Pennsylvania Medicaid (Medical Assistance)Updated April 8, 2021 Medicaid
Medical Assistance is the name of Pennsylvania’s Medicaid program. It provides health coverage to low-income residents, including children, pregnant women, parents, seniors, and individuals with disabilities.
|Program Name||Medical Assistance|
|Apply Online||Welcome to COMPASS|
|Appeal a Denial||Hearings and Appeals|
|Find a Local Office||County Office Contact Information|
To be eligible for Pennsylvania Medicaid, you must be a resident of the state of Pennsylvania, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
You must also be one of the following:*
- Be responsible for a child 17 years of age or younger
- Have a disability or a family member in your household with a disability
* ACA Medicaid expansion covers eligible low-income adults.
Annual Household Income Limits (before taxes)
|Household Size*||Maximum Income Level (Per Year)|
*For households with more than eight people, add $6,038 per additional person.
Available Services Include:
|Early and periodic screening||Nurse midwife services|
|Emergency services||Nursing facility services|
|Family planning services||Outpatient hospital services|
|Federally qualified health center services||Physician services|
|Home health services||Prescriptions|
|Inpatient hospital services||Rural health clinic services|
|Laboratory and X-ray services||Tobacco cessation for pregnant women|
|Maternity services||Transportation to medical care|
|Hospital stay||$3/day (up to $21 for total stay)|
|Prescriptions (brand name)||$3|
|X-ray or other medical diagnostic test||$1.00|
For other health services, the amount of the copayment is based on the Medical Assistance fee for the service.
|MA Fee for the Service||Copayment|
|$2 - $10||$0.65|
|$10.01 - $25||$1.30|
|$25.01 - $50||$2.55|
|$50.01 or more||$3.80|
Copayments are not required for:
- Persons younger than 18 years old.
- Pregnant women (including the postpartum period)
- Residents of a long-term care facility
- Individuals receiving hospice care.
- Women in the Breast and Cervical Cancer (BCCPT) Program
- Individuals in the Title IV Foster Care Adoption Assistance Programs