Medicaid-General Information

Publications

• Guide to Medical Assistance for Northwest PA Families

• Dental Assistance Factsheet

• Fast Moving US House Bill Would Radically Restructure Medicaid

• Medicaid Expansion by County 2017

• Who Gets Medicaid in Pennsylvania?

• Medical Assistance for Workers With Disabilities: A Guide to Eligibility

• Medical Assistance Eligibility Manual

• MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage

• Medical Assistance Copayments: A Factsheet for Consumers

• Tips for Choosing a Medicaid Managed Care Plan: Southwest Zone; Lehigh-Capital Zone; New West Zone

• Denied a Service By Your Managed Care Plan? Appeal!

• Medical Assistance Dental Benefit Reductions: A Fact Sheet for Dentists

Other Resources

• COMPASS: Apply Online

• DPW: Health Care / Medical Assistance

Eligibility, Enrollment and Retention

Publications

• Medicare Savings Program Guide 2019

• Medical Assistance for Workers With Disabilities: A Guide to Eligibility

• Medical Assistance Eligibility Manual

• Medicare Savings Program Guide 2016

• MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage

• Pamphlet: Should I Apply for Medicaid or CHIP?

• Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?

• Chart: Should I Apply for Medicaid or CHIP?

Other Resources

• COMPASS: Apply Online

Children

Publications

• Guide to Medical Assistance for Northwest PA Families

• Medical Assistance Eligibility Manual

• PH-95 (Loophole) Guide – How to Get Medical Assistance for Children with Severe Disability

• Advocating for Behavioral Health Services for your Child

• Understanding Wraparound Services for Children in Health Choices

• Appealing Wraparound Services in HealthChoices

• Reporting Parental Income for Medical Assistance for Children with Disabilities: Frequently Asked Questions

• How to determine whether a child with mental illness or bio-neurological disorder meets the standards for disability

• Accessing Behavioral Health Services for Your Child: The Interagency Service Planning Team (ISPT Meeting)

Other Resources

• DPW Manual: Children with Special Needs

• DPW Manual: Services/Benefits for Children

• DPW: For Children

Seniors

Publications

• 2019 Monthly Income and Resource Limits for Medicaid and Other Health Programs

• Basic Fact Sheet about HCBS Waivers

• Part D Low Income Subsidy: How to Qualify

• Medical Assistance Eligibility Manual

• HCBS Waiver Appeal Fact Sheet

• No Medicare Part D Co-Pays for Waiver Recipients in 2012

• How Your Medical Assistance Coverage Will Change When You Get Medicare

• Billing Issues for Consumers with both Medicare and Medical Assistance: A Guide for Dual Eligible Consumers

• Home and Community Based Services (HCBS) Waiver Programs:
  A Manual for Consumers and Advocates

• Personal Care Home Residents Rights Brochure

• Personal Care Home Manual for Advocates

• What are your Rights in the Home & Community Based Services (HCBS) Waiver Programs Service Plan Development Process?

Immigrants

Publications

• Immigrant Health Care Manual For Advocates

• Medical Assistance Eligibility Manual

• FAQ on Medical Assistance for Legal Immigrants in their First Five Years (CLS)

Other Resources

• DPW Handbook: Alien Status Chart

Low Income Families

Publications

• 2019 Monthly Income and Resource Limits for Medicaid and Other Health Programs

• Medical Assistance Eligibility Manual

• Medical Assistance Copayments: A Factsheet for Consumers

Persons with Disabilities

Publications

• Medical Assistance for Workers With Disabilities: A Guide to Eligibility

• Medical Assistance Eligibility Manual

• MAWD or Marketplace? What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage

• Understanding MAWD: The Medical Assistance for Workers With Disabilities Program A Guide for Advocates

• The DPW Employability Assessment Form: A Guide for Physicians

• Writing a Letter of Medical Necessity: A Guide for Physicians

• Home and Community Based Services (HCBS) Waiver Programs:
  A Manual for Consumers and Advocates

• Health Care Coverage When Leaving a Job: A Guide for Advocates

Other Resources

• DPW: MAWD Application (pdf)

• DPW: Employability Assessment Form (PA 1663) (pdf)

• DPW: Health Sustaining Medications Form (PA 1671) (pdf)

Medicaid/Medicare Dual Eligibles

Publications

• PA Special Needs Plans for Dual Eligibles Available in 2019

• 2019 Medicare Part D Standard Zero Premium Prescription Drug Plans

• 2019 Monthly Income and Resource Limits for Medicaid and Other Health Programs

• Medicare Savings Program Guide 2019

• Part D Zero Premium Plans 2017

• Dual Billing Guide

• Learning How to Use Your Medicare and Medicaid Health Insurance

• Medical Assistance Eligibility Manual

• Medicare Savings Program Guide 2016

• Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?

