Eligibility


General Eligibility Requirements

You must meet income, resource (in many cases), and other eligibility requirements in order to be eligible for Medical Assistance (Medicaid). Eligible members may include:

  • Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG)
  • Individuals aged 65 and older, blind and disabled (Identified for Medical Assistance purposes as SSI-related)
  • Families with children under age 21 (Identified for Medical Assistance purposes as TANF-related)
  • Single and married individuals with a temporary disability, age 59 - 64, limited income or special circumstances (Identified for Medical Assistance purposes as GA-related) such as:
    • Under-going drug and alcohol treatment
    • Victims of domestic violence
    • Caring for a child or disabled person
    • Special Medical Assistance conditions


This information is issued on behalf of Highmark Wholecare, coverage by Gateway Health Plan, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.

Ready to Apply?

You must be eligible for Medical Assistance before becoming a Highmark Wholecare member. To see if you are eligible visit the Commonwealth of Pennsylvania Application for Social Services (COMPASS).

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