.jpg)
This section of PALawHelp.org has information and resources about Medical Assistance issues in Pennsylvania.
Click on a resource category listed below to see information related to that category.
Accessing Home and Community-Based Services When Income Appears Too High
People with income that is no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, OBRA Waiver, or LIFE program may still be able to qualify for these programs using a qualified Income Spend Down Trust. This fact sheet explains how to use a qualified Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit.
Accessing the Community HealthChoices Waiver: A Guide to Waiver Eligibility for Advocates
This guide provides an overview of the application process for the Community HealthChoices waiver – including the functional eligibility review and the County Assistance Office (CAO) financial eligibility review. To qualify, applicants must be aged 21 or older and meet both functional and financial eligibility standards. Functional eligibility is determined by looking at a person’s ability to perform certain activities and tasks that are needed for daily living. Financial eligibility is determined by looking at a person’s income and resources (assets), such as bank accounts, property, and retirement accounts.
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
Community HealthChoices (Video)
This video from the Pennsylvania department of Human Services explains the new Community HealthChoices program. Community HealthChoices will coordinate your health care coverage to improve the quality of your health care experience — serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. (2016)
How to Obtain Mental Health and Drug & Alcohol Services in Pennsylvania
A guide from the Pennsylvania Health Law Project explaining how to obtain Mental Health Services and Drug & Alcohol Services under various programs in Pennsylvania. [PDF]
Medical Assistance Eligibility Manual
Information from the Pennsylvania Health Law Project on the eligibility requirements for Medical Assistance benefits and how to establish eligibility for the benefits. (April 2020)
What You Should Know About Your House When You Enter a Nursing Home or Receive Care at Home
This brochure is for anyone who owns a home and may receive Medical Assistance to pay for their care in a nursing home or in the community.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org. The Toll Free Helpline is open on Mondays and Wednesdays beginning at 8:00 AM Eastern.
Application for cash assistance, SNAP and Medical Assistance Benefits
You can apply for cash assistance, SNAP and Medical Assistance benefits online with Pennsylvania Department of Human Services. Paper forms can also be printed from the website.
Benefits.gov
Benefits.gov is the official benefits website of the U.S. government whose mission is to increase citizen access to benefit information, while reducing the expense and difficulty of interacting with the government. It is a free, online confidential tool that helps you find government benefits you may be eligible to receive.
COMPASS - Apply for Public Benefits and Services from the Commonwealth of Pennsylvania
Pennsylvania residents can apply for a variety of programs offered by the PA Department of Human Services, including public assistance, food stamps, health care coverage, energy assistance and other social service programs at this site
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Completing the Employability Assessment Form (PA 1663) - A Guide for Healthcare Providers
Information for health care providers explaining how to effectively complete the Employability Assessment Form to verify your patient's health conditions, illnesses, and/or disabilities to support your patient’s application for Medical Assistance.
Facts About MAWD (Medical Assistance Benefits for Workers with Disabilities) (Video)
This video from Pennsylvania Health Law Project provides information on the Medical Assistance Benefits for Workers with Disabilities (MAWD) program which provides low-cost health insurance to people who are disabled and working. (2021)
MAWD or Marketplace? - What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage
Information on the selection of medical insurance by persons eligible for Medical Assistance for Workers with Disabilities (MAWD). Today, people with serious health issues and persons with disabilities who are working or may be able to work, can choose between Marketplace health insurance and MAWD. Includes eligibility requirements for each program, how to apply and highlights factors to consider when choosing coverage.
