Free Health Coverage Through
The Pennsylvania Medical Assistance Program
What is
Medical Assistance?
Medical Assistance, also known as "MA" or "Medicaid," provides free health care coverage to Pennsylvania residents who fit into one of the eligibility groups that are covered by the MA Program and who have income, and sometimes resources, that fall below the level set by the State for their category of MA eligibility. (Please note: Resources are not counted if there are children under 21 living in the household.)
Can I have other health care coverage and still qualify for MA coverage?
Yes, you can have private coverage and also have MA. But MA is always the "payer of last resort," which means that it will only pay for the healthcare costs that are not covered by your other health care plans.
Is MA available for persons with Medicare coverage?
Yes, persons meeting the MA income and resource limits can have both MA and Medicare. MA provides regular MA coverage for Medicare beneficiaries who have income at or below 100% of the federal poverty level and have resources that are below the MA limits. For persons who are eligible for both MA and Medicare, MA will pay the fees that Medicare does not cover, such as Medicare Part A and Part B premiums, deductibles and copays. MA also offers another program for person with incomes and resources that are slightly higher than 100% of the federal poverty level. This program can help to pay for some of the costs incurred by Medicare beneficiaries, such as all or part of the Part B Premium payment.
What are the MA income limits?
Income limits vary by eligibility group, and even within eligibility groups. For instance, infants and pregnant women are eligible if they have incomes up to 185% of the federal poverty level ($32,653/year for a household of four), but the limit is much lower for adolescents. Income and resource eligibility limits for adults vary dramatically depending on the applicable eligibility group. And income eligibility for children varies depending upon the children's' ages. Please note that children with severe disabilities (meeting SSA guidelines) do not have their parents' income considered when a financial eligibility determination is made.
What are the eligibility groups covered by MA?
MA covers the following groups:
1. Families with "dependent" children (usually a single parent or a non-parent family member caring for a related child or children.) This includes families not receiving welfare or TANF cash.
2. Children who receive federal and state adoption assistance or foster care maintenance payments.
3. Infants and children up to 21 years of age.
5. Persons 65 years and older.
6. Persons who are blind and others with disabilities. This includes permanent and temporary disabilities.
7. Low-income Medicare beneficiaries (up to 100% of the federal poverty level.)
8.
Adults without
dependent children who:
-
are
caring for an ill or disabled adult or an unrelated child under 13 in their
home;
-
are
59-64 years old;
-
are
receiving domestic violence protective services (9 month lifetime limit);
-
are
participants in drug and alcohol treatment programs (9
month lifetime limit);
-
are
working at least 100 hours per month;
-
have
HIV/AIDS;
-
need
Health Sustaining Medications;
-
are
temporarily or permanently unable to work due to an illness or a condition (physical or mental);
9. People whose incomes are too high to qualify for MA, but who have medical bills, which if deducted from their income, would qualify them financially for MA.
Not all people in these eligibility groups qualify for MA. Everyone must also meet applicable income limits and, in households with no children, resource limits as well. All applicants must also meet the immigrant eligibility requirements, unless applying for an Emergency Medical Condition.
What does MA cover?
Coverage varies by eligibility group, but MA generally covers hospital care, doctors' visits, nursing home care, laboratory tests and x-rays, family planning, drug and alcohol treatment, and mental health care. Most eligibility groups also cover prescription drugs. Children can receive anything that is medically necessary, even if it is not generally available under the MA program. Persons eligible for nursing facility care who instead choose to receive home or community based services through an MA "waiver" program can receive a wide range of services, as well.
Is any other free health care coverage available?
Yes. For example, the Children's Health
Insurance Program (CHIP) offers free health care coverage for uninsured children who are
not eligible for MA due to excess income. Children in households with
incomes up to 200% of the federal poverty level after deductions are eligible
for free CHIP. This means that children in a household of four with an
income of $35,300/year, after child care deductions, would be eligible for free
coverage. There is also low-cost CHIP, which is available to uninsured children
in households with incomes up to 235% of the federal poverty level after
deductions ($41,478/year for a four person household.) Unlike MA, to be
eligible for CHIP, children may not have other health insurance.
For more information on other health care programs and options, such as Adult Basic Coverage and Health Care through Health Centers, please see the Health Programs page.
Is MA coverage available for immigrants?
MA is available for many, but
not all, categories of legal immigrants. (For more on this topic, please
see Immigrant
Information.) Also, any immigrant who is not eligible
for regular MA coverage due to immigration status can get Emergency
Medical Coverage through MA to pay for Emergency Medical Conditions.
Applicants for Emergency Medical Coverage are not required to provide Social
Security number or immigration status.
How do I
apply?
Most people can apply either by
mail or at their local County Assistance Office (CAO). (See lists of CAOs for the office serving your area.)
See How
to Apply for MA
for more information.
