Pennsylvania Medical Assistance: eligibility, benefits, and how to apply

Last verified: June 2026

What is Pennsylvania's Medical Assistance program?

Medical Assistance (MA) is Pennsylvania's name for Medicaid, the joint federal-state health insurance program for people with low to moderate incomes. The Pennsylvania Department of Human Services (DHS) administers it through the Office of Medical Assistance Programs. As of mid-2025, approximately 3.4 million Pennsylvanians were enrolled in Medical Assistance — roughly one in four state residents, per KFF state health data.

Pennsylvania expanded Medicaid under the Affordable Care Act. Most adults ages 19–64 qualify at or below 138% of the Federal Poverty Level. Children qualify up to 317% FPL through the separate Children's Health Insurance Program (CHIP). Pregnant women qualify up to 215% FPL through Medical Assistance. There is no asset test for MAGI-based Medical Assistance — savings accounts and home ownership do not disqualify applicants.

Applications are submitted through COMPASS, Pennsylvania's online benefits portal at compass.dhs.pa.gov. You can also apply by phone, mail, or in person at a local County Assistance Office (CAO).

HealthChoices: Pennsylvania's mandatory managed care program

Most Medical Assistance enrollees receive their care through HealthChoices, Pennsylvania's mandatory Medicaid managed care program. HealthChoices launched in 1996 — making it one of the oldest mandatory Medicaid managed care programs in the United States. The program operates across three components: Physical HealthChoices for medical care, Behavioral HealthChoices for mental health and substance use disorder services, and Community HealthChoices for long-term services and supports.

When you enroll in Medical Assistance, you select a managed care organization (MCO) from the plans available in your county. MCOs operating in Pennsylvania include UPMC For You, Keystone First (AmeriHealth Caritas), PA Health & Wellness, Aetna Better Health, and Health Partners Plans. The available plans vary by region. Your MCO coordinates your care, maintains a provider network, and handles prior authorizations.

To find the MCOs available in your county and to pick a plan, visit enrollnow.net or call 1-800-692-7462 (the DHS HelpLine).

County Assistance Offices: a defining feature of Pennsylvania's system

Pennsylvania administers Medical Assistance through a network of County Assistance Offices located in each of the state's 67 counties. Unlike states that centralize eligibility determination in a single state office, Pennsylvania routes applications through local CAOs, where eligibility workers review cases and issue decisions. This structure means applicants can walk into a local office in any county and get in-person assistance.

Interviews, which are required for some eligibility categories, can often be conducted by phone at CAOs — you typically do not need to appear in person. CAOs also process renewals, case changes, and appeals. To find your local CAO, visit pa.gov/agencies/dhs/contact/cao-information.

Per 42 CFR 435.912, DHS must complete eligibility determinations within 45 days for most applicants, or 90 days for disability-based categories.

Community HealthChoices serves seniors and people with disabilities

Community HealthChoices (CHC) is the component of HealthChoices that covers long-term services and supports — including nursing facility care and home- and community-based services (HCBS) — for people who are dually eligible for both Medicare and Medicaid, and for people with physical disabilities who need personal care. CHC replaced Pennsylvania's older waiver programs (the Aging Waiver, the COMMCARE Waiver, and others) through a phased rollout that began in Southwest Pennsylvania in 2018 and completed statewide by early 2020.

As of June 2024, over 383,000 Pennsylvanians were enrolled in CHC, per the Pennsylvania Health Law Project. Approximately 34% were receiving home- and community-based services, while 11% were residing in a nursing facility. Five MCOs currently administer CHC across five geographic zones statewide: Aetna Better Health, Health Partners Plans, PA Health & Wellness, UPMC For You, and AmeriHealth Caritas/Keystone First.

Who qualifies for Pennsylvania Medical Assistance?

Medical Assistance serves several distinct coverage groups. Each has its own income limits and rules:

• Adults ages 19–64: income at or below 138% FPL (ACA expansion group)
• Children under 19: income up to 317% FPL through CHIP (above 138% FPL)
• Pregnant women: income up to 215% FPL through the Healthy Beginnings Plus program
• Seniors and people with disabilities: SSI recipients qualify automatically; others qualify under separate income and asset rules
• Children with special needs (PH95): covers children under 18 with disabilities whose parents earn too much for standard MA categories
• Former foster care youth: covered through age 26 regardless of income, per federal requirements

Pennsylvania does not use a waitlist for the standard Medical Assistance expansion group. Adults who meet the income requirement are entitled to coverage immediately.

Pennsylvania Medical Assistance eligibility at a glance

FPL = Federal Poverty Level. Income limits based on 2026 HHS federal poverty guidelines. No asset test for MAGI-based groups (adults, children, pregnant women). Nursing facility applicants face a separate $8,000 resource limit.

Pennsylvania Medical Assistance guides