According to the Department of Welfare, approximately 1.9 million of the 12.5 million residents of the State of Pennsylvania received assistance for medical care. Medical Assistance, also called Medicaid helps to pay for health care services for low income individuals, pregnant women, and children under the age of 18 who live on a limited income with high medical costs. If you need help with medical expenses and reside in the state of Pennsylvania, then you may want to apply for Pennsylvania Medicaid.
Instructions
1. Download and print the Pennsylvania Medicaid application form through the Pennsylvania Department of Public Welfare's website, at dpw.state.pa.us. If you do not have access to a printer, you may also go to your county's health and human services office.
2. Check what type of benefits you want to receive. If you are applying solely for Medicaid, choose "medical assistance." You will have a series of yes or no boxes to fill out on the medical assistance application, which will cover areas such as language, migrant worker status, permanent home, housing assistance and whether you have received a disqualification from receipt of services.
3. Enter your personal information, including your first name, middle initial, and last name. You will need to enter your address, how long you have resided at the location, telephone number, and previous address. You will also need to enter whether or not you have received benefits in another state or if you have used another name or social security number.
4. Fill in information for each member of your household, which includes anyone who lives at your address. You will need to enter the first and last name of each individual, whether they are applying for medical assistance, other names used, date of birth, gender, social security number, how they are related to the applicant and their educational level. You will then need to enter their veteran status, marital status, race, whether or not they have a Pennsylvania Access Card, the name on their birth certificate, mother's maiden name, and a state identification number.
5. Complete the criminal history inquiry. Although those with a criminal record can still receive benefits, they must comply with all court orders, probation requirements, parole, and be on time with payment of court or other fines.
6. Continue to answer questions about citizenship, sponsorship, if anyone in the household is a student, in the military, a widow or directly related to a veteran. Answer questions regarding disability status in regards to medical attention, drug or alcohol problems, health sustaining medication, social security, mental disability, and domestic violence.
7. Complete the employment and income information that goes over self-employment, number of hours worked, and asks whether anyone in the household worked in the last five years. You will need to include a work history. Provide verification of household income, including pay stubs, unemployment forms or other documentation to verify the income for each working member of your household.
8. Enter information about other medical insurance, loss of job, and if anyone is pregnant or seriously ill in the household.
9. Include information about property ownerships, including home, car, truck or motorcycle, life insurance policies, and burial plots.
10. Enter information about your unpaid medical bills, as well as paid medical expenses three months prior to the application date.
11. Include information about your household expenses, including utility costs, energy assistance, meals and shared expenses. You may need to provide verification of expenses, including rent, property taxes, insurance, lot rent, and utilities.
12. Sign and date the application form and either bring it into the county office or send it via mail.
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