Low-income seniors are more likely than their middle or high-income peers to lack access to healthcare. Fortunately, Medicaid helps Philadelphia seniors who otherwise afford insurance premiums access the healthcare they need. Understanding the eligibility requirements, however, is one of the biggest barriers seniors often face to accessing the care they need. At AmeriBest Home Care, we strive to empower seniors in our community to live independently and assist them in meeting their needs. Here is our comprehensive guide on Medicaid, both eligibility requirements and benefits.

Medicaid Benefits

Medicaid, also called the Medical Assistance Program, is funded jointly by the state and federal governments. Medicaid provides healthcare coverage to low-income families and individuals, including seniors. The program covers a wide range of services to meet seniors’ healthcare needs including,

Doctor visits
Hospitalization
Emergency care visits
Prescriptions
Long-term care

The Pennsylvania Department of Human Services (DHS) administers the Medical Assistance Program. Apply for Medicaid through the DHS website or by visiting their local County Assistance Office.

Qualifying for Medicaid in Philadelphia

To qualify for Medicaid in Philadelphia, you must satisfy four requirements: Residency, Citizenship or Immigration Status, Category, and Income/Resource Limits. Navigating these requirements can seem daunting. Let’s break them down.

(1) Residency

The state of Pennsylvania considers you a resident as long as you are present in the state and intend to stay. You don’t have to have a permanent residence, nor do you have to spend any specified amount of time in the state. You do need a place to receive mail, since Medical Assistance sends information via US Mail.

(2) Citizenship and Immigration Status

You have to prove that you are either a US citizen or that you have the required immigration status to receive Medicaid. You are a citizen if you were born in the US, regardless of your parent’s citizen status. Immigrants must be “lawfully present” in the US or “qualified”. Qualified immigrants include,

Green card holders
Refugees
Asylees
Cuban/Haitian entrants
Conditional entrants
Individuals paroled into the US for more than a year
Certain survivors of trafficking or domestic violence and their children
Persons granted withholding of deportation or removal

Lawfully present immigrants include,

Those with temporary resident status or pending applications
Family unity beneficiaries
Those with employment authorization
Those with approved visa petitions

(3) Category & (4) Income Limits

Income and resource aid limits vary by category, so it’s important to determine the category you fit into. You may meet the criteria for more than one category, in which case you should apply under the category that provides you the most benefits.

For seniors, these categories include,

Healthy Horizons

Adults 65+ whose

Disability is expected to last more than 12 months
With income at 100% of the Federal Poverty Limit
With resources limited to $2000 for a single person or $3000 for a couple

Medicare Savings Program

Adults who

Qualify for Medicare
With income at 135% of the Federal Poverty Level
With resources limited to $7860 for a single person or $11,800 for a couple

HCBS Waiver Programs

Home and Community-Based Services Waiver for those who

Require an institutional level of care
Require other functional care that varies by specific waiver
Have an income limit of 300% of the Federal Benefit Rate
Have a resource limit of $8000

Examples of income that may be counted when determining eligibility include,

Temporary Assistance for Needy Families (TANF) benefits
Supplemental Security Income (SSI)
Supplemental Nutrition Assistance Program (SNAP) benefits
Low Income Home Energy Assistance Program (LIHEAP) benefits
Foster Care payments
Certain housing or utility subsidies
Weatherization Payments

Home Care vs Facility-Based Assisted Living in Philadelphia PA

Are You Applying for Medicaid to Cover Senior Care in Philadelphia, PA?

At AmeriBest Home Care, we want to empower you to choose the right care and program for you or your loved one. We can help educate you on the categories, limits, and options available to you. Whether you’re caring for elderly parents or someone with a disability, it’s important to consider your options carefully.