Medical Assistance: How Pennsylvania Runs Medicaid

If you need a Medicaid office in Pennsylvania, start with the vocabulary. The commonwealth calls its Medicaid program Medical Assistance, often shortened to MA. The Pennsylvania Department of Human Services (DHS) administers it, and DHS's Office of Medical Assistance Programs sets coverage rules, provider payments and managed care contracts.

DHS does not operate a single walk-in counter for the whole state. Applications and renewals move through County Assistance Offices, known as CAOs, along with the online COMPASS portal, mail, telephone and community partners such as hospitals and health centers. Our directory lists three Medicaid offices in Pennsylvania, and each sits in a different county. That pattern reflects how the system works: services follow county lines.

Pennsylvania expanded Medicaid to low-income adults in January 2015. Adults aged 19 to 64 can qualify when household income is at or below 138 percent of the federal poverty level. Children, pregnant women, older adults and people with disabilities qualify under separate categories, each with its own income limits and, in some cases, resource limits.

Most enrollees receive care through HealthChoices, the state's mandatory managed care program. You choose a health plan, and the plan pays your doctors, pharmacy and hospital bills. Adults who have both Medicare and Medicaid, or who need long-term services and supports, are generally enrolled in Community HealthChoices. Your ACCESS card proves you are covered, and your plan sends its own member card as well.

Because Pennsylvania has 67 counties and more than 13 million residents, local offices carry a heavy load. Wait times, appointment rules and phone queues vary from one county to the next, so a quick call often saves a wasted trip.

Medicaid Office Listings in Audubon, Irwin and Lemoyne

Our database includes three Pennsylvania listings. The Norristown Pennsylvania Medicaid Office is at 1000 Madison Avenue in Audubon, in Montgomery County, and the phone number is 610-631-5920. The Irwin Pennsylvania Medicaid Office is at 10950 Old Route 30 in Irwin, in Westmoreland County, and its number is 724-861-3670. The Lemoyne Pennsylvania Medicaid Office is at 106 Lowther Street in Lemoyne, in Cumberland County, reachable at 717-712-1220.

Read the names closely. The Norristown listing carries an Audubon address, because Norristown is the Montgomery County seat while Audubon is a separate community nearby in Lower Providence Township. Always check the street address rather than the name before you travel.

The three listings cover very different parts of the commonwealth. Audubon lies northwest of Philadelphia in the suburban ring. Irwin sits east of Pittsburgh, in the commuter belt of Westmoreland County. Lemoyne is on the west shore of the Susquehanna River, directly across from Harrisburg. Together they touch southeastern, southwestern and south-central Pennsylvania.

Office hours, walk-in rules and the services offered at each site can change without much notice. Call the listed number first. Ask whether the office accepts new applications in person, helps only with existing cases, or requires an appointment, and ask what documents to carry.

Applying for Pennsylvania Medical Assistance: Documents and Timelines

You can apply four ways: online through COMPASS, by phone, by mail, or in person at a County Assistance Office. Online is fastest for most people, and you can upload photos of documents from a smartphone. Paper applications go to the CAO that serves your county of residence.

Gather these items before you start:

Once DHS has your application, federal rules generally give the state 45 days to decide, or 90 days when a disability determination is needed. You may receive a notice asking for more proof. Respond by the date printed on it, because missing that deadline is a common reason applications are denied. Keep copies of everything you send.

If you disagree with a decision, you have the right to appeal and request a fair hearing. The notice lists the deadline, and a shorter window applies if you want benefits to continue while the appeal is pending. Free legal aid organizations in many counties can help you prepare.

Philadelphia Suburbs, Pittsburgh Commuter Towns and Rural Counties

Access to a Medicaid office depends heavily on where you live. Philadelphia and Allegheny County, the state's two largest population centers, have several County Assistance Offices each and handle the highest application volumes. Suburban counties such as Montgomery and Cumberland usually have fewer sites, but good road links and frequent public transit make visits manageable.

Rural counties in the northern tier and central mountains, including Potter, Cameron and Sullivan, are a different story. Distances are long, winter weather can close roads, and a single office may serve the whole county. For these residents, COMPASS and the telephone are often more practical than a drive.

Even after you are approved, your county matters. Behavioral health services under HealthChoices are arranged through county-based contracts, and each county has its own provider network. The Medical Assistance Transportation Program, or MATP, is also run locally and offers rides to covered medical appointments for people with no other way to get there.

In Westmoreland County, where Irwin is located, many residents travel toward Pittsburgh for specialists, so check that your health plan includes the hospital you use. In Cumberland County, residents often cross the river to Harrisburg for care, and the same plan-network check applies.

Language access also varies. Federal rules require language assistance, which matters in diverse communities such as Norristown and parts of Philadelphia. Ask for an interpreter when you call or visit; there is no charge.

Next Steps for Pennsylvania Residents Seeking Medicaid

Use this short sequence to move from searching to getting covered. First, confirm your county and find the CAO that serves it. Second, call the office, or the nearby listing in Audubon, Irwin or Lemoyne if it is closest, and ask about hours and appointments. Third, gather your documents and apply through COMPASS if you have internet access.

After approval, choose a HealthChoices plan promptly. If you do not choose, DHS assigns one for you. Keep your ACCESS card, save your case number, and report changes in income, address or household size as soon as they happen. Watch your mail each year for a renewal notice, and return it on time to avoid a gap in coverage.

If your income is above Medicaid limits, you may still qualify for subsidized coverage through Pennie, Pennsylvania's health insurance marketplace, or for CHIP for children. A CAO or a certified application counselor can point you to the right program. Start with a phone call and bring a list of questions.

