Medicaid is a program that provides health coverage to some low-income Pennsylvania residents. Medicaid (also called Medical Assistance) covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid. Non-citizens who do not have immigration documents cannot enroll in Medicaid.
· For certain categories of people, eligibility for Medicaid is based on the amount of your household income.
In Pennsylvania you may be eligible for Medicaid if you are an infant, a child, pregnant, or a parent of a child and your family income meets the Medicaid income standards.
Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the Pennsylvania Department of Public Welfare for more information.
· Families who get cash benefits from TANF (also known as Temporary Assistance for Needy Families) can get Medicaid.
Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.
Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for 12 months. Or, your children may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.
· Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid.
Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.
· People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you have high medical expenses that, when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
· Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.
If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.
If your household income is below 135% of the poverty level, Medicaid will pay for your monthly Medicare premiums only. This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.
· There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the Pennsylvania Department of Public Welfare at (800) 692-7462.