State Medicaid Guidelines in Pennsylvania

Medicaid is a means-tested health assistance program that is jointly funded by the federal government and individual state governments. Despite joint funding, state governments ultimately run their Medicaid programs independently with policies varying from one location to another. Unlike Medicare, which is a social insurance entitlement program, Medicaid eligibility focuses largely on financial criteria to determine who is eligible for benefits. Over 1.9 million people receive Medicaid coverage in Pennsylvania, as of October 2010. Pennsylvanians have to conform to several state guidelines in order to qualify.

Who Receives Medicaid Coverage?

• Medicaid in Pennsylvania serves select groups of residents. Among the groups typically covered by Medicaid are low-income adults and their children, pregnant women, individuals with disabilities, the elderly and the medically needy.

Income Guidelines

• Income guidelines determine who is eligible for Medicaid in Pennsylvania. Exact income limits depend on the situation of the applicant or applicants. Factors such as the number of members in the household and the level of household income as it compares with the federal poverty level provide the primary indicators of eligibility. Pennsylvania's Medicaid official reviews numerous sources of income when evaluating cases. Counted sources of income include wages, reported earnings from self-employment, interest earned on investments and savings, pension payments, Social Security disability payments and retirement benefits. Certain sources of welfare-based income do not count against applicants. Such non-counted sources include Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), housing subsidies, energy assistance and food stamps.

Resource and Asset Guidelines

• Pennsylvania's Medicaid program also imposes resource and asset guidelines when screening applicants for eligibility. Households with ample resources may not qualify, while those with fewer assets are more likely to be accepted. Counted assets include savings accounts, checking accounts, stocks, bonds and trust funds. Other resources such as a home or a single vehicle do not count against an applicant.

Residency Guidelines

• State guidelines require Medicaid applicants to demonstrate residency in Pennsylvania and legal status in the country. This means that U.S. citizens must provide proof of identity, including a government issued photo identification card and a social security card, as well as evidence of residence within the state. Non-citizen aliens residing in Pennsylvania need to have proof of their legal status in the form of a Green Card or other immigration documents. Illegal immigrants cannot enroll in Pennsylvania's Medicaid program.

Application Guidelines

• Prospective applicants will find the complete list of guidelines for the Pennsylvania Medicaid program on the state's COMPASS website to apply (see "Resources") or visit any of the state's Department of Public Welfare offices for further assistance.