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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.
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.
How to apply? If you are already enrolled in Medicaid, contact your caseworker or your local County Assistance Office . They can check if you have a verified disability on your case and, if not, can help you update your case.
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.
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
Instructions. English and Spanish forms can be found under the title "Form to apply for Medicaid for the Elderly and People with Disabilities or Medicare Savings Program" under section "Forms to apply for benefits".
Call 800-925-9126, Option 1 to check claim status, client eligibility, benefit limitations, current weekly payment amount, and claim appeals. Eligibility and claim status information is available 23 hours a day, 7 days a week, with scheduled down time between 3 a.m. and 4 a.m., Central Time.
