{"id":14236,"date":"2026-10-20T07:15:36","date_gmt":"2026-10-20T07:15:36","guid":{"rendered":"https:\/\/cintexwireless.com\/blog\/?p=14236"},"modified":"2026-10-20T07:15:38","modified_gmt":"2026-10-20T07:15:38","slug":"pa-medicaid-fee-schedule","status":"publish","type":"post","link":"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule","title":{"rendered":"PA Medicaid Fee Schedule Decoded: Which Rate Applies?\u00a0"},"content":{"rendered":"\n<p>Understanding Medicaid payment rates can be confusing, especially when outpatient services and nursing home care follow different rules. To identify the relevant payment, use the PA Medicaid fee schedule alongside the rules for the provider category, treatment delivered, and reimbursement arrangement. <\/p>\n\n\n\n<p>This guide explains how to find the right information and separate provider reimbursement from eligibility limits and patient costs.&nbsp;<\/p>\n\n\n\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_77 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title ez-toc-toggle\" style=\"cursor:pointer\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#1_What_Is_the_PA_Medicaid_Fee_Schedule\" >1. What Is the PA Medicaid Fee Schedule?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#2_How_to_Find_and_Read_Pennsylvania_Medicaid_Payment_Rates\" >2. How to Find and Read Pennsylvania Medicaid Payment Rates?&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Search_the_Official_Medical_Assistance_Fee_Schedule\" >Search the Official Medical Assistance Fee Schedule&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Check_the_Details_Behind_the_Listed_Rate\" >Check the Details Behind the Listed Rate&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#3_Which_Medicaid_Payments_Use_a_Different_Rate_System\" >3. Which Medicaid Payments Use a Different Rate System?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#4_How_Much_Does_Medicaid_Pay_for_a_Nursing_Home_in_Pennsylvania\" >4. How Much Does Medicaid Pay for a Nursing Home in Pennsylvania?\u00a0<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#How_Pennsylvania_Calculates_Nursing_Facility_Rates\" >How Pennsylvania Calculates Nursing Facility Rates?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#What_Residents_May_Have_to_Pay_Toward_Nursing_Home_Care\" >What Residents May Have to Pay Toward Nursing Home Care?&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#5_What_Does_Medicaid_Pay_for_in_PA\" >5. What Does Medicaid Pay for in PA?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#6_Which_Financial_and_Eligibility_Requirements_Apply_to_Pennsylvania_Medicaid\" >6. Which Financial and Eligibility Requirements Apply to Pennsylvania Medicaid?&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Income_Limits_Depend_on_Your_Eligibility_Category\" >Income Limits Depend on Your Eligibility Category&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Additional_Rules_for_Long-Term_Care\" >Additional Rules for Long-Term Care&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#7_Put_Your_Medicaid_Eligibility_to_Work_Beyond_Medical_Bills\" >7. Put Your Medicaid Eligibility to Work Beyond Medical Bills&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#8_FAQ\" >8. FAQ&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Is_the_PA_Medicaid_fee_schedule_what_patients_have_to_pay\" >Is the PA Medicaid fee schedule what patients have to pay?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#How_much_does_Medicaid_pay_for_a_Nursing_Home_in_Pennsylvania\" >How much does Medicaid pay for a Nursing Home in Pennsylvania?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#What_are_the_income_limits_for_Pennsylvania_Medicaid\" >What are the income limits for Pennsylvania Medicaid?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#What_are_the_rules_for_Medicaid_in_Pennsylvania\" >What are the rules for Medicaid in Pennsylvania?&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Does_the_outpatient_schedule_apply_to_HealthChoices_managed_care\" >Does the outpatient schedule apply to HealthChoices managed care?&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/cintexwireless.com\/blog\/pa-medicaid-fee-schedule\/#Conclusion\" >Conclusion&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"1_What_Is_the_PA_Medicaid_Fee_Schedule\"><\/span>1. What Is the PA Medicaid Fee Schedule?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Pennsylvania calls its Medicaid program Medical Assistance (MA). Its outpatient fee schedule identifies payment information for services reimbursed through fee-for-service (FFS), where providers submit claims for individual services.