Written by a parent, not a doctor. Nothing here is medical advice.

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Pennsylvania program

Government health insurance for your child (Medical Assistance)

Pennsylvania's free Medicaid plan for children under 19, called Medical Assistance. It can sit behind insurance you already have.

What it is

Pennsylvania's free Medicaid plan for children under 19, called Medical Assistance. It can sit behind insurance you already have.

Medical Assistance covers children under 19 whose household income meets the limit for their age. A drop in pay can change the answer even if last year's income was higher. The county decides who belongs in your child's household and which income counts.

Eligibility rules
  • Your child must live in Pennsylvania and be under 19. Ordinary child MA does not require a disability diagnosis.
  • The county uses your child's tax household and current monthly income. Dividing annual income by 12 gives only an estimate after a pay change.
  • The January 13, 2026 table gives these monthly base lines for four people: $5,913 under age 1, $4,318 at ages 1–5 and $3,658 at ages 6–18.
  • For three people the line at ages 6 to 18 is about $3,028 a month. The county adds a small allowance when a family is just over, so being close is worth an application.
  • A child who is a citizen or lawfully in the country can get full Medical Assistance. If your child's immigration status blocks full coverage, ask the counselor about Emergency Medical Assistance, which covers emergencies but not the whole course of treatment.
Why families with insurance still consider MA
  • If your child is on a work plan, it pays first. MA can add coverage for your child without a premium, or stand alone.
  • Rides and medically necessary home care may become available after the separate reviews.
What to weigh before changing coverage
  • The financial counselor can check whether each treating clinic accepts both plans and how it handles bills.
  • Removing a child from a work plan may not reduce a family premium. Returning to that plan later can have its own enrollment rules.
What you get
  • No premium for covered hospital care, chemotherapy, medicines and tests. Children under 18 generally have no MA copays.
  • Dental and vision care for your child.
  • Rides to appointments and home nursing when the separate requirements are met.
  • Earlier eligible medical bills can be covered.
What the help includes
  • Cancer care, hospital stays, prescriptions, dental and vision are part of full MA coverage. Rides and nursing require their own arrangements.
  • For children under 21, EPSDT can cover medically necessary care within federal Medicaid benefit categories. It does not promise every requested service.
  • Your work plan is billed first. For covered care, the clinic cannot bill you the deductible or copay the work plan left, even when Medical Assistance pays nothing extra. If a bill arrives anyway, ask the financial counselor to check it before paying.
If you decide to apply
  1. Ask the hospital's financial counselor to help you complete the COMPASS application, or use the County Assistance Office.
  2. Have ready: recent pay stubs, your child's ID, insurance cards and bills from earlier months.
  3. Ask the counselor whether the hospital can open temporary coverage while the county reviews your application.

1-866-550-4355 · Official page ↗

After you ask
  • The county reviews your MA application and sends a written decision. Your financial counselor can check the processing deadline and whether a qualified hospital can start temporary coverage through COMPASS. The hospital’s temporary-coverage review and your full application are separate steps.
  • Coverage can reach back three eligible months before the application month through 2026. For child applications from January 1, 2027, it reaches back two months.
  • Children under 19 receive 12 months of continuous eligibility, federally required since January 1, 2024. Limited exceptions include turning 19, moving out of state, voluntary withdrawal, death, or eligibility granted in error because of fraud, abuse or perjury.
  • The county confirms your child’s renewal date and whether a longer young-child coverage period applies. The coverage notice gives the date your family should use.
  • Hospital temporary coverage begins on the hospital’s eligibility decision date. Without a full application by the end of the following month, it ends then. A full application submitted within that period keeps temporary coverage in place until the agency decides. The hospital submits its decision electronically within five business days.
Good to know

Work insurance can stay in place and gets billed first. Before choosing an MA plan, check the hospital, oncology group and pharmacy with the financial counselor.

Other details
  • PH95 is a separate MA route for a child under 18 who meets the disability rules. It leaves parents' income out after verifying it.
  • Keeping both plans means keeping the work premium and managing two insurance cards. The exact MA plan still needs to cover your treatment team.
  • HIPP can review the employer premium after a family member has MA. Joining it changes how MA care is billed.
  • If your child's Medical Assistance plan refuses a treatment, you have 60 days from the letter to appeal, and the plan usually answers within 30 days. When waiting could harm your child, ask for the urgent version, which is decided within about three days.
  • If the plan's own appeal fails, you have 120 days to ask the state for a hearing and 15 days to ask for an outside medical review. Your social worker can say which route fits the letter you received.
  • If the plan tries to stop a service your child already has, you must ask in writing within ten days of the notice to keep it going during the appeal. Your social worker can check the exact date on the letter.

Federal background: Medicaid and Medicaid as second insurance.

Official sources
Ask your social worker

“Could Medical Assistance reduce our child's treatment bills while we keep our insurance? What would managing both plans involve, and would you help us apply if it makes sense?”

