In 2014, families across America began to experience a new healthcare system, known as the Affordable Care Act (ACA), or colloquially as “ObamaCare” (because the ACA was an initiative of President Barack Obama).
The ACA is implemented differently in different states. In general, individuals may choose a healthcare plan by shopping in the “Healthcare Marketplace.” The Marketplace is an online shopping terminal (though information can be accessed over the phone and sent by mail). The following Q & A applies to Pennsylvania – currently (2014).
Does the new healthcare system impact Medical Assistance (MA) for my child?
It depends; if a family is eligible through PH95 (MA for a disabled child only), there is no change. If the family is eligible for MA based on financial eligibility, the process is the same for now. Families should apply for MA based on financial eligibility and/or MA through PH 95 (for children with disabilities) as usual; however changes are anticipated in the near future.
How do you apply for Medical Assistance (MA) for a child with a developmental disability, such as Autism Spectrum Disorder?
The MA application process has not changed. The new health insurance Marketplace is not affecting the application process or the way MA insurance is being dispensed. The CAR Autism Roadmap™ contains directions on how to access MA in the following articles:
- How to Apply for Medical Assistance in Pennsylvania
- Quick Primer on Medical Assistance for Children and Adolescents in Pennsylvania
Is CHIP, the Children’s Health Insurance Partnership, affected by the new health insurance system?
Yes, CHIP is part of the Healthcare Marketplace. Child-only commercial plans will be available for those who do not qualify for CHIP, because they do not meet disability criteria or because they are over income limits. More information about CHIP can be found in the CAR Autism Roadmap™:
Can State-mandated autism insurance be accessed through the Healthcare Marketplace?
No, at this time there is no communication between this benefit and the Marketplace. Autism mandated coverage remains limited and can be very different depending on the insurance carrier. For more information about accessing state-mandated autism insurance, please go to the following article within the CAR Autism Roadmap™:
Can Supplemental Security Income (SSI) for an 18 year old (child) transitioning to adult status be accessed through the Marketplace?
No, the application process for SSI remains the same and is not accessible through the Marketplace. For more information and instructions, go to the following article within the CAR Autism Roadmap™:
Can adults apply for Social Security Disability Insurance (SSDI) through the Marketplace?
No, at this time there is no provision for SSDI to be accessed through the Marketplace. To learn how to access this coverage, please go to the following article within the CAR Autism Roadmap™:
Is Medicaid still available to adults who have a disabling condition?
Yes, adults who have a documented, established disability before they turn 21 years old are able to access medical insurance, if they meet certain criteria. To learn more about this, read the following article within the CAR Autism Roadmap™:
The Affordable Care Act mandates that everyone must have health insurance. What is the deadline for this and are there any exceptions?
Yes, the ACA mandates that everyone must have health insurance by 2014. There are very few exceptions to this rule. To learn more about this, go to: