Pennsylvania Medicaid Benefits

Pennsylvania has three different Medicaid programs available to residents. Medical Assistance is the general Medicaid program which provides coverage for most low-income adults in the state. Anyone who doesn't qualify based on the income guidelines for Medical Assistance may be eligible for Adult Basic coverage. Children from low-income families are covered by the Children's Health Insurance Program (CHIP). The primary benefit of all of these programs is payment of physical and mental health costs.

Medical Assistance

• Residents of Pennsylvania receiving Medical Assistance may receive benefits through the Health Choices Managed Care program or through a fee-for-service provider, depending on which county they live in. In counties where benefits are provided by Health Choices, Medical Assistance recipients have two or three managed care organizations to choose from. Benefits are then provided through the network of practitioners within the managed care organization. In a fee-for service county, residents are provided with a list of practitioners participating in the Medical Assistance program and can choose which they prefer to use. All medical care and prescription drug coverage is provided by these programs, but there may be some restrictions, for example, physical therapy may be required prior to approval being given for a surgical procedure.

  In addition to general physical and mental health services, specific benefits programs under Medical Assistance include breast and cervical cancer screening and treatment; Healthy Beginnings, a program which provides prenatal and 60 days of postnatal care for pregnant women and coverage for children under age 19 in low-income families; and AIDS/HIV information and services, which helps pay for home health care and pharmaceutical treatment. Medical Assistance also helps pay for mental health services, including drug and alcohol counseling and general mental health counseling.

  Pennsylvania Department of Public Welfare
  800-692-7462

Adult Basic

• Adults in Pennsylvania who have income above the limit required to qualify for Medical Assistance may qualify for benefits under Adult Basic. The program is designed to provide assistance for individuals with no other health insurance. Benefits of the program include physician services from primary care physicians and specialists, emergency care, diagnostic tests, in-patient and out-patient hospital care, maternity care, rehabilitation and skilled nursing care.

CHIP

• CHIP (Children's Health Insurance Program) is the program in Pennsylvania designed to provide health coverage for children in low-income families. All uninsured children up to age 19 whose families are not eligible for Medical Assistance are covered by CHIP, although some high-wage families may be required to pay co-pays for some services. Benefits under the CHIP program include regular check-ups, dental services, prescription drugs, vaccinations, hospital care, lab tests, mental health care, and vision care. There are no exclusions for pre-existing conditions under the CHIP program.

  CHIP
  800-986-KIDS