Understanding Medicaid & CHIP in Pennsylvania
Free or very low-cost health coverage for Delaware County families. Plain language, step-by-step guidance.
What is Medicaid?
Medicaid is free or very low-cost health insurance provided by the government for people with limited income. In Pennsylvania, it's officially called Medical Assistance (MA) or sometimes "Healthy Horizons."
Medicaid covers a wide range of services:
- Doctor visits and check-ups
- Hospital care (inpatient and outpatient)
- Prescriptions (with very low or no copay)
- Mental health and substance use treatment
- Prenatal care and delivery
- Emergency care
- Dental care for children
- Vision care for children
- Medical transportation
What is CHIP?
CHIP stands for Children's Health Insurance Program. It covers children and teens under 19 whose family earns too much for Medicaid but still can't afford private insurance.
CHIP costs $0 to $60 per month per child depending on your income — much less than private insurance.
CHIP covers:
- Doctor visits and well-child checkups
- Prescriptions
- Dental and vision care
- Mental health services
- Emergency care
- Specialist visits
Do I Qualify? Income Limits
These are 2025 estimates. Don't assume you earn too much — many working families qualify. There is no asset test for most adults under 65.
| Who | Income Limit (% of FPL) | Monthly Income Limit (Family of 4, 2025) | Program |
|---|---|---|---|
| Adults 19–64 | Up to 138% FPL | Up to ~$3,588/month | Medicaid / Medical Assistance |
| Pregnant people | Up to 220% FPL | Up to ~$5,717/month | Medicaid for Pregnant Women |
| Children (Medicaid) | Up to 162–220% FPL | Varies by age | Children's Medicaid |
| Children (CHIP) | Up to 319% FPL | Up to ~$8,296/month (~$97,200/year) | Pennsylvania CHIP |
| Workers with disabilities (MAWD) | Up to 250% FPL | Up to ~$6,498/month | MAWD — Medicaid for Workers with Disabilities |
How to Apply — Step by Step
Step 1: Gather Your Documents
Collect ID, proof of income, proof of residence, and Social Security numbers for everyone applying. (See checklist below.)
Apply Online at COMPASS — Easiest Option
Go to compass.state.pa.us and complete the online application. Available 24/7. You can save and return later.
OR Call — 1-866-550-4355
A DHS worker can take your application over the phone, Mon–Fri 8 AM–5 PM.
OR Visit a Delaware County Assistance Office
Chester: 701 Crosby Street Suite A, Chester, PA 19013 — (610) 447-5500
Darby: 845 Main Street, Darby, PA 19023 — (610) 461-3800
Both open Monday–Friday, 8 AM–5 PM
Wait for a Decision
Most decisions are made within 45 days. If you're pregnant, it's usually within 10 days. Watch your mail AND your COMPASS online account.
Receive Your Coverage Card
You'll receive a HealthChoices MCO card. You'll need to choose a primary care doctor in your plan's network. Call the number on your card for help.
Documents You'll Need
Gather these before you apply to make the process faster. Don't have everything? Apply anyway — you can submit documents later.
- Photo ID — Driver's license, state ID, or school ID for children
- Social Security Number — For each person applying (if available)
- Proof of citizenship or lawful presence — Birth certificate, US passport, green card, or work permit
- Proof of income (last 30 days) — Pay stubs, employer letter, or self-employment records. If unemployed, write "none."
- Proof of home address — Utility bill, lease agreement, or any official mail with your name and current address
Keep Your Medicaid: Renewal Tips
Medicaid renews every 12 months. Over half of Pennsylvanians who lost Medicaid in 2023–2024 were still eligible — they lost it due to paperwork issues, not income.
- Always update your address with DHS when you move — even within the same city
- Open every envelope from "PA DHS" or "County Assistance Office" — don't ignore yellow or blue envelopes
- Log into compass.state.pa.us every few months to check your renewal date
- Respond to ANY renewal request within the deadline — even if nothing has changed
- If you get a termination notice: Call PHLP immediately at 1-800-274-3258 — they provide free legal help
Common Mistakes That Cost Coverage
- Not updating your address when you move — Your renewal letter goes to your old address and you never see it
- Missing the renewal deadline — It is NOT automatic for most adults; you must respond
- Throwing away DHS mail — It looks like junk mail but it's not
- Assuming you don't qualify because you work — Most working people under the income limit still qualify
- Not applying for children due to immigration fears — Your child's application does not affect your own status
Special Medicaid Programs
Since April 2022, Pennsylvania provides full Medicaid coverage for 12 months after your pregnancy ends — whether through birth, miscarriage, or stillbirth. This coverage continues even if your income goes above the normal Medicaid limit during those 12 months.
If you work and have a disability, you may qualify for Medicaid even with a higher income — up to 250% FPL (about $6,498/month for a family of 4). There is a small monthly premium. This program allows people with disabilities to work without losing their healthcare coverage.
Emergency Medicaid covers emergency medical care regardless of immigration status. It does NOT require proof of citizenship or a Social Security number. It covers the emergency stabilization of a condition that is an immediate threat to life or health.
If you have Medicaid and need a ride to a medical appointment, you may be entitled to free transportation. Contact the Delaware County Medical Assistance Transportation Program (MATP) at (610) 490-1300. Schedule at least 2 business days in advance.
Frequently Asked Questions
No. Most working adults qualify if their household income is under 138% of the Federal Poverty Level (about $3,588/month for a family of 4 in 2025). Many full- and part-time workers, including gig workers and the self-employed, qualify for Medicaid.
Medicaid has no enrollment period. You can apply any day of the year — January 1st, a Tuesday in July, any time. If you think you might qualify, apply today at compass.state.pa.us.
Yes. Your child qualifies as a U.S. citizen and is fully eligible for Medicaid and CHIP. You do not need to provide your own immigration status to apply for your child. ChesPenn Health Services also serves everyone regardless of immigration status.
Usually within 45 days for most applicants. If you are pregnant, approval typically takes within 10 days. Watch both your mail and your COMPASS account online for updates.
Medicaid covers: doctor visits, hospital care (inpatient and outpatient), prescription drugs (with very low copays), mental health and substance use treatment, prenatal care and delivery, emergency care, dental care for children, vision care for children, medical transportation, durable medical equipment, and much more.
If your doctor is in your Medicaid Managed Care Organization (MCO) network, yes. If not, you may need to switch doctors or request an exception. When you receive your MCO card, call the number on it to confirm your doctor is in-network, or search online using your MCO's provider directory.
Report any changes in income or insurance to DHS. You may still qualify for Medicaid if your employer's insurance is unaffordable, or your children may remain eligible for CHIP. Always report changes within 10 days — don't wait until your renewal.
You have the right to appeal any denial or termination. Call the Pennsylvania Health Law Project (PHLP) free at 1-800-274-3258. They provide free legal help specifically for Medicaid problems and can represent you in a Fair Hearing. Act quickly — deadlines apply.
Need Help Applying?
Free enrollment assistance is available. Call one of these helplines — they will help you apply at no cost.