Medicaid Eligibility

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A mother and father hug their son, who has Down's syndrome.

Pennsylvania's Medicaid program, also known as "Medical Assistance", provides comprehensive health care coverage for vulnerable populations and people with limited incomes. Historically, Medicaid was only available to narrow groups, such as low-income children and adults with disabilities.  But in 2015, Pennsylvania adopted Medicaid expansion under the Affordable Care Act (ACA). Now, children and adults can qualify for coverage based solely on having limited income.  Medicaid's broad coverage ensures access to care so people of all ages and abilities can live healthy and full lives. 

People must apply for Medicaid coverage and renew their benefits each year. Even though there are a number of ways to qualify for Medicaid coverage, 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. Income, and sometimes resource limits and other eligibility criteria, usually apply.  To learn more about Medicaid eligibility in Pennsylvania, including how to apply, view our Medical Assistance (Medicaid) Eligibility Manual.

In addition to providing health care coverage, 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.

If you have applied for Medicaid and your application was denied, or if your Medicaid coverage is being stopped or terminated, call PHLP's Helpline at 1-800-274-3258 for assistance.  We can help when Medicaid coverage is denied or terminated inappropriately by advising or representing you in the appeal process to help you get coverage.  We also work with social workers, APPRISE counselors, doctor’s offices, and family members/caregivers who are seeking advice on Medicaid eligibility or help resolving an eligibility problem. 

How to apply for Medicaid in Pennsylvania:

If your application is denied, contact PHLP's Helpline at 1-800-274-3258. Visit our Get Legal Help page to learn more about getting help through PHLP's Helpline.

Who does Medicaid serve?

Who gets Medicaid in Pennsylvania? What difference does it make in their lives? In this publication, we've highlighted a handful of incredible Pennsylvanians who have agreed to share their stories, to show the impact this important program has on the lives of so many folks across our state.

Read Their Stories
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