Pennsylvania’s Medicaid Program: Eligibility, Benefits, and How to Apply

Millions of Pennsylvanians need financial help in order to be able to afford their health care and/or long-term care. Medicaid, a joint state and federal insurance program, is designed to provide that help to eligible families and adults.

What is Medicaid?

Medicaid is an insurance program that provides free or low-cost health coverage to very, very low-income families, pregnant women, and elderly as well as to people with disabilities.

Medicaid should not be confused with Medicare, a federal health insurance program primarily designed to provide coverage to people aged 65 and over as well as some younger individuals with disabilities.

In Pennsylvania, Medicaid is also known as Medical Assistance.

Who is eligible for Medicaid in Pennsylvania?

You must meet income and other requirements in order to be eligible for Medicaid. In general, in Pennsylvania, Medicaid covers residents who are:

  • Aged 19-64 with incomes at or below 133% of the Federal Poverty Level (to put things into context, that equates to about $20,420 for a family of three)
  • Aged (age 65 and older), blind, or disabled
  • In families with children under age 21
  • Have special conditions

Chances are extremely good that someone you know receives Medicaid. In Pennsylvania nearly 2.9 million people receive health and long-term care coverage through Medicaid and the Children’s Health Insurance Program (CHIP).

Many (about 700,000) of these Pennsylvanians receive their Medicaid coverage through the expansion of Medicaid (this was part of the Affordable Care Act, also known as Obamacare). Medicaid expansion gives states the option to cover more low-income adults up to 133% of the federal poverty level.

Before expansion, Pennsylvania’s Medicaid program only covered a few very low income adults in special child care-taker roles. Expansion allowed Pennsylvania to cover most very low-income adults (up to 133% of the federal poverty level, or about $12,000 a year) whether or not they had children.

As part of the Affordable Care Act, the federal government helped Pennsylvania to be able to afford this expansion by covering most of the costs for these “newly insured.”

What is CHIP? Who is Eligible?

 Children’s Health Insurance Program, or CHIP, provides free or low-cost health insurance for uninsured Pennsylvania children and teens who:

  • Are less than 19 years of age
  • Are part of families where parents do not have the necessary health coverage through their jobs
  • Are not eligible for or enrolled in Medicaid
  • Are U.S. citizens or legal residents

Most children who receive CHIP coverage get it for free because their families have very low incomes.

But even families who have incomes a bit higher can still purchase CHIP at reduced rates. Over a certain income limit (about $63,000 for a family of three, for example), families can purchase CHIP at cost.

Learn more about CHIP coverage costs based on different income levels here.

Want More Details?

Pennsylvania’s Department of Human Services (PA DHS) runs the state’s Medicaid and CHIP programs. View a complete list of eligibility requirements at the DHS website.

Want to Apply?

Call your local county assistance office to ask about options. Visit PA DHS to review the complete eligibility requirements, learn how to apply, and review the services you can receive if eligible.

  • By website
    • Apply for or renew your medical assistance benefits online by using Pennsylvania’s website, COMPASS.
  • By phone
    • Apply by calling the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
  • In person or by mail
    • Apply by contacting your local county assistance office, downloading the appropriate application form(s), and sending them to the office.