&nbsp;<\/p>\n\n\n\n<p>The PA Medicaid fee schedule concerns provider reimbursement. A listed amount is neither a patient\u2019s bill nor an income ceiling for qualifying for coverage.&nbsp;<\/p>\n\n\n\n<p>It also does not establish every Medicaid payment. HealthChoices managed care organizations generally reimburse providers under their contracts and applicable program requirements. Before using any figure, identify whether the service falls under FFS, managed care, or another payment methodology.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"2_How_to_Find_and_Read_Pennsylvania_Medicaid_Payment_Rates\"><\/span>2. How to Find and Read Pennsylvania Medicaid Payment Rates?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>A useful search matches the service and provider circumstances. A matching service description is only one detail to verify before selecting a payment rate.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Search_the_Official_Medical_Assistance_Fee_Schedule\"><\/span>Search the Official Medical Assistance Fee Schedule&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Start with Pennsylvania&#8217;s <a href=\"https:\/\/www.pa.gov\/agencies\/dhs\/resources\/for-providers\/ma-for-providers\/ma-fee-schedule\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Medical Assistance Outpatient Fee Schedule Search<\/a>.<\/p>\n\n\n\n<p>Enter the available service details, such as provider type, specialty, procedure code, or place of service. Narrow your search to identify the relevant rate.<\/p>\n\n\n\n<p>Pennsylvania updates the online schedule daily. Downloadable files are updated quarterly and require PROMISe provider login credentials.<\/p>\n\n\n\n<p>Because rates and billing requirements can change, use the current online schedule and check any applicable Medical Assistance bulletins before relying on a payment amount.\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Check_the_Details_Behind_the_Listed_Rate\"><\/span>Check the Details Behind the Listed Rate&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Confirm modifiers, effective periods, billing units, service limits, and provider-specific restrictions. Check whether prior authorization (PA) is required and review relevant MA bulletins.&nbsp;<\/p>\n\n\n\n<p>A listed code and rate do not independently guarantee payment. Member eligibility, coverage rules, documentation, and claim requirements still apply.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"534\" src=\"https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2026\/10\/pa-medicaid-fee-schedule.jpg\" alt=\"pa-medicaid-fee-schedule\" class=\"wp-image-14237\" srcset=\"https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2026\/10\/pa-medicaid-fee-schedule.jpg 800w, https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2026\/10\/pa-medicaid-fee-schedule-768x513.jpg 768w, https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2026\/10\/pa-medicaid-fee-schedule-400x267.jpg 400w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\"><em>Reviewing the PA Medicaid fee schedule helps families distinguish provider payment rates from their own healthcare expenses (Image by Pexels)\u00a0<\/em><\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"3_Which_Medicaid_Payments_Use_a_Different_Rate_System\"><\/span>3. Which Medicaid Payments Use a Different Rate System?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>The outpatient PA Medicaid fee schedule is one payment resource within a larger system. HealthChoices managed care payments generally follow plan contracts, subject to applicable requirements.&nbsp;<\/p>\n\n\n\n<p>Home and community-based services (HCBS) and waiver services may have program-specific schedules. Nursing facilities use separate reimbursement methods, while inpatient institutions may receive diagnosis-related or other institution-specific payments.&nbsp;<\/p>\n\n\n\n<p>Special methodologies also apply to certain providers, including federally qualified health centers. Always identify the program and provider category before comparing amounts across services.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"4_How_Much_Does_Medicaid_Pay_for_a_Nursing_Home_in_Pennsylvania\"><\/span>4. How Much Does Medicaid Pay for a Nursing Home in Pennsylvania?\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Pennsylvania Medicaid does not pay one standard daily amount to every nursing home. Payment depends on the facility&#8217;s approved rate, the applicable payment period, and whether care is paid through fee-for-service Medicaid or Community HealthChoices.<\/p>\n\n\n\n<p>Pennsylvania publishes facility-specific nursing home rates, including minimum payment rates for Community HealthChoices managed care.