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 |
| Expanded Medicaid | Yes |
| Website | dhs.pa.gov |
| Phone | 866-550-4355 |
| Apply Online | Welcome to COMPASS |
| Appeal a Denial | Hearings and Appeals |
| Find a Local Office | County Office Contact Information |
Eligibility Requirements
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:*
- Pregnant
- 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) |
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
| 5 | $41,284 |
| 6 | $47,322 |
| 7 | $53,360 |
| 8 | $59,398 |
*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 |
Copayments
| Hospital stay | $3/day (up to $21 for total stay) |
| Prescriptions (generic) | $1 |
| 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