Medical Assistance for Workers with Disabilities (MAWD) - A Guide to Eligibility
Medical Assistance for Workers with Disabilities (MAWD) is a state health insurance program for people who are working and have a disability or serious health condition. MAWD is often a good option for people who make too much money to qualify for other categories of Medical Assistance (MA or Medicaid) but who nonetheless need health insurance. MAWD provides comprehensive health insurance coverage and as compared to other MA programs, has high income and resource limits. MAWD also has flexible work and disability requirements. This guide explains each MAWD eligibility requirement in depth and tells you how to apply for MAWD coverage. (January 2025)
Fact Sheet: Medical Assistance Transportation Program (MATP)
Information about transportation services available through the PA Medical Assistance program. [PDF]
Application for cash assistance, SNAP and Medical Assistance Benefits
You can apply for cash assistance, SNAP and Medical Assistance benefits online with Pennsylvania Department of Human Services. Paper forms can also be printed from the website.
Benefits.gov
Benefits.gov is the official benefits website of the U.S. government whose mission is to increase citizen access to benefit information, while reducing the expense and difficulty of interacting with the government. It is a free, online confidential tool that helps you find government benefits you may be eligible to receive.
COMPASS - Apply for Public Benefits and Services from the Commonwealth of Pennsylvania
Pennsylvania residents can apply for a variety of programs offered by the PA Department of Human Services, including public assistance, food stamps, health care coverage, energy assistance and other social service programs at this site
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Local County Assistance Offices
County Assistance Offices are located throughout Pennsylvania. You can submit applications and renewals at your local county assistance office drop box or online using COMPASS. Caseworkers are available at the county assistance office to help you and answer your questions in person or over the phone, if the office is closed to the public. This is a listing of the location and how to contact local County Assistance Offices in Pennsylvania.
Accessing Home and Community-Based Services When Income Appears Too High
People with income that is no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, OBRA Waiver, or LIFE program may still be able to qualify for these programs using a qualified Income Spend Down Trust. This fact sheet explains how to use a qualified Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit.
Accessing the Community HealthChoices Waiver: A Guide to Waiver Eligibility for Advocates
This guide provides an overview of the application process for the Community HealthChoices waiver – including the functional eligibility review and the County Assistance Office (CAO) financial eligibility review. To qualify, applicants must be aged 21 or older and meet both functional and financial eligibility standards. Functional eligibility is determined by looking at a person’s ability to perform certain activities and tasks that are needed for daily living. Financial eligibility is determined by looking at a person’s income and resources (assets), such as bank accounts, property, and retirement accounts.
Benefits Available for Low Income Persons
A Summary of Benefits available through your County Assistance Office from Neighborhood Legal Services Association.
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
Completing the Employability Assessment Form (PA 1663) - A Guide for Healthcare Providers
Information for health care providers explaining how to effectively complete the Employability Assessment Form to verify your patient's health conditions, illnesses, and/or disabilities to support your patient’s application for Medical Assistance.
Disabled Adult Child (DAC) Medical Assistance Benefits
People who get Supplemental Security Income (SSI) are automatically approved for Medicaid (called “Medical Assistance”) in Pennsylvania. There are special circumstances that allow people to keep getting Medicaid after their SSI benefits end. (2023)
Do I Need a Medical Form to Get Medicaid?
Pennsylvania expanded Medicaid in 2015. Before Medicaid expansion, most lower-income adults who wanted Medicaid had to get forms from their doctors saying that they had health problems. Now, most lower-income adults can get Medicaid without medical forms. Community Legal Services of Philadelphia provides information on this change.
Facts About MAWD (Medical Assistance Benefits for Workers with Disabilities) (Video)
This video from Pennsylvania Health Law Project provides information on the Medical Assistance Benefits for Workers with Disabilities (MAWD) program which provides low-cost health insurance to people who are disabled and working. (2021)
Fact Sheet: Medical Assistance Transportation Program (MATP)
Information about transportation services available through the PA Medical Assistance program. [PDF]
Getting Medical Assistance for a Child (under 18) with a Severe Disability, Behavioral or Autism Spectrum Disorder
Information by the Pennsylvania Health Law Project on getting medical assistance for children, under 18, with a disability, behavioral or autism spectrum disorder.
