Pennsylvania Medicaid Eligibility


 

Pennsylvania Medicaid Income Guidelines

Medical Assistance in Pennsylvania is the state-run health insurance program for low-income children and families. Other individuals qualify based on their income and medical needs, and there are specific requirements for each group. SSI beneficiaries and those who receive TANF assistance are automatically qualified for Medicaid, as it is immediately assumed by the government that such individuals can clearly not afford to buy private health insurance. Low-income Medicare recipients can also use Medicaid to help meet their Medicare payments. All groups of individuals accepted must be residents of Pennsylvania, and U.S. citizens or legal residents.

Benefits through the Pennsylvania Medical Assistance program include clinic and federally qualified health center services, inpatient hospital stays, outpatient care and doctor’s office visits. Even specialized services not offered through many regular medical insurance plans are covered, such as dental and vision care, and chiropractic services. Below is a list of the groups accepted for Pennsylvania Medicaid, according to their respective income levels in relation to the Federal Poverty Level.

Group                                       Income (percent of FPL)

Infant                                                    185%

Child age 1-5                                        133%

Child age 6-19                                      100%

Parent (unemployed)                            26%

Parent (employed)                                26%

Pregnant Women                                  185%

Single Aged/Blind/Disabled                   100%

Aged/Blind/Disabled Couple                  100%

 

 

Other Eligible Groups

  • Families who receive Temporary Assistance for Needy Families (TANF) benefits
  • Supplemental Security Income (SSI) beneficiaries
  • Disabled individuals who no longer qualify for SSI benefits
  • Low-income Medicare recipients
  • Qualified Medicare Beneficiary (QMB) program: Medicaid pays your Medicare monthly premium, deductibles, and coinsurance if your income is below the poverty level.
  • Specified Low-Income Medicare Beneficiary (SLMB) program: Medicaid pays your monthly premiums only if your income is below 120% FPL.
  • Medically Needy program: Medicaid for those who have high medical expenses that when subtracted from your income deem you eligible for Medicaid.

 

Federal Poverty Level 2012

 

Resources

Pennsylvania Department of Welfare: Medical Assistance

COMPASS: Apply online for Pennsylvania MA

Pennsylvania County Assistance Offices