Pennsylvania Medicaid: who should you call?

Start with your exact program and plan

Look at your plan name and enrollment notice. Ask which program covers the help you need. A plan name alone does not confirm your benefits, your current enrollment or whether a doctor is in your network.

For physical health: use your plan’s member services

Pennsylvania’s Physical HealthChoices directory lists plans by region. It also lists member services and Enhanced Member Supports Unit numbers. Find your county, match your exact plan, and ask for help finding a doctor or understanding the next step. Use the official directory linked below.

For mental health or substance use care: check your county

Behavioral HealthChoices uses a county-based organization that can be different from your physical health plan. The state’s county directory shows where to start. Ask which providers are in that network and accepting new patients. A directory listing does not confirm an open appointment.

For long-term care: ask about Community HealthChoices

Community HealthChoices may apply if you are 21 or older and have both Medicare and Medicaid, or need certain Medicaid long-term services and supports. Other rules and exclusions apply. For program questions, the state’s participant help line is 1-800-757-5042; PA Relay is 711. Ask which program fits your situation before choosing a plan.

Use these questions before an appointment

Ask your plan: “Is this doctor and this location in my exact network? Does this service need a referral or prior approval? Who sends that request? Could the facility or another provider bill separately?” Then ask the doctor’s office to confirm it accepts your exact plan and new patients. Keep the date and reference number from the call.

If you receive a bill or a denial

Ask the plan to explain the charge or decision and point you to the relevant part of your current handbook. Ask what you can do next, how to get the explanation in writing, and which complaint or appeal deadline applies. If a deadline is listed on your notice, do not wait for a general coverage explanation to check it.

What this guide can confirm

These official contact routes were checked on October 21, 2026. This guide helps you find the right place to ask. Your plan still needs to confirm your enrollment, covered service, provider and any required approval.

Your next three steps

1. 1

   Identify the right part of your coverage

   Confirm your exact plan, county and whether you need physical health, behavioral health or long-term care help.

2. 2

   Use the official contact route

   Open the state directory below. Match your plan and program before calling.

3. 3

   Ask for a clear next step

   Ask who handles your request, what information they need, and when you should hear back.

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