Medical Assistance (MA, also known as Medicaid) is a public insurance system. It may be used to cover medical bills that insurance does not pay or can be used as a primary insurance if a child is not covered by other insurance. MA will cover everything from routine office visits, to prescription drugs, to speech-language therapy. However, not all service providers accept MA. Parents must check to determine if their child’s pediatrician, local hospital, and therapists accept it.
In Pennsylvania, MA is currently available to children with disabilities without consideration of parental income. The state has considered charging a co-pay for services, based on income, and it collects information on parental income when a family applies for MA; however, MA does not take parent income into account when determining eligibility at this time. Any income in a child’s name is considered, however, including money in certain trust funds.
Why Medical Assistance?
Medical Assistance has the broadest coverage of medical and mental health services for persons under 21 of any insurance plan. It covers services rarely covered by employer provided insurance and currently operates without any annual or lifetime caps, which are often imposed by other insurance plans.
Services covered under the Medical Assistance program may include:
- Mental Health/Wrap-Around Services
- In-Home Personal Care Services
- Diapers (for children 3 years and older)
- Nutritional Supplements (prescribed by a physician)
- In-Home Nursing
- Physical Therapy
- Occupational Therapy
- Speech Therapy
Medical Assistance can be a child’s only insurance or it can be secondary to other coverage. Many families find Medical Assistance useful to supplement/cover those services and/or equipment that are not covered by a child’s primary insurance.
Will My Child Qualify?
In Pennsylvania, many children with disabilities/developmental delays will qualify for Medical Assistance, regardless of their parent’s income. Here are some basic rules:
A child can qualify for Medical Assistance even if he/she has other health insurance (although, the other insurance usually needs to be billed first). The income and/or assets of the parents/caregivers does not count in determining eligibility for Medical Assistance, if the child’s condition meets certain disability standards. In Pennsylvania, “disability” is defined as:
- The child has a medically diagnosed physical or mental impairment (or combination thereof);
- The impairment has lasted or is expected to last for at least one year or to result in death;
- The limitations caused by the impairment substantially reduce the child’s ability to do the things and behave in the ways that children that age typically do.
How Do I Apply?
It is possible to apply online through the COMPASS program, however most families have had better success completing the application and bringing it to their County Assistance Office in person. (See the Additional Resources section at the bottom of this article to find a link to help you locate your local County Assistance Office.)
To apply in person, follow these directions:
- Call or visit your local County Assistance Office. The phone number will be in the blue pages of the phone book under “Government Offices–State,” “Public Welfare Department of (Name of your County) County Assistance Office.” Or use the County Assistance Office Locator listed in Additional Resources at the end of this article.
- Ask for the application PA 600 P, the Application for Medical Assistance.
- Complete the form as if you are the child. Under Pennsylvania State law, income of parent(s) must be listed, despite the fact that it is NOT considered when making a determination of the eligibility of the child (provided the child meets the disability requirements). Income of stepparents need not be reported. However, if your child receives income, such as Social Security benefits, do list that information.
- Write on the top of the application: “MA FOR DISABLED CHILD HANDBOOK SECTION 355.4.”
- Apply for Supplemental Security Income (SSI). In some Pennsylvania counties, caseworkers are insisting that parents apply for SSI for the child and get rejected before they will authorize Medical Assistance. They may require you to present a rejection letter. You can apply for SSI over the phone, and it only takes about twenty minutes. The toll free number is 1-800-772-1213. Tell the caseworker that you are trying to acquire a medical card for your child who has a disability; you need a rejection letter sent to your home if you don’t qualify for SSI.
- Once you have the letter and your Medical Assistance application is completed, call your local County Assistance Office again to schedule an intake interview. Be sure to verify the items you need to bring with you.
- Attend the intake interview; bring all necessary documents with you.
If your child appears to qualify for MA, the caseworker you meet at the intake interview can issue you a temporary MA card. The card may be used immediately, but it is only temporary, pending authorization. Your child’s application will be reviewed further to determine whether he or she has a “disability” as defined for MA eligibility. If your child is turned down for the permanent card, you will not have to pay back any money for the services or items purchased with the temporary card (as long as you were honest in reporting facts regarding the disability).
What Documents Should I Bring to the Intake Interview?
In general, you will need to bring documentation of your child’s medical diagnosis, documentation that your child qualifies for educational services, and your child’s Individualized Family Service Program (IFSP) or Individualized Education Program (IEP). Never leave original documents with the County Assistance Office; always bring copies.
Check with your County Assistance Office to see which documents in particular it requires. The items on the list below are typical of the kinds of documentation your County Assistance Office may require:
- Copy of your child’s Social Security card (or receipt from Social Security that an application for a card has been filed)
- Copy of your child’s Birth Certificate
- For Non US Citizens, proof of immigration status (your child must have permanent residency status – a Green Card – to qualify for Medical Assistance)
- Proof of address (a copy of a utility bill will do)
- Copy of any other health insurance for your child
- Verification of any income that the child receives in his/her name (for example, child support, social security benefits, etc.)
- Parent/caregiver income information (your two most recent pay stubs should be sufficient)
- Recent (within one year) medical information from a physician (for example, your child’s psychiatrist, psychologist, neurologist, pediatrician), which includes a diagnosis, prognosis, treatment plan, and any medications
- Your child’s IFSP or IEP
- Letters from your child’s speech therapist, occupational therapist, and/or any other therapists who treat your child pertaining to your child’s need for services
- Copy of parent/guardian Social Security card and driver’s license/photo identification is necessary for verification of US citizenship
- Letter denying your child for SSI
It usually takes 3-4 weeks for eligibility to be determined. If you have not heard from the County Assistance Office after 4 weeks, you can feel free to contact them to find out the status of your application.
- Supplemental Security Income for Children with Disabilities
- Children’s Health Insurance Program
- Obtaining Wrap Around Services for Your Child
- Should I Allow My School District to Bill Medicaid for Services for My Child?