Keep a simple folder, paper or digital, with every notice, letter and confirmation number. When you call an office, write down the date, the name of the person you spoke with and what they told you. That record is useful if a document goes missing or a deadline is disputed.

Medicaid in Pennsylvania is administered by the state health and human services agency, providing health coverage for eligible low-income residents through a combination of fee-for-service and managed care delivery systems tailored to the state's population needs.

Medicaid Office locations are available in 3 cities across Pennsylvania. They are spread across 3 counties.

Cities with the highest concentration include Lemoyne, Irwin, Audubon, which have the largest Medicaid caseloads in the state and dedicated eligibility offices to serve high-need urban populations.

Residents of Pennsylvania can apply for Medicaid online through the state's health benefits portal or health exchange, by calling the Medicaid agency's toll-free number, or by visiting a local eligibility office with the required documentation.

Norristown Pennsylvania Medicaid Office

View Details Call Now (610) 631-5920

Norristown Pennsylvania Medicaid Office

Address
Get Direction
Hours

Irwin Pennsylvania Medicaid Office

View Details Call Now (724) 861-3670

Irwin Pennsylvania Medicaid Office

Address
Get Direction
Hours

Lemoyne Pennsylvania Medicaid Office

View Details Call Now (717) 712-1220

Lemoyne Pennsylvania Medicaid Office

Address
Get Direction
Hours

Residents of Pennsylvania who currently receive Medicaid should complete their annual renewal on time to avoid a gap in coverage. Most states send renewal notices by mail and email, and online renewal is typically the fastest method to maintain uninterrupted healthcare coverage.

Browse Medicaid Office by county across Pennsylvania to find the nearest location.

Local Medicaid Notes for Montgomery, Westmoreland and Cumberland Counties

The three listings in our database fall in counties with different profiles. Montgomery County, home to Audubon and the county seat of Norristown, is one of the largest suburban counties in the Philadelphia region. Residents there often have access to several hospital systems, so plan network choices can be broad. Westmoreland County, with Irwin near the Allegheny County line, mixes commuter suburbs with rural townships farther east, where distances grow. Cumberland County, with Lemoyne on the Susquehanna, sits in the Harrisburg area and includes the county seat of Carlisle.

County lines matter because your application is processed by the County Assistance Office for the county where you live, not where you work or receive care. If you move between counties, report your new address so your case can transfer. Moving within Pennsylvania does not end your eligibility, but failing to update your address can cause missed notices and lost coverage.

Before you visit any listing, check the county page for nearby offices and compare hours. Bring photo identification and original documents, and ask for a receipt or confirmation number for anything you drop off. If a listing is not the right fit, staff can usually tell you which office serves your address.

Community partners can fill gaps. Federally qualified health centers, hospital financial counselors and Area Agencies on Aging often assist with applications at no cost, which helps older adults and people with limited internet access in rural parts of these counties. Residents who are unsure which county applies can start with the county pages above, then confirm with the county's assistance office by phone.

Pennsylvania Medicaid Office FAQs

Pennsylvania calls its Medicaid program Medical Assistance, or MA. The Department of Human Services administers it statewide, and its Office of Medical Assistance Programs oversees coverage rules, provider enrollment and managed care contracts. Day-to-day eligibility work happens through County Assistance Offices, which take applications, request verification and process renewals for residents of their counties. Health care itself is delivered by private managed care organizations under the HealthChoices program, so your doctor bills your plan rather than DHS. If you have a problem with a bill or a denied service, contact your plan first, then DHS if the issue is not resolved.

No. You can apply online through COMPASS, by phone or by mail, and many people never visit an office. In-person visits are useful when you need help with a complicated case, want to drop off documents, or lack internet access. Our listings in Audubon, Irwin and Lemoyne are starting points, but hours and services can change, so call 610-631-5920, 724-861-3670 or 717-712-1220 first and ask what the site handles. If the office cannot help with your request, ask which County Assistance Office serves your address and whether you need an appointment to be seen.

Since January 2015, adults aged 19 to 64 can qualify when household income is at or below 138 percent of the federal poverty level, even without children or a disability. Other groups qualify through separate rules, including children, pregnant women, parents and caretaker relatives, adults 65 or older, and people who are blind or disabled. Some categories also count resources such as savings. Citizenship or eligible immigration status is required for full coverage, though emergency services may be covered for others. Because limits change each year with the poverty guidelines, check current figures with a County Assistance Office or COMPASS.

Federal rules generally allow up to 45 days for a decision, and up to 90 days if a disability determination is required. Many straightforward applications are decided faster, especially when income can be verified electronically. Delays usually come from missing documents, so respond quickly to any request for information. You can check your status through your COMPASS account or by calling the County Assistance Office that handles your case. If you wait beyond these time frames without an answer, ask to speak with a supervisor or contact a legal aid organization in your county for help.

Yes. The Medical Assistance Transportation Program, known as MATP, provides non-emergency transportation to covered medical services for eligible residents who have no other way to get there. MATP is administered locally in each county, so the process for scheduling rides, the notice required and the type of transport differ by area. In rural counties, rides may be arranged through shared-ride providers, while other areas may offer transit passes or mileage reimbursement. Call your county's MATP provider several days ahead of your appointment. Your County Assistance Office or health plan can tell you which provider covers your county.

You still have options. Pennie, Pennsylvania's state-run health insurance marketplace, offers private plans, and many households qualify for premium tax credits based on income. Children in families above Medicaid limits may qualify for the Children's Health Insurance Program, known as CHIP, which is free or low-cost depending on income. Pennsylvania also has Medical Assistance for Workers with Disabilities, a program that lets some employed people with disabilities buy into coverage even with higher earnings. A County Assistance Office, Pennie or a certified navigator can screen you for each program without charge. Apply promptly, since coverage start dates depend on timing.