What Are Pennsylvania's Medicaid Requirements?


Quick Answer

General eligibility requirements for Medicaid in Pennsylvania include children 20 years old or younger, adults 64 or younger whose income is at or below 138 percent of the federal poverty line, or adults 65 or older or individuals with disabilities. Social Security defines the accepted disabilities.

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Full Answer

In addition, Pennsylvania residents must either be U.S. citizens or have a Medicaid-approved immigration status, have a Social Security number and qualify based on their income. The state has set income limits based on household size and the federal poverty line, although requirements do vary by the specific Medicaid program.

Pennsylvania has four ways to apply for medical assistance: phone, online, mail and in-person. County assistance offices accept in-person applications; however, the state recommends bringing in a completed application found on HealthChoicesPA.com. The fastest way to apply is online at compass.state.pa.us. After applying, a resident may receive a letter asking for more information. Caseworkers at the county assistance offices can help the applicant obtain what is needed.

An approved applicant receives an Access Medicaid card via mail, which is accepted by doctors, hospitals and pharmacies across the state. Recipients should always confirm that a doctor accepts Medicaid prior to the appointment. Those in the Pennsylvania's Medicaid program, called Health Choices, must enroll in a managed care program, from which there are nine to choose. After being accepted into Health Choices, the resident receives a welcome packet with information about the different managed care providers. Each recipient's eligibility is reviewed yearly.

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