How pa medicaid application form 2025

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The PA-4 form will be used to assist the assessor in determining whether home and community based long-term care services can best meet the needs of the individual. Complete the top portion of the PA-4 with the individuals name, address, phone number, date of birth, veteran status, Social Security and Medicaid number.
Typically it takes up to 30 days to get a decision once a Medical Assistance (MA) application is submitted. However, if the applicant is experiencing a medical emergency, the County Assistance Office (CAO) can speed up the proceeding of the application.
What documents and information do you need for your Medicaid application? Your name and date of birth. Your Social Security number. Your monthly payment amounts for rent, mortgage, or utilities. Proof of citizenship or immigration status. Proof of income, like paystubs or W-2s.
Other Eligibility Requirements Your Identity. Your identity can be verified by PA drivers license, PA identification card, or a government-issued passport. Your Social Security Number (SSN) Your PA Residency. Your Citizenship. Your Household.
Income Asset Limits for Eligibility 2025 Pennsylvania Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingle Income Limit Asset Limit Institutional / Nursing Home Medicaid $2,901 / month* $2,000 Medicaid Waivers / Home and Community Based Services $2,901 / month $2,0001 more row Dec 20, 2024
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