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
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