved or denied. It takes approximately 30 days to process a Medicaid application.
Medicaid applications will be denied if applicants do not meet the eligibility requirements. Also, beneficiaries can have their benefits terminated or reduced if their eligibility status changes while they are enrolled.
Learn more about Pennsylvania Medicaid eligibility requirements here.
If your Medicaid application is denied or the amount of your benefits is reduced, you have the right to file an appeal.
You can submit your appeal request in the following ways:
The Pennsylvania Department of Human Services will review your claim and may ask for additional information or evidence of your eligibility.
Pennsylvania Medicaid recipients must report changes that can influence their eligibility status, including relocating to a new address.
If you move to a new residence within Pennsylvania, you can update your address with the Pennsylvania Department of Human Services in the following ways:
Note: Medicaid benefits do not transfer. If you move to a new state, you must reapply for Medicaid in your new location. If you have further questions about moving with Medicaid, visit the national Medicaid Contact Us here.
For help with a Medicaid application, or for any further questions about the Medicaid program, contact the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
You can also visit or call a local County Assistance Office for further assistance. Find your nearest County Assistance Office location and contact information here.
While we are not affiliated with the government in any way, our private company engaged writers to research the Medicaid program and compiled a guide and these answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.
Our free Medicaid Guide is filled with helpful information about how to apply, program eligibility and how to get in touch with local offices. You can view or download our free guide here.
Last Updated: September 22, 2022
Table of Contents
To apply for Medicaid in Pennsylvania, complete the following three steps:
Learn what documents you need here.
To apply for Medicaid online, click here to access the COMPASS.
To apply for Medicaid by mail, click here to access the application form, fill it out, and mail it with the necessary documents to your local County Assistance Office.
To apply for Medicaid in person, click here to find your nearest County Assistance Office.
To apply for Medicaid by phone, call the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
To apply for Medicaid by fax, click here to access the application form, fill it out, and fax it with the necessary documents to your local County Assistance Office.
If you have questions about the application process or require assistance, call the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
Or, contact your nearest local Pennsylvania County Assistance Office. Find contact information for local offices in Pennsylvania here.
Pennsylvania Medicaid recipients must report changes that can influence their eligibility status.
You can report a change in the following ways:
You can check the status of your Medicaid application online or by phone:
The Pennsylvania Department of Human Services will review your application to verify if you are eligible for Medicaid. In some cases, the state may ask for additional information before approving your application. Pennsylvania will mail applicants a letter detailing if their Medicaid application was approved or denied. It takes approximately 30 days to process a Medicaid application.
Medicaid applications will be denied if applicants do not meet the eligibility requirements. Also, beneficiaries can have their benefits terminated or reduced if their eligibility status changes while they are enrolled.
Learn more about Pennsylvania Medicaid eligibility requirements here.
If your Medicaid application is denied or the amount of your benefits is reduced, you have the right to file an appeal.
You can submit your appeal request in the following ways:
The Pennsylvania Department of Human Services will review your claim and may ask for additional information or evidence of your eligibility.
Pennsylvania Medicaid recipients must report changes that can influence their eligibility status, including relocating to a new address.
If you move to a new residence within Pennsylvania, you can update your address with the Pennsylvania Department of Human Services in the following ways:
Note: Medicaid benefits do not transfer. If you move to a new state, you must reapply for Medicaid in your new location. If you have further questions about moving with Medicaid, visit the national Medicaid Contact Us here.
For help with a Medicaid application, or for any further questions about the Medicaid program, contact the Pennsylvania Consumer Service Center for Health Care Coverage at (866) 550-4355.
You can also visit or call a local County Assistance Office for further assistance. Find your nearest County Assistance Office location and contact information here.
While we are not affiliated with the government in any way, our private company engaged writers to research the Medicaid program and compiled a guide and these answers to frequently asked questions. Our goal is to help you get the benefits that you need by providing useful information on the process.
Our free Medicaid Guide is filled with helpful information about how to apply, program eligibility and how to get in touch with local offices. You can view or download our free guide here.
Last Updated: September 22, 2022
