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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.
COMPASS
COMPASS is an online tool for Pennsylvanians to apply for many health and human service programs and manage benefit information, including SNAP, TANF, Medicaid, LIHEAP and other social service programs.
Fact Sheet: Medical Assistance Transportation Program (MATP)
The Medical Assistance Transportation Program (“MATP”) is available to any Medical Assistance (“MA”) enrolled consumer who needs help with non-emergency transportation to and from MA-covered health care services or treatments. This information from the Pennsylvania Health Law Project explains the transportation services available through the PA Medical Assistance program. [PDF] (April 2013)
Getting Medical Assistance for a Child with a Disability, Behavioral or Autism Spectrum Disorder under the PH-95 Category
Information by the Pennsylvania Health Law Project on getting medical assistance for children, under 18, with a disability, behavioral or autism spectrum disorder. (April 2019)
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.
Medicaid Health Insurance Premium Payment Program (HIPP)
Medicaid Health Insurance Premium Payment Program (HIPP) was developed to help families with at least one person enrolled in Medicaid pay for private health insurance through an employer.
Medicaid/Medical Assistance
This is the section of the Pennsylvania Department of Human Services website with information for people applying for or currently receiving Medicaid, also known as Medical Assistance (MA).
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)
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.
Accessing Home and Community-Based Services When Income Appears Too High
People with income no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, other home and community-based services waivers, or LIFE program may be eligible for a Waiver or LIFE program using a qualified Income Spend Down Trust. This fact sheet explains how to use an Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit. (October 2025)
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. (March 2025)
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.
Fact Sheet: Medical Assistance Transportation Program (MATP)
The Medical Assistance Transportation Program (“MATP”) is available to any Medical Assistance (“MA”) enrolled consumer who needs help with non-emergency transportation to and from MA-covered health care services or treatments. This information from the Pennsylvania Health Law Project explains the transportation services available through the PA Medical Assistance program. [PDF] (April 2013)
How to Appeal a Denial in Community HealthChoices
If your Community HealthChoices (CHC) managed care plan denies your request for a service, such as personal assistance services, you have the right to appeal. You can also appeal if your plan stops or reduces a service you have been getting. If your plan says the service you want is “not medically necessary,” this explains how to appeal that determination (June 2024)
How to Obtain Mental Health Services and Substance Use Treatment 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] (September 2024)
Medicaid Health Insurance Premium Payment Program (HIPP)
Medicaid Health Insurance Premium Payment Program (HIPP) was developed to help families with at least one person enrolled in Medicaid pay for private health insurance through an employer.
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. If you cannot afford the co-pay, your pharmacist or doctor CANNOT refuse to give you medications or refuse to treat you. Tell your healthcare provider if you cannot afford to pay. Your provider must treat you, but you will still owe the provider the co-pay. (May 2020)
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)
Q&A: What Congress’ Latest Healthcare Cuts Mean for Pennsylvania October 2025
Update from Pennsylvania Health Law Project, Community Legal Services and Pennsylvania Health Access Network about the latest health care changes enacted by Congress and how these changes will affect Pennsylvanians. Included are a fact sheet and the recording of a webinar on the topic presented on October 7, 2025. (October 2025)
Reminder! Keep Your Medicaid Case File Up to Date
This information from the Pennsylvania Health Law Project explains how to update your case file information with Medicaid. If you are on Medicaid now, be sure to update your contact information, like mailing address and phone number, with the County Assistance Office. This will help ensure you get important updates and renewal paperwork in the mail and by phone. (September 29, 2025)
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.
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. (Nov. 2019)
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. If you need help applying for MAWD, or if you receive a denial after submitting your MAWD application, call PA Health Law Project’s toll free Helpline at 1-800-274-3258 for free legal assistance to help you resolve a denied application and get the coverage you need. (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. (2015)
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)
The Medical Assistance Transportation Program (“MATP”) is available to any Medical Assistance (“MA”) enrolled consumer who needs help with non-emergency transportation to and from MA-covered health care services or treatments. This information from the Pennsylvania Health Law Project explains the transportation services available through the PA Medical Assistance program. [PDF] (April 2013)
Writing a Letter of Medical Necessity for Nursing & Home Health Services: A Guide for Pediatric Healthcare Providers
This guide for Pediatric Healthcare Providers explains how to write a strong letter of medical necessity to ensure their patient receives the shift care services they need. Parents can furnish this resource to physicians to assist the physician in preparing documentation to ensure their children get the care they need.
COMPASS
COMPASS is an online tool for Pennsylvanians to apply for many health and human service programs and manage benefit information, including SNAP, TANF, Medicaid, LIHEAP and other social service programs.
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.
Reminder! Keep Your Medicaid Case File Up to Date
This information from the Pennsylvania Health Law Project explains how to update your case file information with Medicaid. If you are on Medicaid now, be sure to update your contact information, like mailing address and phone number, with the County Assistance Office. This will help ensure you get important updates and renewal paperwork in the mail and by phone. (September 29, 2025)
Writing a Letter of Medical Necessity for Nursing & Home Health Services: A Guide for Pediatric Healthcare Providers
This guide for Pediatric Healthcare Providers explains how to write a strong letter of medical necessity to ensure their patient receives the shift care services they need. Parents can furnish this resource to physicians to assist the physician in preparing documentation to ensure their children get the care they need.
