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Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services. Check any that you are applying for: Home and Community Waiver Services – Type/Name of Waiv. Please read the entire form. Print the requested information in the unshaded sections.
- Medicaid Provider Forms
Medicaid Provider Forms. The Office of Medical Assistance...
- Medicaid Provider Forms
You can apply online at: www.compass.state.pa.us. This is an application for cash, health care and SNAP benefits. If you need this application in another language or someone to interpret, please contact your local county assistance office. Language assistance will be provided free of charge.
This is an application for cash, health care and the Supplemental Nutrition Assistance Program (SNAP) benefits. If you need this application in another language or someone to interpret, please contact your local county assistance office.
Medicaid Provider Forms. The Office of Medical Assistance Programs (OMAP) produces and distributes over 70 forms and envelopes for use at no charge to Medicaid providers. There may be a limit to how many forms can be ordered at one time.
Use this application to see what coverage choices you qualify for: • Free or low-cost health insurance from Medical Assistance or the Children’s Health Insurance Program (CHIP) • A new tax credit that can help pay your health insurance premiums
Submit a form. Medicaid, also known as Medical Assistance (MA) in PA, helps Pennsylvanians access healthcare and supportive services essential to living a healthy life.
Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services. Check any that you are applying for: Care in a facility Home and Community Waiver Services – Type/Name of Waiver/Service: Other: Please read the entire form. Print the requested information in the unshaded sections.