<\/p>\n\n\n\n<p>To find an amount for a <a href=\"https:\/\/cintexwireless.com\/blog\/can-you-change-nursing-homes-on-medicaid\" target=\"_blank\" rel=\"noreferrer noopener\">particular nursing home<\/a>, check the state&#8217;s Nursing Facility Rates page and select the relevant facility and effective quarter.<\/p>\n\n\n\n<p>These provider payments are separate from the amount a Medicaid resident may be required to contribute toward care.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"How_Pennsylvania_Calculates_Nursing_Facility_Rates\"><\/span>How Pennsylvania Calculates Nursing Facility Rates?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Pennsylvania establishes facility-specific daily, or per diem, rates. Case mix reflects residents\u2019 care needs, and quarterly adjustments can change payments. Community HealthChoices also has published nursing facility minimum payment rates.&nbsp;<\/p>\n\n\n\n<p>During the 2026 PDPM transition, the resident-care component blends older RUG-III and PDPM calculations. <\/p>\n\n\n\n<p>For October\u2013December 2026, that blend is 25% RUG-III and 75% PDPM; full PDPM calculation begins January 2027.\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_Residents_May_Have_to_Pay_Toward_Nursing_Home_Care\"><\/span>What Residents May Have to Pay Toward Nursing Home Care?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Residents may contribute income toward care after permitted deductions, such as personal-needs allowances, applicable health expenses, and qualifying spouse or family allowances.&nbsp;<\/p>\n\n\n\n<p>This patient-pay amount is calculated separately from provider reimbursement. Families should request the written resident-responsibility determination rather than estimate it from a facility\u2019s published rate.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"5_What_Does_Medicaid_Pay_for_in_PA\"><\/span>5. What Does Medicaid Pay for in PA?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>The benefits available to a member reflect their eligibility group, clinical needs, coverage limitations, and health plan requirements. The table below outlines common benefit categories; individual services still require confirmation.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Benefit area<\/strong>&nbsp;<\/td><td><strong>Examples and considerations<\/strong>&nbsp;<\/td><\/tr><tr><td>Physician\/preventive care&nbsp;<\/td><td>Office visits, screenings, and eligible preventive services&nbsp;<\/td><\/tr><tr><td>Hospital services&nbsp;<\/td><td>Covered inpatient and outpatient treatment&nbsp;<\/td><\/tr><tr><td>Pharmacy&nbsp;<\/td><td>Covered prescriptions, subject to formulary and authorization rules&nbsp;<\/td><\/tr><tr><td>Behavioral health&nbsp;<\/td><td>Eligible mental health and substance use treatment&nbsp;<\/td><\/tr><tr><td>Long-term care&nbsp;<\/td><td>Qualifying nursing facility and HCBS services&nbsp;<\/td><\/tr><tr><td>Other benefits&nbsp;<\/td><td>Eligible dental, vision, <a href=\"https:\/\/cintexwireless.com\/blog\/online-therapy-that-takes-medicaid\" target=\"_blank\" rel=\"noreferrer noopener\">therapy<\/a>, equipment, and transportation services\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Coverage and reimbursement answer different questions. The PA Medicaid fee schedule helps explain provider payment; your benefit package determines whether a service is covered. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"6_Which_Financial_and_Eligibility_Requirements_Apply_to_Pennsylvania_Medicaid\"><\/span>6. <strong>Which Financial and Eligibility Requirements Apply to Pennsylvania Medicaid?<\/strong>&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>Eligibility follows a different framework from the PA Medicaid fee schedule. Start with your coverage category, then check its financial and nonfinancial requirements.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Income_Limits_Depend_on_Your_Eligibility_Category\"><\/span>Income Limits Depend on Your Eligibility Category&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>For Pennsylvania adults ages 19\u201364 applying through the Medicaid expansion category, the effective income threshold is generally 138% of the Federal Poverty Guidelines.<\/p>\n\n\n\n<p>For 2026, Pennsylvania lists annual <a href=\"https:\/\/cintexwireless.com\/blog\/what-is-the-monthly-income-limit-for-medicaid-in-pa\" target=\"_blank\" rel=\"noreferrer noopener\">income limits <\/a>of $22,025 for one person, $29,864 for two, and $45,540 for a household of four.