Medicaid is a program funded and run jointly by state governments and the federal government in the United States. It provides health care coverage to low-income individuals and families. In Pennsylvania, Medicaid is sometimes called Medical Assistance.

Understanding Medical Assistance Eligibility in Pennsylvania

Federal laws require state governments to provide Medicaid coverage to some groups of qualifying individuals, and others have expanded their Medicaid programs to provide coverage to many more low-income adults. Pennsylvania is one of these states. This, in effect, bridges the gap between Medicaid and getting help paying your insurance premiums through a Healthcare Marketplace subsidy. 

To qualify for Medicaid benefits in Pennsylvania, you will need to meet strict income and asset requirements. You will also need to fall into a qualifying category. This may include:

  • An adult between the ages of 19 and 64 whose income is at or below 133% of the current Federal Income Poverty Guidelines (FPIG)
  • A senior aged 65 or older who is blind or disabled
  • A pregnant woman
  • A family with children under the age of 21
  • Some special situations

If you are over the age of 65 or have a disability, you could qualify for both Medicare and Medicaid coverage. This allows you to file claims with both programs. They will work in conjunction to pay for your care and should significantly lower your out-of-pocket costs.

Medicaid Covers a Wide Range of Medical Care Needs

According to Medicaid, anyone receiving this type of benefit should have coverage for:

  • Inpatient hospitalization
  • Outpatient hospital services
  • Doctors visits and related services
  • Laboratory testing and x-ray services
  • Home health services
  • Long-term facility care, including assisted living and nursing home placement

Each state determines its own amounts paid, the scope of services, and duration covered. This could mean you also have access to other covered health services, including:

  • Prescription drug coverage
  • Physical therapy
  • Occupational therapy
  • Case management for chronic conditions
  • Other services not included on the mandatory list

Applying for Medicaid in Pennsylvania

If you apply for and get approved for Supplemental Security Income (SSI) through the Social Security Administration, you will normally get approved for Medicaid automatically. If the team from Berger and Green helps you prepare and file your SSI claim, we will help you with your medical care coverage as well.

If you are not applying for SSI but need Medical Assistance benefits in Pittsburgh, you can apply for this type of health care coverage by using the COMPASS website.  

Alternatively, you can call the Consumer Service Center for Health Care Coverage at 1-866-550-4355 or visit your nearest county assistance office — there are seven options in Allegheny County.

Talk to a Social Security Disability Benefits Attorney in Pittsburgh

If you have an impairment that prevents you from working, you may qualify for Social Security Disability Insurance or Supplemental Security Income as well as Medical Assistance through Medicaid. The team from Berger and Green can review your qualifications, double-check your claim, and even file your application on your behalf. Let us handle the process for you. We can also take on an appeal if the Social Security Administration already denied your claim.

Call or text us today at 412-661-1400 to learn more.