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Apply by Mail. Download, fill out, and print a paper application then send it to your local County Assistance Office. Download a form (PDF)
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.
Medical Assistance for Workers with Disabilities (MAWD) is a Medicaid eligibility category that allows people with disabilities to have a job and keep their Medicaid coverage. This includes any services and supports that you receive through a waiver program.
OMAP oversees quality management and innovation in Medicaid and is also responsible for enrolling providers, processing provider claims, establishing rates and fees, contracting and monitoring of managed care organizations, and helping monitor for potential fraud and abuse in the program.
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
How Do I Apply? 1. Complete the enclosed application. (If you need help, call the Helpline at 1-800-842-2020 or TDD 711 for the hearing impaired. You can also contact your local county assistance ofice (CAO) or check the DHS website at www.dhs.pa.gov. You can also apply online at www.compass.state.pa.us. 2.
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.
