When an applicant is applying for Medicaid in Pennsylvania, he or she must provide certain types of personal information in order to find out if they meet Medicaid eligibility requirements. Since 1992, Gateway Health has focused on serving the members of our community who are eligible for Medical Assistance. The program is … Medicaid expansion — which is a cornerstone of the ACA — has played a significant role in the declining uninsured rate in Pennsylvania … To apply for long-term care Medicaid, elderly Pennsylvania residents can do so online at COMPASS or fill out a paper application, “Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services” and either drop it off or mail it to their local County Assistance Office (CAO). Medicaid Plus, LLC serves New Jersey, Pennsylvania, Delaware and Maryland Phone: 855.471.6771 Email: [email protected] According to U.S. Census data, the uninsured rate fell from 9.7 percent in 2013 to 5.5 percent in 2017. There are several Medicaid programs that people in Pennsylvania can be eligible for. There is no additional asset disregard. Pennsylvania Medicaid Application. Provided at home, adult day care, or in assisted living. Pittsburgh. This is a new program and is the combination of three former waiver programs: aging waiver, attendant care/ act 150 waiver, and independence waiver. Pennsylvania expanded Medicaid as of January 1, 2015. Pennsylvania Medicaid. At the time of this writing, the medically needy income limit for an individual is $425 and $442 for a married couple. Families with children in the household – under their care and control, Revocable and irrevocable burial reserves subject to specified limits, Information about household members (name, date of birth, and Social Security number), Proof of disability or medical records showing a lasting medical condition, Family planning (birth control, pregnancy and birth care), Services through the Child Health Check-Up program, Income limit: 138% of the Federal Poverty Limit, For Immigrants: Must have a “qualified” status for five years, unless exempt. Residents seeking to answer the question “What are the requirements for Medicaid?” will need to understand the guidelines created by the federal government. The Medicaid application form is a comprehensive understanding of an applicant’s profile that is used to determine eligibility for benefits in Pennsylvania. Call 1-866-600-2139 (TTY: 711), 24 hours a day, 7 days a week. When determining who is eligible for Pennsylvania Medicaid, officials take into account certain sources of income, including wages, pensions and spouse’s income, among other sources. The process of qualifying for Medicaid in PA includes provisions to help the neediest applicants first with the state and federal resources available to the program. For potential beneficiaries, understanding Medicaid benefits eligibility requirements will increase the likelihood of receiving assistance. You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid. However, eligibility for Medicaid regarding income may change slightly on a state-by-state basis. Pennsylvania Medicaid Application. Further complicating eligibility are the facts that the criteria vary with marital status and that Pennsylvania offers multiple pathways towards eligibility. Your financial situation — specifically your annual income — is one of the largest determinants of your ability to receive Medical Assistance benefits. The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage. If you have other medical/health insurance coverage, be sure to give that information to your caseworker What if I Have Questions? During this interview, you will be required to bring documents that prove the information that you provided on your initial Pennsylvania Medicaid application. Once your inquiry is reviewed, a PA Health & Wellness representative may contact you regarding your inquiry. The Affordable Care Act is a substantial reform of the U.S. health care insurance system. It provides health and long-term care services to low income children, families, persons with disabilities, and the elderly. To find out if you are covered for dental care, call your county assistance office or, if you are in the HealthChoices/Managed Care program, call your managed care organization (MCO). For an update on the Medicaid expansion debate and timeline in Pennsylvania, see our Pennsylvania Expansion update below. Pennsylvania Medicaid program is a public insurance system which currently covers more than two million residents. Be sure to check out our other articles about Medicaid. Historically, Medicaid was only available to narrow groups, such as … The Medicaid Payback: Pennsylvania’s Medical Assistance Estate Recovery Program What follows is an updated version of an article that was authored by Attorney Gerhard and previously published in the Pennsylvania Bar Association’s law journal, the Pennsylvania Bar Association Quarterly.. By Robert C. Gerhard, III, Esquire. On Monday, the Pennsylvania Department of Human Services announced that the state Medicaid program will now cover all medically necessary gender transition services. Medicaid, or Medical Assistance as it is officially called in the state of Pennsylvania, is a combination of efforts by the federal and state governments. Provider resources for Pennsylvania Community Plan products including prior authorization information, provider manuals, forms, recent news and more. Aetna Better Health of Kansas. Learn more here. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Patients who participate in assistance programs including Medicaid, PACE/PACENET, CHIP, SNAP, and WIC may be eligible for fee reductions. Reflects Medicaid state plan coverage of the eligibility group for parents and other caretaker relatives. Understanding how to qualify for Medicaid in Pennsylvania is an important step for low-income individuals or families who want to obtain health care benefits. Medicaid benefits eligibility in Pennsylvania starts with satisfying one or more of the basic requirements for a Medicaid category. If the couple’s total assets are $26,076 or less, the community spouse is entitled to 100% of it. Make note, the asset limits for Medicaid qualification via the Medically Needy Pathway are different than those listed above. PA Health & Wellness exists to improve the health of While the federal government sets specific program guidelines, each of the states is given the flexibility to run their Medicaid program as they see fit within the federally set parameters. To qualify, you must meet the Pennsylvania Medicaid Income limits listed below. In addition to covering 30 percent of births in Pennsylvania, Medicaid was the primary