Pennsylvania Medicaid Application Information

Pennsylvania Medicaid program is a public insurance system which currently covers more than two million residents. It’s important to separate it from other public insurance systems which could be categorized as welfare programs, since Medicaid does not provide any direct financial help and it’s created to help low-income individuals connect to quality health care providers.

There are two types of Medicaid programs in Pennsylvania, which depends on the county you live in. After you’ve applied, you’ll be enrolled with one of these programs and you’ll receive appropriate card of that particular kind of Medicaid program. It’s important to know that you can’t choose which program you want to use, since this is administrative protocol and depends on your local government. You’ll basically get the same quality of health care, delivered slightly differently. These two programs are called “fee-for-service” and Medicaid managed care.

Recipients of “fee-for-service” Medicaid health insurance are also in ACCESS Plus program which combines physical and behavioral health services. Recipients of Medicaid managed care are automatically enrolled with HealthChoices program. Either way you’ll get a chance to use both physical and behavioral health care options. Physical care includes inpatient and outpatient services, while behavioral health care cover alcohol and substance abuse, as well as additional behavioral treatments. For more information on available services included in ACESS Plus and HealthChoices programs, go to Pennsylvania Department of Public Welfare website: http://www.dpw.state.pa.us. For more information about HealthChoices program, go to http://www.dpw.state.pa.us/foradults/healthcaremedicalassistance/healthchoicesgeneralinformation/index.htm where you can find lists of qualifying health care providers as well as the list of counties which are covered by this type of Medicaid.

If you’re local health department enrolls you in ACESS Plus program, you can find all available information on the official website: http://www.accessplus.org/homepage.aspx.

Regardless of which Medicaid program you’ll get to use, you’ll have to pick your Primary Care Provider (PCP) which is a doctor which plays cruicial role in managing your health on long-term basis. When you think you have a health problem, you’ll need to make an appointment with your PCP which could refer you to a specialist to examine your problem even further. The important thing is that you always carry your Medicaid insurance card, each time you go to see a doctor, regardless of if you’ve made an appointment of if you need to go to Emergency room.

Finally, you also need to know that even if you’re using Medicaid you’ll still have to pay a small amount for certain health care services. Throughout the documentation you’ll be able to read about these and they are usually called “co-payments”. These are needed to fund Medicaid program and they are usually quite small. For example, you’ll need to pay $1 for each prescription refill of a generic drug or $6 for each day you spend in a hospital (in this case, the maximum amount you can pay by law is $42). You can find a list of services which require co-payment on http://www.accessplus.org/homepage.aspx.

Eligibility Requirements

There are several categories which are eligible for Pennsylvania Medical Assistance programs:

 

  • Families with children under the age of 21, with low- and very low-income.

  • Senior citizens older than 65 years of age, which are disabled in a certain way.

  • People aged from 59 to 64, with temporary disables.

 

If you belong to one of these categories, you should apply for Medicaid program. Still, a large part of whether you’ll be approved are your financial resources. This is different from one case to another, which means that there’s no official list of documents which you’ll need to collect. Insight into financial resources are based upon the bank documents like checking and savings accounts, trust funds, life insurance, vehicles you own, burial funds and non-resident property. According to Pennsylvania law, your home is not factored into eligibility for Medical Assistance program.

There are also some other cases when you could apply for Medicaid. In these cases you should make an appointment with your physician, which needs to fill out application form called “PA1663”. These cases are:

 

  • If a person is permanently disabled or has a chronic medical condition,

  • If a person has a chronic medical condition but is still working,

  • If a person required health sustaining medication or other form of medical help in order to work,

  • If a person is the caretaker for a household member who is ill or who has a disability (in case there’s no one else in the household to care for that person),

  • And finally, if a person is immigrant with an emergency medical condition.

Medicaid Application Instructions

There are several ways to apply for Pennsylvania Medicaid program:

 

  • The fastest way is to apply via website. The state of Pennsylvania has created a website for different kinds of welfare and social programs and that’s www.compass.state.pa.us. This is where you can easily sign-up for your own account and from there simply fill online form. This is perhaps the most convenient way to apply for different programs, since COMPASS helps you determine if you’re eligible for those programs. If you need any additional information regarding this web site and the process of applying for Medicaid, call helpline at 1-800-692-7462 (Monday through Friday, between 8:30am to 4:45pm).

  • You can also visit your local county assistance office where you can always find all of the needed information about Medicaid and other programs, as well as all of the needed documentation and forms. A good thing is that you can also seek assistance from trained stuff which will help you fill out forms and answer all your questions.

If you need help finding out where your local county assistance office is located, than go to http://www.dpw.state.pa.us/findfacilsandlocs/countyassistanceofficecontactinformation/index.htm. This is where you can find a list of all county assistance offices in Pennsylvania as well as their phone numbers.

  • A third way to sign up for Medicaid program is to download and print an application form. This document is named “Application for cash, assistance, SNAP and Medical Assistance Benefits” and could be found here: http://www.dpw.state.pa.us/ucmprd/groups/public/documents/communication/s_001597.pdf. After you’ve filled out this form, all you need is to mail it to your county assistance office, to start with the procedure of evaluation.

 

After you’ve successfully applied, you should receive a notice whether you’re application is approved or denied in a period no longer than 30 days. Some patients who need urgent medical need can be approved in a period of five days.