How to Appeal a Denial in HealthChoices
If your HealthChoices managed care plan denies your request for a service, such as a medication, home health care, or durable medical equipment, you have the right to appeal. You can also appeal if your plan stops, reduces, or changes a service you have been getting. [PDF]
How to Keep your Medicaid File Updated
Reporting changes to your caseworker when certain life events happen, such as moving, getting a new job, or having a baby, is an important requirement for receiving benefits. The Pennsylvania Health Law Project developed this resource on the importance of keeping your Medicaid file up to date, how to update it and the types of life changes you must notify
How to Obtain Mental Health and Drug & Alcohol Services in Pennsylvania
A guide from the Pennsylvania Health Law Project explaining how to obtain Mental Health Services and Drug & Alcohol Services under various programs in Pennsylvania. [PDF]
Impact of Criminal Record on Public Benefits in Pennsylvania
Chart from Community Legal Services of Philadelphia outlining the effect on the eligibility for public benefits for people with criminal records.
2025 Income and Resource Limits for Medicaid and Other Health Programs
Public benefit programs like Medicaid (“Medical Assistance” in Pennsylvania) use the federal poverty income guidelines to determine who qualifies for coverage. The 2025 guidelines were published January 17, 2025. The effective date of the limits listed below varies and may not take effect until March for some of the programs.
MAWD or Marketplace? - What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage
Information on the selection of medical insurance by persons eligible for Medical Assistance for Workers with Disabilities (MAWD). Today, people with serious health issues and persons with disabilities who are working or may be able to work, can choose between Marketplace health insurance and MAWD. Includes eligibility requirements for each program, how to apply and highlights factors to consider when choosing coverage.
Medicaid Estate Recovery: A Primer (Video)
This video from Community Legal Services explains the basics of Medical Assistance ("Medicaid") Estate Recovery and answers important questions about the program. It explains what happens if you own a home and receive Medical Assistance to pay for care in a nursing home or in the community. Funding for this video was made possible by Philadelphia Corporation for Aging (PCA). (2014)
Medical Assistance Copayments - A Factsheet for Consumers
Fact sheet on the law when you cannot afford to pay your medical co-pays for Medical Assistance benefits.
Medical Assistance Coverage of Over-the-Counter (OTC) Medications
Medicaid (called Medical Assistance or “MA” in Pennsylvania) covers some categories of over-the-counter (OTC), or nonprescription, medicine. View this information from Pennsylvania Health Law Project to find out what is covered and how to apply your benefits to OTC medications. (March 2021)
Medical Assistance Dental Coverage for Adults
Information on Dental Coverage under Pennsylvania's Medical Assistance program. If you are age 21 and older and covered by Pennsylvania’s Medical Assistance program, you likely have dental coverage. (July 2017)
Medical Assistance Eligibility Manual
Information from the Pennsylvania Health Law Project on the eligibility requirements for Medical Assistance benefits and how to establish eligibility for the benefits. (April 2020)
Medical Assistance for Workers with Disabilities (MAWD) - A Guide to Eligibility
Medical Assistance for Workers with Disabilities (MAWD) is a state health insurance program for people who are working and have a disability or serious health condition. MAWD is often a good option for people who make too much money to qualify for other categories of Medical Assistance (MA or Medicaid) but who nonetheless need health insurance. MAWD provides comprehensive health insurance coverage and as compared to other MA programs, has high income and resource limits. MAWD also has flexible work and disability requirements. This guide explains each MAWD eligibility requirement in depth and tells you how to apply for MAWD coverage. (January 2025)
Medical Assistance Managed Care in Pennsylvania - A Guide to Pennsylvania’s HealthChoices Program for Families
This brochure explains the basics of Medical Assistance (MA) Physical Health coverage for children in Pennsylvania through the HealthChoices Program. (May 2014)
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org. The Toll Free Helpline is open on Mondays and Wednesdays beginning at 8:00 AM Eastern.