payer in about 53 percent of pregnancy-associated deaths. In essence, Medicaid is designed to help families and persons from low income households who meet criteria for the selections it offers. Medicaid was the primary payer in Pennsylvania in about 53 percent of pregnancy-associated deaths and nearly 60 percent of all pregnancy-associated deaths came between six weeks and one year after giving birth, largely outside of the 60-day limitation on coverage. General Eligibility Requirements. If the applicant has income in excess of the $2,382 / month limit, rather than the total asset limit of $8,000 ($2,000 plus $6,000 disregard), the total asset limit is $2,400. When only one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. If a person’s income is equal to or less than 300 percent of the FBR, their asset limit is $2,000 (with an additional $6,000 disregard, totaling up to $8,000 in exempt assets). To locate a CAO near you, click here. Patients who need a physician and are using this directory should contact the physician's office to determine: 1) if they will accept Pennsylvania MA fee-for-service, known as ACCESS; and 2) if the physician is accepting new patients before making an appointment. This is especially true if you choose to apply for benefits in person at an acceptance facility. Additionally, to qualify for Medicaid coverage, proof of residency, such as utility bills or other documents with an individual’s name and address, will be required. Pennsylvania Medicaid Benefits. again if you become eligible for Medicaid in the future. Our Philadelphia Medicaid planning attorneys can help you protect your assets and qualify for Medicaid sooner. Resources LimitsMedicaid eligibility for some is also determined using resource and household size in comparison to resource limits. Gateway Health makes it easier then ever for Medicare Assured members to find and understand which prescription drugs are covered. Medicaid, called Medical Assistance in Pennsylvania, is a public health insurance program run by the state with help from the federal government. Supplemental Nutrition Assistance Program (SNAP) If you get SSI, you may be able to get help Whether you will be required to attend an interview depends on your situation: If you are applying for Medicaid for your child(ren) alone, then no interview will likely be required. Phone Issues 9/27/21 - Some callers to the P-EBT phone line may receive a "number not in service" message. The provider is required to bill the other insurance before billing Medicaid. To qualify for Medicaid, which is called Medical Assistance in Pennsylvania, petitioners must provide officials with information about their household that includes financial records, residency status and more. Introduction. Just call Member Services and follow the prompts for the Nurse Helpline. They will provide you with a list of enrolled providers for MA patients. Income eligibility: The income limit is $425 a month if single and $442 a month if married (as of 2018). 2) Services My Way (SMW) – This is a program option that allows seniors receiving services via Community HealthChoices to self-direct their own care. Your provider is required to tell you in advance if your Medicaid Health Care Benefits Package does not pay for a service. Note that to ensure all PA Medicaid application information is accurate and correct, Pennsylvania’s Department of Human Services uses an income verification process. For Pennsylvania residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid. In the State of Pennsylvania, Medicaid coverage for non-preferred drugs is obtained by submitting a Pennsylvania Medicaid prior authorization form.Filled out by a physician or pharmacist, this form must provide clinical reasoning to justify this request being made in lieu of prescribing a drug from the Preferred Drug List (PDL). Aetna Better Health® Premier Plan MMAI is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. These categories include seniors who are 65 years of age or older, pregnant women, blind or disabled individuals and families with children younger than 21 years of age. $2,000 or less in cash/non-exempt assets if single. Finally, we will answer some of the most frequently asked questions about Pennsylvania Medicaid Eligibility. Mercy Care (Arizona) Aetna Better Health of California. In this post, we will provide information about Pennsylvania Medicaid eligibility criteria for children and family, pregnancy, the elderly, the blind, and the disabled. Learn more in our Affiliate Disclaimer. Difference between Medicare and Medicaid Programs Pennsylvania Medicaid coverage, also known as HealthChoices, allows eligible individuals and families to access various health care services at a low rate or for free. However, with regular Medicaid, the income of both spouses, regardless of if one or both spouses are applying for benefits, is counted towards the income limit. Eligibility must meet the requirements under state and federal law. The call is free. Pennsylvania Dentists PA - Medicaid Public Health Care: State - Regional - Private Resources In most instances the contacts listed below are regional providers within a given zip code area. *While there is a monthly income limit for nursing home Medicaid, one is not able to keep income up to this level once his / her eligibility has been established. PA Health & Wellness provides quality Medicaid & health insurance plans in Pennsylvania. By using our website, you agree to our terms of use and privacy policy. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management. Pennsylvania's Medicaid program provides medical insurance to groups of low-income people and individuals with disabilities. This, in Medicaid speak, is called the Community Spouse Resource Allowance (CSRA), and in Pennsylvania is also known as the non-applicant spouse’s “protected share”. Additional Info. Stated differently, in order for an applicant to have an asset limit of $8,000, his or her income must be under $2,382 / month. Furthermore, the Pennsylvania Department of Human Services (DHS) reviews applications and determines eligibility. Average Overall User Rating for Providers in Pennsylvania who take Medicaid: 4 (out of 5) If you have an account, you can log in or create your MyCOMPASS PA account. Pennsylvania law requires that the state Medicaid program pay for nursing home care for all residents, regardless of their length of residency, if nursing home care is a medical need and the program’s financial criteria is met. 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. That means we may earn a commission for purchases made through our website. 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