• No Medicare Part D Co-Pays for Waiver Recipients in 2012

• Medicare Part D: A Guide For Advocates and Providers Who Work With Older Adults in Pennsylvania

• How Your Medical Assistance Coverage Will Change When You Get Medicare

• Billing Issues for Consumers with both Medicare and Medical Assistance: A Guide for Dual Eligible Consumers

Long Term Care

Publications

• Basic Fact Sheet about HCBS Waivers

• Medical Assistance Eligibility Manual

• HCBS Waiver Appeal Fact Sheet

• Home and Community Based Services (HCBS) Waiver Programs:
  A Manual for Consumers and Advocates

• Personal Care Home Residents Rights Brochure

• Personal Care Home Manual for Advocates

• What are your Rights in the Home & Community Based Services (HCBS) Waiver Programs Service Plan Development Process?

Other Resources

• NSCLC: Long-Term Services & Supports

Prescription Drug Access

Publications

• Medical Assistance Pharmacy and Dental Benefit Limits

• Medical Assistance Prescription Coverage Limit

• No Medicare Part D Co-Pays for Waiver Recipients in 2012

• Important Information About Your Prescriptions

• Medicare Part D: A Guide For Advocates and Providers Who Work With Older Adults in Pennsylvania

• How Your Medical Assistance Coverage Will Change When You Get Medicare

• Completing the Health Sustaining Medications Form: A Guide for Physicians

Other Resources

• DPW: Pharmacy Services

• Medical Assistance Preferred Drug List

• DPW: Pharmacy FAQs

Behavioral Health

Publications

• Access to Drug & Alcohol Treatment Services in HealthChoices: Know Your Rights!

• How to Obtain Mental Health and Drug & Alcohol Services in Pennsylvania

• Understanding Wraparound Services for Children in Health Choices

• Appealing Wraparound Services in HealthChoices

• How to determine whether a child with mental illness or bio-neurological disorder meets the standards for disability

• Accessing Behavioral Health Services for Your Child: The Interagency Service Planning Team (ISPT Meeting)

Waivers

Publications

• Basic Fact Sheet about HCBS Waivers

• HCBS Waiver Appeal Fact Sheet

• No Medicare Part D Co-Pays for Waiver Recipients in 2012

• Home and Community Based Services (HCBS) Waiver Programs:
  A Manual for Consumers and Advocates

• What are your Rights in the Home & Community Based Services (HCBS) Waiver Programs Service Plan Development Process?

Other Resources

• DPW: Long Term Care Services

• DPW: Alternatives to Nursing Homes

• Home & Community Based Services: Provider Search

Transportation

Publications

• Medical Assistance Transportation Program (MATP) 2013 Fact Sheet

Other Resources

• Medical Assistance Transportation Program

Appeals

Publications

• How To Appeal a Denial in Community HealthChoices

  Where to Call for CHC Help- Southwestern PA

  Where to Call for CHC Help- Southeastern PA

  Person-Centered Service Planning

• Denied a Service By Your Managed Care Plan? Appeal!

• Appealing a Coverage Decision Made by Your Medical Assistance Plan

• Appealing Wraparound Services in HealthChoices

• Sample medical records request letter (.doc)

• Sample Grievance Letter (.doc)

• Writing a Grievance Letter (.doc)

Managed Care/HealthChoices

Publications

• A Consumer Guide to HealthChoices

• Tips for Choosing a Medicaid Managed Care Plan: Southwest Zone; Lehigh-Capital Zone; New West Zone

• Denied a Service By Your Managed Care Plan? Appeal!

• Appealing a Coverage Decision Made by Your Medical Assistance Plan

Other Resources

• DPW: Health Care / Medical Assistance

Access Plus

Publications

• Facts About ACCESS Plus