What is a Medicaid Program?

The Medicaid Program is a program in which Americans can get health coverage. This health program is for everyone including children, parents, seniors, individuals having disabilities, and pregnant women. Although, in some of the states, Medicaid programs cover adults making below a certain income level. Medicaid programs are called by various names in different states. Overall, federal Medicaid law and regulations govern Medicaid programs.

Eligibility for Medicaid Eligibility in PA

For any individual who wants to qualify for PA Medicaid Eligibility, you need to be a resident of Pennsylvania state, a national of the U.S., permanent resident of the U.S., citizen, or legal alien. All those who want health care or insurance assistance can apply for the Medicaid program on the condition that their financial situation is characterized as low or very low income.

For PA Medicaid Eligibility, you can be a pregnant woman, carrying the responsibility of a child who is 17 years or less, personally have a disability or have a family member who is disabled in your household. To be eligible for the Medicaid program, your income must be less than the standard based on the size of your family. For example, if you are single, then the income must not be more than $17,131 per year before taxes and if you have a family size of 8 people then your income must not be more than $59,398 per year before taxes.

Medicaid Eligibility In Pennsylvania

How can a person apply for the Medicaid program in Pennsylvania?


If you want to apply online, then you can visit COMPASS which is an online portal. If you want some extra information regarding your application then you can visit the Health care or Medical Assistance page. From this page, you can download the application form without doing many formalities. A person can also discover whether he or she is qualifying for Medicaid in pa or not through the Marketplace application.

Understand Pennsylvania Medicaid program


The Medicaid program in Pennsylvania is popularly known as “Medical Assistance”. The program is designed to provide comprehensive health care coverage for people who have limited income or who are vulnerable individuals. Previously, the Medicaid program was only given to select groups which includes children with low income and adults suffering from certain disabilities.

However, in the year 2015, the state of Pennsylvania implemented the expansion of the Medicaid program under the Affordable Care Act (ACA). From then, children or adults both can apply for Medicaid eligibility in Pennsylvania. The eligibility will be based on how low their income is. The broad coverage of the Medicaid program is designed to ensure that people of all age groups and different capabilities are given access to health care and are able to live full and healthy lives.

People can apply for the Medicaid broad coverage every year and can renew the coverages. There are various ways in which people can qualify for Medicaid eligibility in Pennsylvania yet many do not apply for any program or category. 

All the submitted applications are submitted to the County Assistance Office (CAO) and are reviewed by the representative for eligibility purposes. After careful analysis, Medicaid programs are given to the eligible people. Some of the criteria that are considered are income, resource limits, and other essential requirements.

Along with health care services, there are some additional services provided by Medicaid such as Long-term services and supports (LTSS) in nursing amenities or group homes or at home. Although, the overall application process for Medicaid LTSS is different from just applying for health care coverage.

If you have applied for the Medicaid program and your application has been rejected, then you can consult a renowned insurance firm such as Chermol & Medicare Insurance Solutions (CMIS). Some people might learn that their Medicaid program has been stopped or terminated. In these cases, CMIS will provide you with the necessary assistance.

If you want to seek advice on the Medicaid program and how to apply for it then you must refer to CMIS who will help you to get the best coverage that will be beneficial for you and the members of your family.

Essential Facts about Medicaid Program

  • Elderly and disabled people comprise 30% of the overall population under Pennsylvania Medicaid programs. This accounts for about 78% of overall expenses spent on Medicaid.
  • In the year 2019, Medicaid is responsible for funding 35% of the births in Pennsylvania. That accounts for approximately 134,247 births.
  • Of all the nursing home residents, Medicaid is responsible for funding two-third of those residents.
  • In the year 2020, there were approximately 871,000 Pennsylvanians who benefited from Medicaid and other health care programs in December.
  • In February 2021, the total number of people who enrolled in the Medicaid program in Pennsylvania was at 3.1 million.
  • The overall revenue in the hospitals of Pennsylvania who were following Medicaid expansion programs decreased by 32% between the year 2014 and the year 2020.


    Medicaid Services

    As Medicaid is a federal health care program, there is a federal law that states that there must be 15 basic health care services that must be provided under this program. The federal law also specifies that Medicaid programs can also cover 28 optional benefits. However, in the state of Pennsylvania, there are 24 optional benefits that are covered including vision, prescription drugs, dental, physical therapy, hospital care, and home health services that are covered under Part D plans in PA.

    The Medicaid services might also include Affordable Care Act (ACA’s) 10 important health benefits including preventive care, expanded mental health, and other substance use treatment services.