Pennsylvania Medicaid Office
Find Pennsylvania Medicaid contact information, eligibility requirements, income limits, and how to apply.
Pennsylvania Medicaid agency
- Agency
- Pennsylvania Department of Human Services (DHS)
- Website
- https://www.pa.gov/agencies/dhs
- Phone
- 1-866-550-4355
- Address
- P.O. Box 2675 Harrisburg, PA 17105-2675
- Hours
- Customer Service Center: Monday–Friday, 8 a.m.–4:30 p.m. Eastern (1-866-550-4355)
Pennsylvania Medical Assistance office (DHS)
Pennsylvania calls its Medicaid program "Medical Assistance," and the Department of Human Services (DHS) administers it for more than three million Pennsylvanians. Day-to-day intake runs through County Assistance Offices (CAOs) — not the Harrisburg central office — and through COMPASS, the statewide online benefits portal.
How to reach DHS Medical Assistance
- Statewide Customer Service Center — 1-866-550-4355 for application help, benefit questions, or to report a change. As of June 16, 2025, the Consumer Service Center also takes long-term care (LTC) and home and community-based services (HCBS) applications by phone.
- COMPASS portal — compass.dhs.pa.gov handles Medical Assistance, CHIP, SNAP, and other DHS benefits from a single account.
- County Assistance Office — every county has at least one CAO for in-person help. DHS maintains a CAO locator at pa.gov/agencies/dhs/contact/cao-information.
- Agency website — pa.gov/agencies/dhs for program rules, provider directories, and policy bulletins.
DHS publishes plain-language notices when federal Medicaid policy changes. The agency posted a notice in 2025 that federal legislation enacted that July will alter Medicaid and SNAP rules; recipients are advised to keep COMPASS contact information current so renewal notices and implementation updates reach them.
Who qualifies for Medical Assistance in Pennsylvania?
DHS sorts Medical Assistance applicants into two financial tracks: MAGI (Modified Adjusted Gross Income) and Non-MAGI. The tracks use different income rules, different resource rules, and in some cases different application forms. Pennsylvania took the ACA Medicaid expansion, so adults age 19 through 64 with household income up to 133% of the Federal Income Poverty Guidelines (FPIG) — the agency's own term for the federal poverty figures — can qualify on income alone.
MAGI categories
- Children age 18 and under
- Pregnant women, with continued coverage through 12 months postpartum
- Parents and caretakers of children under 21
- Adults age 19–64 at or below 133% FPIG (the expansion group)
- Family planning services
Non-MAGI categories
- Adults age 65 and older
- People who are blind or have disabilities
- Medical Assistance for Workers with Disabilities (MAWD) — a buy-in for people with disabilities who work
- Long-term care (LTC) and home and community-based services (HCBS) applicants
What counts as resources for Non-MAGI applicants?
DHS counts cash, checking and savings, certificates, stocks, bonds, life insurance, vehicles beyond the first, revocable burial funds, and non-resident real property. It does not count the home, one vehicle, burial space and marker, or burial reserves up to specified limits. MAGI applicants, pregnant women, and households with a child under 21 face no resource limit at all — except for Medicare Buy-In programs and MAWD, which always count resources.
Citizenship, residency, and SSN
Medical Assistance is open to U.S. citizens, refugees, and certain lawfully admitted non-citizens. Other non-citizens may qualify for emergency-only coverage. Pennsylvania has no minimum-length residency requirement; the applicant only needs to be a current Pennsylvania resident. An SSN is required for each applying household member, and CAO staff will help apply for one if needed.
Renewals run every 12 months
DHS attempts ex parte renewals first — checking federal and state data to confirm continuing eligibility without paperwork. When data confirms, coverage continues automatically. When data doesn't match, COMPASS or the mail delivers a pre-populated renewal packet that must be returned by the printed deadline or coverage closes.
Pennsylvania Medical Assistance income limits (2025)
Two reference points matter here. MAGI groups use percentages of the Federal Income Poverty Guidelines (FPIG), which DHS calls FPIG rather than FPL. Non-MAGI groups for older adults and people with disabilities use Pennsylvania's Non-Money Payment (NMP) and Medically Needy Only (MNO) categories with state-specific dollar limits. The dollar figures below are from the DHS 2025 chart and update annually — verify the current number before relying on it.
MAGI income limits
| Group | Income standard | Notes |
|---|---|---|
| Adults 19–64 (expansion) | 133% FPIG | No asset test on MAGI; budget runs on tax-counted income. |
| Pregnant women | Continues 12 months postpartum | No asset test for MAGI pregnancy coverage. |
| Children under 19 | Higher MAGI thresholds; CHIP tiers above that | No resource test; preventive, behavioral, dental, vision included. |
| Parents and caretakers | CAO computes the household budget group case by case | — |
Non-MAGI: Non-Money Payment (NMP) — 2025
| Household size | Net monthly income limit |
|---|---|
| 1 person | $1,016.10 |
| 2 persons | $1,524.30 |
NMP applicants must also meet a $2,000 resource limit for one person, $3,000 for two.