Reporting Parental Income for Medical Assistance for Children with Disabilities - Frequently Asked Questions
Information on requirements for reporting income of parents of children receiving Medical Assistance due to a disability - PH 95 (February 2022)
Special Needs Trust
Northwestern Legal Services provides an overview of what a Special Needs Trust is, who needs one, and how to get one. (October 2018)
Tips for Choosing a Health Plan
This step-by-step guide developed by the Pennsylvania Health Law Project will help Medicaid consumers choose a new health plan this summer. The changes will only be applied to those who get their Medicaid through the physical HealthChoices system- they do not apply to Community HealthChoices. Consumers who do not choose a new health plan by August 23, 2022, will be auto-enrolled in one.
Tips on Applying for Welfare Benefits
Helpful tips from Neighborhood Legal Services Association about filing an application for benefits from the Department of Public Welfare.
What You Should Know About Your House When You Enter a Nursing Home or Receive Care at Home
This brochure is for anyone who owns a home and may receive Medical Assistance to pay for their care in a nursing home or in the community.
You Have the Right to Disagree with the Welfare Office
Information from Neighborhood Legal Services Association on filing appeals to decisions made by your County Assistance Office.
Community HealthChoices
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually eligible for both Medical Assistance and Medicare, older adults, and individuals with physical disabilities — serving more people in communities while giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
Community HealthChoices (Video)
This video from the Pennsylvania department of Human Services explains the new Community HealthChoices program. Community HealthChoices will coordinate your health care coverage to improve the quality of your health care experience — serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. (2016)
COMPASS - Apply for Public Benefits and Services from the Commonwealth of Pennsylvania
Pennsylvania residents can apply for a variety of programs offered by the PA Department of Human Services, including public assistance, food stamps, health care coverage, energy assistance and other social service programs at this site
Health Care/Medical Assistance
This is the section of the Pennsylvania Department of Human Services website with information for people applying for or currently receiving Medical Assistance.
Medical Assistance Benefits for Workers with Disabilities
Information on Medical Assistance for Workers with Disabilities (MAWD) from the Pennsylvania Department of Human Services. MAWD lets Pennsylvanians with disabilities take a fulfilling job, earn more money and still keep their full medical coverage. With MAWD you can keep Medical Assistance while you work, even if your earnings increase above the limits for other Medical Assistance programs.
Office of Medical Assistance Programs
Section of the Pennsylvania Department of Human Services website dedicated to the Office of Medical Assistance Programs which administers and oversees the Medical Assistance program in Pennsylvania.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Pennsylvania Breast & Cervical Cancer Early Detection Program
Information on the Pennsylvania Breast & Cervical Cancer Early Detection Program, which is a free breast and cervical cancer early detection program of the Pennsylvania Department of Health. It is funded by the Department of Health and through a grant the Department receives from the Centers for Disease Control and Prevention.
Pennsylvania Health Insurance Premium Payment (HIPP) Program
Information from the Pennsylvania Department of Human Services on the PA Health Insurance Premium Payment Program. The Health Insurance Premium Payment (HIPP) Program is a program developed to help families, who have at least one person enrolled in Medical Assistance (MA), pay for private health insurance through an employer.
STAY CONNECTED with the Lifeline Telephone and Broadband Assistance Program
The Lifeline Program is a federal government benefit that provides eligible low-income consumers a monthly discount on their phone or internet bill. The benefit can be used for voice (telephone), Broadband internet Access Service (or BIAS, usually called internet service), or a combined telephone/internet service product from a landline or wireless provider.
How to Appeal a Medical Assistance Denial of Assistive Technology
This manual from Disability Rights Pennsylvania will explain your rights when Medical Assistance, including your Medical Assistance managed health care plan, denies prior authorization or denies a program exception. This includes an approval of something less or different than what your doctor prescribed. [PDF] (January 2018)
Medicaid Moving Forward
Information from the Kaiser Family Foundation providing an overview of the Medicaid program and its place in the total health care system.