Why I’m asking: I want fewer treatment bills and a clear picture of how two insurers would work together.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on COMPASS today and report this month's income and any insurance. Name the months with old bills and choose a plan the oncology group takes.

Your social worker

The oncology social worker or financial counselor helps you file, asks the hospital to open temporary MA the qualified hospital’s COMPASS process that day, and follows the 30-day decision.

The care team

Nothing for ordinary child MA. Medical records are needed only for the PH95 disability category.

Who decides
The County Assistance Office (the county benefits office) checks income. The state Department of Human Services and the HealthChoices plan you pick run the coverage.
Ask your social worker
“Can you help me file on COMPASS today and ask the hospital for presumptive eligibility while we wait? Can we list bills from the three prior months and check that the hospital and oncology group take the plan?”

How to apply

First step: Apply at compass.dhs.pa.gov (COMPASS, the state's online application) or call 1-866-550-4355 this week. Ask the hospital counselor today for temporary MA (presumptive eligibility) while the county checks the application.

  1. Apply on COMPASS this week and ask the hospital counselor for presumptive eligibility today.
  2. List the months with bills so the look-back covers the admission.
  3. Pick a HealthChoices plan the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply on COMPASS, by phone at 1-866-550-4355, or at the County Assistance Office. Ask the hospital's financial counselor for hospital presumptive eligibility the same day.

What to gather

  • Child's birth certificate or ID and Social Security number
  • Pennsylvania address
  • This month's income for each parent in the tax household (recent pay stubs)
  • Insurance cards, if any
  • Hospital bills from the three months before the application
  • Form PA 600 HC, if the hospital files the qualified hospital’s COMPASS process for you

How long: The handbook gives the county 30 days from a COMPASS application. Temporary MA from the hospital can start the same day. Once approved, coverage reaches back up to three months before the month you applied (two months from January 1, 2027).

What a yes looks like

A notice with coverage dates and a choice of HealthChoices plan (the Medicaid health plans). Check that the hospital and the oncology group are in that plan before choosing. 12 months of continuous coverage follows.

What a no looks like, and the next move

Check whether the county said no on income, a document or a category. If income is the reason, ask for PH95 by name and appeal by the date on the notice.

Watch out

  • Pennsylvania counts the tax household and this month's income, not last year's return or everyone under the roof.
  • Your child can keep private insurance and have MA too. Do not cancel the work plan to apply.
  • If the county says income is too high, ask in the same application for PH95 (Medicaid for Children with Special Needs), which leaves parents' income out.

Dates that change this

2026-01-13: Income limits are the state's 2026 Federal Poverty Income Guidelines table (January 13, 2026 basis); the 2027 date was not published.

2027-01-01: Coverage reaches back up to three months before the application month now; two months for applications made on or after January 1, 2027.

2024-11-14: Federal Medicaid approved continuous coverage for Pennsylvania children through the month of the sixth birthday (amended November 14, 2024); whether it is running was not verified. Count on 12 months. (not yet confirmed against the final rule)

2026-10-01: From October 1, 2026, federal immigration funding rules change. Pennsylvania preserves a lawfully residing child pathway; the county checks the child-specific category and coverage rules. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 9, 2026.

What it is worth

Full Medical Assistance with no premium. For four people the limits are $5,913 under age 1, $4,318 at ages 1 to 5 and $3,658 at ages 6 to 18, plus a $137.50 allowance when it makes the difference.

  • $5,913/month — Under age 1, family of 4, published line (215%)
  • $4,318/month — Ages 1 to 5, family of 4, published line (157%)
  • $3,658/month — Ages 6 to 18, family of 4, published line (133%)
  • $137.5/month — Published 5% disregard cell, family of 4 (applied only when it changes the answer)
  • $3,028/month — Ages 6 to 18, family of 3, published line (133%)
  • $113.85/month — Published 5% disregard cell, family of 3

Covers: Hospital and clinic care · Chemotherapy and prescriptions · EPSDT: anything medically necessary for a child under 21 · Shift nursing, personal care and home health when approved · Rides to appointments (MATP) · Dental and vision

What it costs the family: No premium. No copays for children.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI budget group; base lines 215 / 157 / 133% FPIG with a 5% disregard applied only if it would make a difference (MA Handbook 312.5)
Insurance status condition
none: MA is secondary to private insurance (OCYF Bulletin 3140-25-01 ch. 7)
Residency
Pennsylvania
Continuous eligibility
12 months (children under 19); the approved through-age-6 extension is not verified as operational
Retroactive months
3 now; 2 from 2027-01-01
Processing standard
30 days from a COMPASS submission (MA Handbook 304.5)

Decisions this site cannot make: County Assistance Office MAGI determination · Hospital presumptive eligibility (qualified hospital, the qualified hospital’s COMPASS process)

Expect friction on: HealthChoices plan choice and oncology network check

The trap: Pennsylvania counts the tax household and this month's income. The county applies the 5% allowance only when it changes the answer, so an income between the base limit and the allowance limit still gets a yes. Do not cancel private insurance to apply.

Where I read this

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