Medical Assistance
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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.
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.
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
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.
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.
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.
Medical Assistance for Workers with Disabilities
Information from the Pennsylvania Health Law Project on the MAWD (Medical Assistance for Workers with Disabilities) Program which allows qualified persons to purchase Medical Assistance if their income does not exceed 250% of the Federal Poverty Level. [PDF]
Medical Assistance for Workers with Disabilities (MAWD) - A Guide to Eligibility
Information from the Pennsylvania Health Law Project about how to qualify for Medical Assistance for Workers with Disabilities (also called “MAWD”), a state health insurance program for individuals who have chronic health problems and are working. (December 2019)
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.
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.
Medical Assistance for Workers with Disabilities: What is MAWD?
MAWD is Medical Assistance for people working with disabilities. For a low monthly premium you may see savings on out-of-pocket costs for doctor visits, durable medical equipment, prescription drugs, emergency care, mental health services, drug and alcohol treatment, hospital stays, rehabilitation services, and medical transportation services. (October 2018)
Fact Sheet: Medical Assistance Transportation Program (MATP)
Information about transportation services available through the PA Medical Assistance program. [PDF]
Understanding the Medical Assistance Transportation Program
Information about the Medical Assistance Transportation Program (MATP). The program is available to any Medical Assistance consumer who needs help with non-emergency transportation to and from health care services or treatments.
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
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.
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.
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.
Many Immigrants Can Get Medical Assistance for Coronavirus Treatment
Information about immigrant eligibility for Medical Assistance and about access to for COVID-19 testing, diagnosis, and treatment.
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.
How to Obtain Mental Health and Drug & Alcohol Services in Pennsylvania
Booklet 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 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 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
Information from the Pennsylvania Health Law Project on the MAWD (Medical Assistance for Workers with Disabilities) Program which allows qualified persons to purchase Medical Assistance if their income does not exceed 250% of the Federal Poverty Level. [PDF]
Medical Assistance for Workers with Disabilities (MAWD) - A Guide to Eligibility
Information from the Pennsylvania Health Law Project about how to qualify for Medical Assistance for Workers with Disabilities (also called “MAWD”), a state health insurance program for individuals who have chronic health problems and are working. (December 2019)
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.
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 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.
Billing Issues for Consumers with both Medicare and Medical Assistance - A guide for dual eligible consumers
Information from the Pennsylvania Health Law Project on how to pay medical expenses if you are receiving both Medicare and Medical Assistance (Medicaid) (October 2011)
Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?
This manual from the Pennsylvania Health Law Project is for advocates and consumers who have Medicare and are also eligible for or enrolled in a Medicaid program. Medicaid in Pennsylvania is called "Medical Assistance" or "MA." Persons with Medicare and Medicaid are frequently referred to a "dual eligibles" due to their being simultaneously eligible for both Medicare and Medicaid. (PDF) (February 2013)
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 special rules on whether a child with a Severe Disability, Behavioral or Autism Spectrum Disorder qualifies for Medical Assistance and how to establish eligibility.
How to Appeal a Denial in Community HealthChoices
This consumer fact sheet from the Pennsylvania Health Law Project provides information on how to appeal service denials under the Community HealthChoices program.
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]
Understanding the Medical Assistance Transportation Program
Information about the Medical Assistance Transportation Program (MATP). The program is available to any Medical Assistance consumer who needs help with non-emergency transportation to and from health care services or treatments.
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)
Disabled People May Get Medical Assistance Through Either Healthy Horizons or MAWD
Information from Community Legal Services of Philadelphia on two programs that provides medical assistance to disabled workers, including what it takes to qualify for assistance under each of the programs. (May 2015)
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.
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.
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).
Benefits Available for Low Income Persons
A Summary of Benefits available through your County Assistance Office from Neighborhood Legal Services Association.
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 Medical Assistance in Pennsylvania. Learn about special circumstances that allow people to keep getting Medical Assistance after their SSI benefits end.
Getting Care under Medical Assistance - A Guide for Parents and Families
f your child is new to Medical Assistance (MA), here is some information about the program you need to know.
Health Law: COVID-19 Federal and State Updates
The Pennsylvania Health Law Project (PHLP) is monitoring the impact of the novel coronavirus (COVID-19) and posting information to ensure that those with Medical Assistance (MA) and the Children’s Health Insurance Program (CHIP) coverage have services, and to securing insurance coverage for the uninsured.
How to Access Benefits During Coronavirus: SNAP (Food Stamps), Medicaid, TANF & LIHEAP
If you lost a job or your hours were cut because of coronavirus (COVID-19), you may be eligible for SNAP (food stamps), Medicaid, cash assistance (TANF) or heating bill assistance (LIHEAP).
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
Impact of COVID-19 Stimulus Payments and Pandemic Unemployment Benefits on Health Insurance Eligibility
Summary of the new COVID-19 economic benefits and information on whether and how they impact eligibility for Medicaid, CHIP and subsidized Marketplace insurance.
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.
2022 Income and Resource Limits for Medicaid and Other Health Programs
Information on income and resource limits for Medical Assistance for 2022 provided by the PA Health Law Project.
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.
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.
Medical Assistance for Workers with Disabilities: What is MAWD?
MAWD is Medical Assistance for people working with disabilities. For a low monthly premium you may see savings on out-of-pocket costs for doctor visits, durable medical equipment, prescription drugs, emergency care, mental health services, drug and alcohol treatment, hospital stays, rehabilitation services, and medical transportation services. (October 2018)
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
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.
Understanding “Wraparound” Services for Children in HealthChoices
This guide is about how to obtain services for children through the Behavioral Health Managed Care Organization.
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.
Young Parents and Welfare Benefits
Fact sheet from the Youth Justice Project providing information about the types of benefits that might be available to young parents and pregnant teens.
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
Community HealthChoices
Information from the Pennsylvania Department of Human Services about Community HealthChoices, a program that will coordinate your health care coverage to improve the quality of your health care experience with a goal of increasing opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes.
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.
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.
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.
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.
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.
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.
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.
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.