The following benefits are covered by Medicaid under federal law:
- Inpatient hospital services
- Outpatient hospital services
- EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
- Nursing facility services
- Home health services
- Physician services
- Rural health clinic services
- Federally qualified health center services
- Laboratory and X-ray services
- Family planning services
- Nurse midwife services
- Certified Pediatric and Family Nurse Practitioner services
- Freestanding Birth Center services (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
States may choose to cover the following services:
- Prescription drugs
- Clinic services
- Physical therapy
- Occupational therapy
- Speech, hearing and language disorder services
- Respiratory care services
- Other diagnostic, screening, preventive and rehabilitative services
- Podiatry services
- Optometry services
- Dental services
- Dentures
- Prosthetics
- Eyeglasses
- Chiropractic services
- Private duty nursing services
- Personal care
- Hospice
- Case management
- Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD)
- State Plan Home and Community Based Services- 1915(i)
- Self-Directed Personal Assistance Services- 1915(j)
- Community First Choice Option- 1915(k)
- TB Related Services
- Inpatient psychiatric services for individuals under age 21
- Health Homes for Enrollees with Chronic Conditions – Section 1945
- Get information about Gateway, the services Gateway provides, doctors and other health care providers giving you care, and your rights and responsibilities as a Gateway member.
- Be treated with respect and recognition of dignity and right for privacy when receiving health care.
- Work with your doctor or other health care provider in making decisions about your health care and to express preferences about future treatment decisions.
- Openly discuss without any limitations by Gateway appropriate or medically necessary treatment choices for your condition with a doctor or other health care provider, including treatment options, risks of treatments, alternative therapies, and consultations or tests that may be self administered, regardless of the cost or if it is a benefit.
- Receive your medical and nursing care without regard to race, color, religion, sex, age, disability, national origin, or without regard to whether you have an advance directive.
- Pick your own doctor from Gateway’s network of doctors.
- Refuse care from certain doctors.
- File a complaint or grievance about Gateway or the care it provides.
- Make recommendations regarding Gateway’s members’ rights and responsibilities policies.
- Request a fair hearing from the Department of Human Services.
- Prepare a Living Will and/or Advance Directive.
- See, or have your medical records copied, within federal and state laws, and to request that your medical records be changed or corrected within federal laws.
- Have your medical records kept private and confidential.
As a Gateway Member you have a responsibility to:
- Give information to your doctor, other health care provider, or Gateway so they can provide care to you.
- Follow the instructions and treatment plans that you agreed on with your doctor or other healthcare provider.
- Provide consent to healthcare providers and Gateway to help them manage your care, to improve your health or for research.
- Understand your health problems. As much as you can, take part in making a plan for treatment goals with your doctor or other health care providers.
- See the doctor you picked on a regular basis.
- Treat the people giving you medical care with the same respect and kindness you expect for yourself.
Si desea una copia de los derechos y responsabilidades de los miembros del Plan de Salud Gateway, llame al 1-800-392-1147.
Derechos y Responsabilidades de las Miembros Declaracion.
Member Programs
For our Medicaid members, help is always just a phone call away. Call 1-855-805-9408 with your questions about:
- A recent diagnosis, treatment options or surgery
- Current symptoms
- Medication side effects
- Self-care home treatments
- When to go to the doctor
- When to go to the Urgent Care Center or Emergency Room
- Preventive care and lab tests
A professional nurse is available 24 hours a day, 7 days a week. If you experience an emergency, please call 911.
Also available to all our Medicaid members, is our wellness coaching program. You have access to several wellness coaches, including:
- Certified Rehabilitation Counselor - Help prevent or reduce falls. This Wellness Coach will ask some questions about your risk for falling and do a home safety checklist. Your coach will also give you tips to help your balance and strength.
- Registered Dietitian Nutritionist - Get answers to your questions about healthy eating from a food expert. This Wellness Coach will work with you to help manage any medical conditions or your overall health.
- Certified Diabetes Care and Education Specialist - Take control of your diabetes. This Wellness Coach will help you learn about taking medicines and lowering your risk of diabetes-related complications. You can set goals for moving more. If you are looking for help with food and nutrition information only, reach out to our Registered Dietitian Nutritionist Wellness Coach!
When you make the right choices, you deserve a reward. Healthier lifestyle decisions are no exception. The Goodness Rewards Programs gives Gateway Health members a reloadable gift card, good at over 100 locations. Every time you complete an eligible health activity, you get a reward!
Contact Goodness Rewards for more information.
Review Frequently Asked Questions here.
Call: 1-800-539-5722
TTY: 711
Monday - Friday, 7 a.m. to 7 p.m.
We have a special program for pregnant women called MOM Matters®. This program gives you the education and support to help you have a healthy pregnancy. Our Maternity Team members are here to answer questions and help you every step of the way. They can help you:
- Find a doctor and set up your appointments for prenatal care. Call us as soon as you find out you are pregnant!
- Answer questions, direct you to community services, and guide you throughout your pregnancy.
- Arrange a home visit by a nurse when needed.
- Provide resources for transportation to and from important doctor appointments.
- Connect you to the smoking quit line at 1-800-784-8669 or 1-800-QUIT-NOW.
- Earn rewards for going to all your prenatal and postpartum care doctor visits!
Enrolled in Boys & Girls Clubs Teen Workforce Academy or want to enroll? You can have the cost of monthly membership dues and monthly Workforce Academy dues paid for by Gateway Health. We have partnered with the Boys and Girls Clubs at the Duquesne/West Mifflin, Shadyside/East Liberty, Millvale Western PA locations to provide our Gateway Health members with this value added benefit. We will provide the $40 per month regular Clubs membership dues plus the $40 per month Workforce Academy dues.
IN ORDER TO QUALIFY FOR THIS VALUE ADDED BENEFIT, YOU MUST BE:
- A current Gateway Health member
- Between the ages of 14-24 years
- Enrolled in the Boys & Girls Club Teen Workforce Academy program or meet the requirements to enroll in the Teen Workforce Academy
- Meet the program criteria and located within Allegheny County Teen Workforce Academy locations: Duquesne/West Mifflin, Millvale, Shadyside/East Liberty
- Teen Workforce Development Academy application form completion, including a short essay and submission of grades/progress report, cannot be more than 3 grades behind in school
For more information about this value added benefit, please call Member Services.
IN ORDER TO QUALIFY FOR THIS VALUE ADDED BENEFIT, YOU MUST:
- Be a current Gateway Health member
- Be at least 17 years old
- Be a PA resident
- Not enrolled in any other school program
Many jobs now require a high school diploma or GED and getting your GED gives you the chance to earn at least $9,000 more a year! Don’t miss the opportunity to take your GED test at NO COST.
Request your GED Benefit Now