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Learn About Requirements for Medicaid in Pennsylvania

UPDATE: The 2020 rules and steps for Medicaid are largely the same as they have been in recent years.

What are the requirements for Medicaid in Pennsylvania? Medicaid eligibility requirements in PA determine whether or not an applicant meets the standards set forth by the state in regard to its government-sponsored medical assistance program.

Unsure of how to qualify for Medicaid? Your Medicaid benefits eligibility in PA is decided based on several mandatory requirements, which range from non-financial to specific income requirements for Medicaid. You must meet all of the Medicaid eligibility criteria in order to reap Medicaid benefits in Pennsylvania.

Who meets the requirements for Medicaid in Pennsylvania?

What are the requirements for Medicaid when it comes to type of patients? The requirements for Medicaid eligibility in Pennsylvania are specific to the state. Note that those eligible for Medicaid in Pennsylvania may not qualify for Medicaid in, say, New Jersey. Learn more about Medicaid requirements by downloading our comprehensive guide.

Even though Medicaid benefits are funded by both the state and the federal governments, the requirements to be eligible for Medicaid are a combination of nationwide standards, as well as state-specific Medicaid qualifications. Unsure of if you have Medicaid eligibility in PA?

If you are unsure of how to qualify for Medicaid as a patient, review the Medicaid benefits eligibility groups of patients:

  • Patients age 65 and older
  • The blind
  • The disabled
  • Families with children under the age of 21
  • Singled and married patients ages 59 to 64 with temporary disabilities (including those caring for children or disabled persons, victims of domestic violence and those currently undergoing any alcohol- or drug-related treatments)
  • Those with Special Medical Assistance conditions

What Are the General Medicaid Requirements in Pennsylvania?

Now that you have reviewed the types of patients who are eligible for Medicaid, you must read through the various established Medicaid requirements. Medicaid eligibility requirements can vary by state, but there are some specifications which apply nationwide.

Explore the different Medicaid requirements by downloading our informative guide.

Meanwhile, some general requirements include the following:

  • You must be able to prove your identity – In the state of Pennsylvania, proof of your identity is a determining factor when it comes to your Medicaid eligibility. In most cases, your DMV driver’s license, your valid state ID card or a different official piece of identification will suffice in proving your identity to the Pennsylvania Department of Human Resources.
  • You must have a Social Security Number (SSN) – You Social Security Number acts as a federal identification number under many circumstances, including when it comes to government-sponsored benefit programs; and Medicaid is no different. Keep in mind that if you are applying for Medicaid on behalf of your spouse, your children or any other potential beneficiaries residing in your home, those SSNs must be supplied in addition to your own.
  • You must be a Pennsylvania resident – Since you plan to get Medicaid benefits in Pennsylvania, it is only fitting that you must prove your state residency when your Medicaid eligibility is being considered. However, keep in mind that there is no time range when it comes to your PA residency. Your Pennsylvania Medicaid benefits eligibility can be approved whether you have lived in the state for just one month or for your entire life.
  • You must be a U.S. citizen – Do you have documents that prove your citizenship in the United States? If so, gather the papers so you can confirm you are a legal citizen. If not, you may also qualify for Medicaid in PA if you are a refugee or a certain type of lawfully admitted alien. If you do not have these types of citizenship documents, you may be eligible for limited medical assistance benefits if an emergency arises.

What are the Medicaid application guidelines in terms of the above general Medicaid requirements? It is important to have support of all of the above items when the time comes to file your paperwork for PA Medicaid benefits. If you are not able to illustrate that you meet all of the mandatory requirements, your Medicaid benefits eligibility can be denied by the state.

Once you have confirmed you meet the non-negotiable Medicaid eligibility requirements outlined above, you can then proceed with reviewing your Medicaid income requirements. That is your final step in determining if you are eligible for Medicaid in Pennsylvania or not.

What Are the Income Requirements for Medicaid?

What are the Medicaid application guidelines in regard to income? Your income requirements for Medicaid take several factors into consideration. Medicaid income requirements take into account wages (though certain deductions can apply), dividends, interest, Social Security, pensions, veterans’ benefits and the income of your live-in spouse.

Conversely, Medicaid eligibility income requirements do not measure the following when determining if you qualify for Medicaid coverage: Supplemental Security Income, Temporary Assistance for Needy Families, Low-Income Home Energy Assistance Program benefits, foster care payments, Supplemental Nutrition Assistance Program benefits, certain subsidies related to your housing and your utilities and payments for weatherization.

The Modified Adjusted Gross Income (MAGI) calculator is the guide by which all income limits are determined in Pennsylvania’s Medicaid eligibility. Both the size of your household and your resources come into play when summarizing these figures. If you live in a family unit that has children under your care and control, who are younger than 21, the resource limits do not apply to your household when reviewing if you are eligible for Medicaid.

Counted resources in PA include:

  • Checking accounts.
  • Savings accounts and certificates.
  • Cash.
  • Stocks and bonds.
  • Vehicles.
  • Life insurance policies.
  • Non-resident properties.
  • Revocable burial funds.
  • Certain types of trust funds.
  • Christmas or vacation clubs.

Those resources that are not counted by the Pennsylvania Medicaid department include: one motor vehicle, burial spaces and markers and both revocable and irrevocable burial reserves (subject to specified limits).