How to get Medicaid or low-cost care in Pennsylvania

What Medical Assistance means in Pennsylvania

Medicaid is a program that pays for health care for people with low incomes. The Department of Human Services is the state agency in charge. People here say Medical Assistance, and both names mean the same coverage.

The state's expansion of Medicaid took effect on January 1, 2015. Since then, adults ages 19 to 64 can qualify based on income, even with no children at home. The limit is 133 percent of the federal poverty level. That is a yearly dollar amount the government uses to measure poverty. HealthCare.gov says it works out to 138 percent because of how income is counted.

Other rules cover pregnant people and children, as well as seniors and people who are blind or disabled. You will need proof of who you are, a Social Security number and proof that you live in Pennsylvania. Our guide on who qualifies for Medicaid explains each group.

How to apply in Pennsylvania

COMPASS is the state's online site for benefits, and it is the quickest place to start. A phone app called myCOMPASS PA does the same job, and both let you upload papers.

Anyone who would rather talk to a person can visit a County Assistance Office. This is the state office that handles benefits in your county. To ask about your case by phone, call 877-395-8930. In Philadelphia, the number to call is 215-560-7226.

Applications are accepted in any month of the year. The papers to gather first are listed in our guide on how to apply for Medicaid. If a letter asks for more proof, you have 30 days to answer, so do not set it aside. Keep every letter in one folder, and reply to each before the date it lists.

What changes in 2027

A federal law passed in 2025 changes some Medicaid rules. Details are on the state's Human Services website. Starting in August 2026, the state began contacting affected people by mail and by phone, including text messages. It also set up an HR1 information line at 1-877-883-6383.

Starting January 1, 2027, many adults ages 19 to 64 must show that they work, study, volunteer or join a job program. You report this when you apply or when you renew. Your coverage does not change on January 1 just because the date arrives. Current members report at their next renewal in 2027.

Parents and caregivers of a child 13 or younger are exempt, using the federal wording. Other people are exempt too, but they may need to send proof. The Medicaid work rules guide on this site lists the other exemptions.

Many adults will renew every six months instead of every year. Members switch to the shorter schedule after a renewal in or after February 2027. For example, if your renewal is due in March 2027, your next one comes in September 2027.

Medicaid will also pay for fewer old bills. From January 1, 2027, expansion adults can get one month of past coverage, down from three months. Everyone else can get two months of past coverage. Apply as soon as you need care so fewer bills fall outside that window.

If your income is above the limit

Pennie is the state's official site for buying private health insurance. On it, you can compare plans and see whether your income qualifies you for help with the monthly cost. If you are losing coverage, the site says to apply at least a week before it ends.

A separate page on that site is for people who lost Medicaid. You may have an access code that opens an account the site already set up. Free local helpers, called assisters, can walk you through the steps.

Health centers that also help with sign-up

Community health centers are clinics with federal funding that charge by income. The Health Resources and Services Administration runs a free Find a Health Center tool, and it asks only for your zip code. The state's health center association also has a page for finding a center.

That group says its health centers offer free help with health insurance sign-up. Ask whether the staff can start your Medical Assistance form at your first visit. For help comparing prices, read our guide to sliding-scale clinics.

Looking up a Pennsylvania doctor

You can check a doctor's license on the Department of State website. The Board of Medicine is part of that department. Its licensing system is called PALS, and you can look up a doctor there before you book.

Flat-fee doctors and emergencies in Pennsylvania

Some doctors in this state charge a flat monthly fee instead of billing insurance for office visits. Doctors call this direct primary care. Cash-pay doctors that you can search by place are listed in our directory. Ask what the fee covers before you sign anything.

If you think you are having a heart attack or cannot breathe, call 911 or go to the nearest emergency room. Federal law says a hospital with an emergency room must examine you whether or not you can pay. A bill can sometimes be cut later, and our guide on hospital financial assistance shows how to ask for that.