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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.
Apply by Mail. Complete and print a paper application then send it to your local County Assistance Office. Download Application
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.
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.
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.
Pennsylvania Application for Benefits. This is an application for cash, Medical Assistance and SNAP benefits. If you need this application in another language or someone to interpret, please contact your local county assistance ofice. Language assistance will be provided free of charge.
