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This application may be used by families with children or by pregnant women who apply for health care benefits under the Medicaid program or the Children’s Health Insurance Program (CHIP). You can apply online at www.compass.state.pa.us. in Pennsylvania. Easy, affordable protection for your family.
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.
Apply by Mail. Download, fill out, and print a paper application then send it to your local County Assistance Office. Download a form (PDF)
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
If you don’t have a social security number, reach out to your local County Assistance Office to apply for one. Medicaid is available to Pennsylvania residents, regardless of how long you’ve been a Pennsylvania resident. Medicaid is available to United States citizens, refugees, and lawfully admitted non-citizens.
• Apply for assistance and have a determination of your eligibility made without regard to race, color, sex, age, handicap, religion, national origin, marital status or political belief. • Have a representative help you fill out the eligibility forms. • Have action taken on your application promptly and be notified of such action.
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.