Accessing Home and Community-Based Services When Income Appears Too High
People with income no more than $500 over the monthly income limit for the Community HealthChoices (CHC) Waiver, other home and community-based services waivers, or LIFE program may be eligible for a Waiver or LIFE program using a qualified Income Spend Down Trust. This fact sheet explains how to use an Income Spend Down Trust to qualify for a Waiver or LIFE program, even if income is above the program income limit. (October 2025)
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. (March 2025)
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. (Nov. 2019)
Disabled Adult Child (DAC) Medical Assistance Benefits
There are special circumstances that allow people to keep getting Medicaid after their SSI benefits end. One of those special circumstances applies to people who are considered a “disabled adult child” and collect Social Security benefits from a parent’s record when that parent becomes disabled, retires, or passes away. If someone loses their SSI because they start to collect these Social Security Disabled Adult Child (DAC) benefits, or because they receive an increase in DAC benefits, special Medicaid eligibility rules apply. Learn about these special rules that may allow the person with a disability to keep their Medicaid coverage. (2023)
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. If you need help applying for MAWD, or if you receive a denial after submitting your MAWD application, call PA Health Law Project’s toll free Helpline at 1-800-274-3258 for free legal assistance to help you resolve a denied application and get the coverage you need. (2021)
Fact Sheet: Medical Assistance Transportation Program (MATP)
The Medical Assistance Transportation Program (“MATP”) is available to any Medical Assistance (“MA”) enrolled consumer who needs help with non-emergency transportation to and from MA-covered health care services or treatments. This information from the Pennsylvania Health Law Project explains the transportation services available through the PA Medical Assistance program. [PDF] (April 2013)
Getting Medical Assistance for a Child with a Disability, Behavioral or Autism Spectrum Disorder under the PH-95 Category
Information by the Pennsylvania Health Law Project on getting medical assistance for children, under 18, with a disability, behavioral or autism spectrum disorder. (April 2019)
How to Appeal a Denial in Community HealthChoices
If your Community HealthChoices (CHC) managed care plan denies your request for a service, such as personal assistance services, you have the right to appeal. You can also appeal if your plan stops or reduces a service you have been getting. If your plan says the service you want is “not medically necessary,” this explains how to appeal that determination (June 2024)
How to Obtain Mental Health Services and Substance Use Treatment 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] (September 2024)
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. (2015)
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. If you cannot afford the co-pay, your pharmacist or doctor CANNOT refuse to give you medications or refuse to treat you. Tell your healthcare provider if you cannot afford to pay. Your provider must treat you, but you will still owe the provider the co-pay. (May 2020)
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.
Q&A: What Congress’ Latest Healthcare Cuts Mean for Pennsylvania October 2025
Update from Pennsylvania Health Law Project, Community Legal Services and Pennsylvania Health Access Network about the latest health care changes enacted by Congress and how these changes will affect Pennsylvanians. Included are a fact sheet and the recording of a webinar on the topic presented on October 7, 2025. (October 2025)
Reminder! Keep Your Medicaid Case File Up to Date
This information from the Pennsylvania Health Law Project explains how to update your case file information with Medicaid. If you are on Medicaid now, be sure to update your contact information, like mailing address and phone number, with the County Assistance Office. This will help ensure you get important updates and renewal paperwork in the mail and by phone. (September 29, 2025)
Reporting Parental Income for Medical Assistance for Children with Disabilities - Frequently Asked Questions
Many children with disabilities qualify for Medicaid, also known as Medical Assistance in Pennsylvania, regardless of their parent’s income. This Medicaid category is known as “PH-95”. When applying for Medicaid, parental income still needs to be included on the application. Here are some frequently asked questions about the PH-95 program and applying for Medicaid for a child with a disability from the Pennsylvania Health Law Project. (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. (June 2022)
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.
Writing a Letter of Medical Necessity for Nursing & Home Health Services: A Guide for Pediatric Healthcare Providers
This guide for Pediatric Healthcare Providers explains how to write a strong letter of medical necessity to ensure their patient receives the shift care services they need. Parents can furnish this resource to physicians to assist the physician in preparing documentation to ensure their children get the care they need.
COMPASS
COMPASS is an online tool for Pennsylvanians to apply for many health and human service programs and manage benefit information, including SNAP, TANF, Medicaid, LIHEAP and other social service programs.
Medicaid Health Insurance Premium Payment Program (HIPP)
Medicaid Health Insurance Premium Payment Program (HIPP) was developed to help families with at least one person enrolled in Medicaid pay for private health insurance through an employer.
Medicaid/Medical Assistance
This is the section of the Pennsylvania Department of Human Services website with information for people applying for or currently receiving Medicaid, also known as Medical Assistance (MA).
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.
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.
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)
Writing a Letter of Medical Necessity for Nursing & Home Health Services: A Guide for Pediatric Healthcare Providers
This guide for Pediatric Healthcare Providers explains how to write a strong letter of medical necessity to ensure their patient receives the shift care services they need. Parents can furnish this resource to physicians to assist the physician in preparing documentation to ensure their children get the care they need.