Non-MAGI: Medically Needy Only (MNO) — 2025
MNO is Pennsylvania's "spend-down" pathway: applicants with income above the NMP limit can still qualify after using their excess income on medical bills during a six-month window.
| Household size | Monthly income limit | 6-month income limit |
|---|---|---|
| 1 | $425 | $2,550 |
| 2 | $442 | $2,650 |
| 3 | $467 | $2,800 |
| 4 | $567 | $3,400 |
| 5 | $675 | $4,050 |
| 6 | $758 | $4,550 |
| Each additional person | $92 | $550 |
Medicare Buy-In (Healthy Horizons) — 2025
Pennsylvania brands its Medicare Savings Programs as Healthy Horizons. The Cost Sharing and SLMB/QI-1 tiers use higher resource limits than NMP; QMB Categorically Needy keeps the $2,000/$3,000 NMP limit because enrollees also receive full Medical Assistance.
| Tier | 2025 FPIG window | Resource limit | What it covers |
|---|---|---|---|
| QMB — Categorically Needy | ≤ 100% FPIG ($1,350 / $1,824 incl. $20 disregard) | $2,000 / $3,000 | Part A and B premiums, deductibles, coinsurance, plus full MA |
| QMB — Cost Sharing only | ≤ 100% FPIG ($1,350 / $1,824) | $9,950 / $14,910 | Part A and B premiums, deductibles, coinsurance |
| SLMB | 100–120% FPIG | $9,950 / $14,910 | Part B premium only |
| QI-1 | 120–135% FPIG | $9,950 / $14,910 | Part B premium only; not co-eligible for MA |
Medical Assistance for Workers with Disabilities (MAWD)
MAWD lets workers with a documented disability buy in to Medical Assistance with a $10,000 resource limit — much higher than the NMP standard — and a monthly premium based on countable income. The buy-in lets people keep coverage as their earnings rise without losing access to attendant care or prescriptions.
How to apply for Medical Assistance in Pennsylvania
One Pennsylvania application — Form PA-600 — covers Medical Assistance, CHIP, SNAP, cash assistance, the State Blind Pension, and LIHEAP. DHS offers four paths to file it, plus a phone line for LTC and HCBS cases that opened in mid-2025.
Online: COMPASS
COMPASS accepts new applications, renewals, document uploads, and change-of-circumstance reports. The same login covers every DHS-administered benefit. A myCOMPASS PA mobile app handles the same functions from a phone.
By phone
The Statewide Customer Service Center at 1-866-550-4355 takes Medical Assistance applications Monday through Friday. As of June 16, 2025, the same number accepts long-term care and HCBS applications — previously those required paper or in-person filing.
In person: County Assistance Office
Every county has at least one County Assistance Office. CAO staff can complete a same-day application interview, accept supporting documents, and screen for related benefits. Find the nearest CAO at pa.gov/agencies/dhs/contact/cao-information.
Paper applications
DHS publishes form PA-600 and several program-specific variants. Mail completed forms to your local CAO.
- PA-600 — the main combined application for Medical Assistance, SNAP, cash, State Blind Pension, and related programs. Published in English, Spanish, Arabic, Cambodian, Chinese, French, Haitian Creole, Portuguese, Russian, Ukrainian, and Vietnamese.
- PA-600-HC — Health Care Coverage application for households only seeking Medical Assistance or CHIP.
- PA-600-WD — Medical Assistance for Workers with Disabilities (MAWD) application.
- PA-600-L — Financial Eligibility application for Long-Term Care, Supports, and Services.
- PA-600-B — Breast Cancer Prevention and Treatment Program application.
How long does a decision take?
Federal law gives DHS up to 45 days to decide a non-disability Medical Assistance application and up to 90 days when the basis is disability. Pregnancy and presumptive eligibility decisions are faster — many move same-day at a Pennsylvania hospital or qualified clinic. Coverage can be retroactive up to three months before the application month if the household had qualifying medical bills during that window.
What Medical Assistance covers in Pennsylvania
Pennsylvania splits Medical Assistance benefits into two managed care tracks. HealthChoices covers physical health for most members; Behavioral HealthChoices covers mental health and substance use disorder care through a separate plan. The two tracks coordinate, so a member sees one set of providers for medical care and another for behavioral health, but both flow from the same Medical Assistance enrollment. Most members pick a HealthChoices physical-health plan in their region; behavioral-health assignment follows county of residence rather than member choice.
Core medical benefits
- Annual check-ups, preventive care, screenings, and immunizations
- Primary and specialty care, urgent care, and emergency services
- Hospital inpatient and outpatient care, surgery, anesthesia
- Prescriptions
- Lab and imaging
- Maternity and newborn care, with continuing postpartum coverage
- Mental health and substance use disorder treatment
Behavioral HealthChoices
Each county or county joinder contracts with a behavioral health managed care organization for outpatient counseling, mobile crisis, inpatient psychiatric care, residential and outpatient substance use treatment, peer support, and recovery services. Members do not pick a behavioral health plan — assignment follows the county of residence.
Dental, vision, and hearing
Pennsylvania Medical Assistance covers dental, vision, and hearing screenings and care. Children also receive routine well visits and immunizations through EPSDT, the federal Medicaid benefit for people under 21. CHIP covers the same essential services for children and teens not eligible for Medical Assistance.
Long-term services and supports
DHS also oversees long-term services and supports for older Pennsylvanians and adults with physical disabilities, through the Office of Long-Term Living (OLTL). These services include nursing facility care, home and community-based services, and supports for people who are dually eligible for Medicare and Medical Assistance. Apply through COMPASS or the Statewide Customer Service Center; LTC and HCBS phone applications opened June 16, 2025.
Intellectual disabilities and autism services
Pennsylvanians with intellectual disabilities or autism access services through the Office of Developmental Programs (ODP) rather than HealthChoices. ODP runs intellectual disabilities services and autism services, including the Adult Community Autism Program (ACAP) — DHS publishes a separate registration path for ACAP on pa.gov.