Medicaid in Philadelphia: Where to Find Care and How to Apply

Fishtown Medicine runs on a membership model, and Medicaid's billing rules do not fit a flat monthly fee. So we do not accept Medicaid here, and we want to be direct about that up front rather than have you find out partway through a call.

What we can do is point you somewhere better than a search engine. Philadelphia has good primary care built for Medicaid, run by people who do this well and do it every day. This page collects that, along with how to apply for Pennsylvania Medical Assistance (the state's name for Medicaid) and what to do if your income moves you in or out of eligibility, which happens often for small business owners and anyone working gig or seasonal hours.

How to apply for or renew Medical Assistance in Pennsylvania

Pennsylvania calls its Medicaid program Medical Assistance (MA). Applying, renewing, and reporting a change in income or household all go through the same state system.

• COMPASS. Pennsylvania's benefits portal handles Medical Assistance applications, renewals, and eligibility checks online. compass.state.pa.us
• Philadelphia County Assistance Office. For help in person or by phone, call 215-560-7226. There are several CAO locations across the city if you prefer to apply face to face.
• Statewide Medical Assistance helpline. Call 1-866-550-4355 for questions about an existing case, a denial, or a renewal that is due.
• Pennsylvania Health Law Project (PHLP). A nonprofit legal aid group that helps people fight denials, delays, and coverage disputes with Medical Assistance, free of charge. Call 1-800-274-3258 or visit phlp.org.

Renewals lapse more often from a missed letter than from losing eligibility outright. If your address or phone number changes, update it in COMPASS the same day, and open every piece of mail from the county assistance office, even the ones that look routine.

Where to find primary care that takes Medicaid in Philadelphia

Philadelphia's Medical Assistance runs through managed care, meaning your coverage is administered by one of a small number of health plans (HealthChoices), and most primary care practices that accept Medicaid work with several of them.

• City of Philadelphia health centers. The Department of Public Health runs neighborhood health centers with primary care regardless of insurance or immigration status, Medicaid included. Find a location or call 311.
• Greater Philadelphia Health Action (GPHA). A federally qualified health center network with several locations across the city, built specifically for Medicaid and uninsured patients. gphainc.org
• Esperanza Health Center. Community-based primary care in North Philadelphia, serving Medicaid patients with bilingual staff. esperanzahealthcenter.org
• Congreso de Latinos Unidos. Community health and social services in Eastern North Philadelphia, including primary care for Medicaid patients. congreso.net
• Public Health Management Corporation (PHMC). Runs several community health centers across the city with Medicaid-based primary care. phmc.org
• Your HealthChoices plan's own directory. AmeriHealth Caritas, Keystone First, and Health Partners Plans (the 3 HealthChoices plans serving Philadelphia) each maintain a provider directory. The member services number on the back of your insurance card is the fastest way to find a primary care doctor already in your plan's network near you.

If you have both Medicaid and Medicare (dual-eligible)

Some people qualify for both programs at once, usually from a combination of age or disability and limited income. Insurers offer a specific kind of plan for this called a D-SNP (Dual-Eligible Special Needs Plan), which combines Medicare and Medicaid coverage into a single plan with extra care coordination built in.

• Oak Street Health and Dedicated Senior Medical Center both work with D-SNP plans and build their care model around this population specifically, so they are where I would point a dual-eligible patient first. See our Medicare guide for more on both.
• Your D-SNP plan's member services line (on the back of the insurance card) can confirm which local primary care practices are in its network.
• APPRISE (see the Medicare guide) also helps sort out D-SNP options specifically, since dual-eligible plans work differently from standard Medicaid or standard Medicare Advantage.

If you run a small business or your income changes

Medical Assistance eligibility is based on household income, and for anyone self-employed, running a small shop, or working gig or seasonal hours, that number moves. A slow month can drop you under the Medicaid threshold; a strong one can push you over it into marketplace territory. Both directions are normal, and neither should catch you without coverage.

• Recheck your eligibility when income changes, not just at renewal. COMPASS lets you report a change any time, and doing it promptly is what keeps a lapse from happening.
• If you land just above the Medicaid line, Pennsylvania's marketplace, Pennie, offers subsidized plans, and many small business owners qualify for meaningful premium tax credits. pennie.com
• If a plan or the county assistance office denies you and you think it's wrong, the Pennsylvania Health Law Project (above) takes these cases for free and knows the appeals process well.

Other help while you get set up

• Dial 211 for help with housing, food, utilities, and other basic needs. 211.org
• 988 Suicide and Crisis Lifeline. Call or text 988, any time, for a mental health crisis.
• Our full Trusted Resources page covers crisis lines, quitting smoking or drinking, and more, regardless of what insurance you carry.

Dr. Ash is a board-certified internal medicine physician at Fishtown Medicine in Philadelphia.