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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.
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.
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 by Mail. Download, fill out, and print a paper application then send it to your local County Assistance Office. Download a form (PDF)
Application for Health Coverage & Help Paying Costs. Use this application to see what coverage you qualify for. • Afordable private health insurance plans that ofer comprehensive coverage to help you stay well. • A new tax credit that can immediately help pay your premiums for health coverage.
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.