<\/p>\n\n\n\n<p>Children and pregnant applicants may qualify under higher income limits, while people aged 65 or older or living with disabilities are assessed under different rules.<\/p>\n\n\n\n<p>Medical Assistance for<a href=\"https:\/\/www.pa.gov\/agencies\/dhs\/resources\/medicaid\/medicaid-workers-disabilities\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"> Workers with Disabilities (MAWD)<\/a> generally requires qualifying employment and disability, countable income below 250% of the poverty guidelines, and countable resources within the $10,000 limit. Separate continuation rules may apply when earnings increase.<\/p>\n\n\n\n<p>These are screening figures, not guarantees of eligibility. Confirm the appropriate coverage category before comparing your income.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Additional_Rules_for_Long-Term_Care\"><\/span>Additional Rules for Long-Term Care&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Pennsylvania\u2019s 2026 individual income threshold for the specified non-money-payment LTC category is $2,982 monthly. Other pathways may apply above that amount.&nbsp;<\/p>\n\n\n\n<p>Applicants must also meet resource and level-of-care requirements. Asset transfers within the five-year lookback, spouse protections, and resident contributions require separate review; consult Pennsylvania\u2019s <a href=\"https:\/\/www.pa.gov\/agencies\/dhs\/resources\/aging-physical-disabilities\/medicaid-payment-long-term-care\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">long-term care eligibility guidance<\/a>.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"7_Put_Your_Medicaid_Eligibility_to_Work_Beyond_Medical_Bills\"><\/span>7. Put Your Medicaid Eligibility to Work Beyond Medical Bills&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>If you\u2019re juggling calls with providers, benefit notices, and appointments, one practical idea is to look at your phone bill. A separate federal benefit may help bring it down, and you may already be closer to qualifying than you think.<\/p>\n\n\n\n<p>That benefit is Lifeline, which offers up to $9.25 per month toward eligible broadband or bundled service, with higher support on qualifying Tribal lands. <\/p>\n\n\n\n<p>Eligibility generally comes down to household income at or below 135% of the Federal Poverty Guidelines or participation in a qualifying program. Medicaid is one of those programs, so if you already receive it, you may be a step ahead. <\/p>\n\n\n\n<p>Verification is still required, and the benefit is non-transferable and limited to one per household.<\/p>\n\n\n\n<p>Service is delivered through an Eligible Telecommunications Carrier (ETC), and <a href=\"https:\/\/cintexwireless.com\/apply?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">Cintex Wireless <\/a>is merging with <a href=\"https:\/\/airtalkwireless.com\/?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">AirTalk Wireless<\/a>, an ETC, so you can explore more device and service choices in one place.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"400\" src=\"https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2022\/05\/image-6.png\" alt=\"How To Receive a Free iPhone from AirTalk Wireless\" class=\"wp-image-4297\" srcset=\"https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2022\/05\/image-6.png 600w, https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2022\/05\/image-6-300x200.png 300w, https:\/\/cintexwireless.com\/blog\/wp-content\/uploads\/2022\/05\/image-6-270x180.png 270w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption class=\"wp-element-caption\"><em>Apply now to see if you can qualify and get a free phone from AirTalk Wireless<\/em><\/figcaption><\/figure>\n\n\n\n<p>Depending on your location and current inventory, phones you may come across include <a href=\"https:\/\/airtalkwireless.com\/products\/apple-iphone-xs\/2058?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">iPhone XS<\/a>, <a href=\"https:\/\/airtalkwireless.com\/products\/samsung-galaxy-s21-5g\/6019?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">Samsung Galaxy S21 5G<\/a>, and <a href=\"https:\/\/airtalkwireless.com\/products\/samsung-galaxy-a20\/17?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">Galaxy A20<\/a>; specific offers and stock vary.