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Pennsylvania Medicaid Eligibility

Medicaid was created in 1965 as part of the U.S. Social Security Act. The program, which is jointly financed by federal and state governments, has evolved over the years from a basic welfare system into a larger-scale public health insurance service. Pennsylvania's Medicaid program is called Medical Assistance, and is administered by the state's Department of Public Welfare (DPW). Roughly 16 percent of the commonwealth's population received Medicaid assistance in 2009. Individuals and families must meet several eligibility guidelines to qualify for Medicaid.

  1. Coverage Groups

    • Medicaid assistance only applies to a select set of coverage groups. These groups include low-income adults; low-income families with children; pregnant women whose income is below 133 percent of the federal poverty line; Supplemental Security Income recipients age 65 and over; recipients of adoption or foster care assistance and certain Medicare beneficiaries. Pennsylvania also extends Medicaid coverage on a case by case basis to optional groups of medically-needy residents, such as individuals who are in institutions, children with disabilities, adults with disabilities and low-income women with breast or cervical cancer.

    Income Requirements

    • One of the primary eligibility categories is income. Recipients of Medicaid generally must demonstrate limited income to be eligible for benefits. Income parameters vary depending on the applicant(s) and the Medicaid services being requested. DPW administrators examine applicants' counted sources of income including wages from formal jobs and self-employment as well as pensions, Social Security benefits and interest earned on investments. Some sources of income do not count against applicants. These sources include food stamps, energy assistance, Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI) and housing subsidies.

    Resource/Asset Requirements

    • Resource limits also factor into an applicant's eligibility. Applicants must demonstrate the full extent of their resources and assets, including bank accounts, stocks, bonds, life insurance, trust funds and multi-vehicle ownership. Some assets do not count against the applicant. These non-counted assets include dwellings, irrevocable burial trusts and a single motor vehicle. Individuals and households with fewer resources stand a better chance of being accepted into the Medicaid program.

    Residency

    • Eligible recipients will also have to provide proof of residency in the state of Pennsylvania. Additionally, applicants must show proof of U.S. citizenship or legal immigration status. Foreign residents living legally in Pennsylvania may still be eligible for Medicaid, but illegal immigrants cannot qualify for benefits.

    Applying for Medicaid in Pennsylvania

    • People interested in applying for Medicaid in Pennsylvania have two options available to them. They can either visit a DPW office in person to speak with a case worker or apply online using COMPASS, the state's Internet portal for all DPW programs and services (see Resources).

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