\u00a0<\/p>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-a89b3969 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/airtalkwireless.com\/lifeline-enrollment?utm_source=blog&amp;utm_medium=article&amp;utm_campaign=GOV101_cintex_redirect_pa_medicaid_fee_schedule_FREEL_YEN\" target=\"_blank\" rel=\"noreferrer noopener\">Apply Now for Your Benefit\u00a0<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"has-background\" style=\"background-color:#e4e4e4\"><strong>IMPORTANT: <\/strong>The government does not subsidize devices. Lifeline programs cover basic service costs only. Free or discounted devices, upgrade plans, or top-ups are exclusive benefits provided by AirTalk Wireless and Cintex Wireless as part of the promotional offers. Terms and conditions apply. Limited-time promotion\u2014offers vary by state, stock availability, and eligibility.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"8_FAQ\"><\/span>8. FAQ&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Is_the_PA_Medicaid_fee_schedule_what_patients_have_to_pay\"><\/span>Is the PA Medicaid fee schedule what patients have to pay?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>No. Pennsylvania&#8217;s Medical Assistance fee schedule lists provider reimbursement information, not a patient&#8217;s bill. Any applicable member cost sharing depends on the benefit, eligibility category, and program rules.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"How_much_does_Medicaid_pay_for_a_Nursing_Home_in_Pennsylvania\"><\/span>How much does Medicaid pay for a Nursing Home in Pennsylvania?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>There is no standard statewide amount. Pennsylvania uses facility-specific nursing home rates, which may change by payment period. Check the state&#8217;s Nursing Facility Rates page for the relevant provider and quarter.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_are_the_income_limits_for_Pennsylvania_Medicaid\"><\/span>What are the income limits for Pennsylvania Medicaid?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>For 2026, the expansion adult income limit is $22,025 annually for one person and $29,864 for two. Children, pregnant applicants, and people applying through disability or long-term care categories follow different financial rules.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_are_the_rules_for_Medicaid_in_Pennsylvania\"><\/span>What are the rules for Medicaid in Pennsylvania?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Eligibility depends on the coverage category, income, household circumstances, Pennsylvania residency, and applicable citizenship or immigration requirements. Certain programs also review resources or medical care needs.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Does_the_outpatient_schedule_apply_to_HealthChoices_managed_care\"><\/span>Does the outpatient schedule apply to HealthChoices managed care?&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Not automatically. The outpatient fee schedule primarily concerns fee-for-service payments. HealthChoices managed care reimbursement generally follows plan contracts and relevant program requirements, which may differ from published fee-for-service rates.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Conclusion\"><\/span>Conclusion&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p>The PA Medicaid fee schedule is a starting point for understanding provider reimbursement, not a complete list of patient costs or Medicaid eligibility limits.<\/p>\n\n\n\n<p>Use Pennsylvania DHS&#8217;s current rate tools to check the relevant service and payment period. For nursing home care, review facility-specific rates separately. Always confirm coverage and any financial responsibility with your Medicaid plan or provider.<\/p>\n","protected":false},"excerpt":{"rendered":"Understanding Medicaid payment rates can be confusing, especially when outpatient services and nursing home care follow different rules.&hellip;","protected":false},"author":18,"featured_media":14238,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","footnotes":""},"categories":[118],"tags":[],"class_list":{"0":"post-14236","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-government-support","8":"cs-entry"},"_links":{"self":[{"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/posts\/14236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/comments?post=14236"}],"version-history":[{"count":2,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/posts\/14236\/revisions"}],"predecessor-version":[{"id":14243,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/posts\/14236\/revisions\/14243"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/media\/14238"}],"wp:attachment":[{"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/media?parent=14236"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/categories?post=14236"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cintexwireless.com\/blog\/wp-json\/wp\/v2\/tags?post=14236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}