Quick Primer on Medical Assistance for Children and Adolescents in Pennsylvania

What is Medical Assistance?

• Medical Assistance (MA) is healthcare insurance for children and adolescents up to 21 years of age who live in Pennsylvania
• MA might pay for things your regular health insurance doesn't pay for, such as some therapies, including wrap around services

How do I apply for Medical Assistance for my child?

Step 1: Apply for Supplemental Security Income (SSI).

• 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.
• Apply for Medical Assistance at the same time you apply for SSI.
• If your child gets SSI, he or she automatically gets Medical Assistance.
• If your child is denied SSI, he or she may still qualify for Medical Assistance. Request to receive an SSI denial letter. Look for the statement in the denial letter that says your child may still be eligible for MA based on disability (in the fine print).

There are a couple of different ways to apply for Medical Assistance. Read "How to Apply for Medical Assitance in Pennsylvania" in the CAR Autism Roadmap™ to find out how to apply. We recommend that you fill out a paper application as indicated in step 2 below. HINT: Get a big envelope, a notebook, or a folder with pockets to keep all your papers organized.

Step 2: Answer every question. Fill out every part.

• Fill out a paper application.
• Write "YES" when it asks "Are you applying for this person?"
• At the top of page four, write "MA FOR DISABLED CHILD HANDBOOK SECTION 355.4" in the margin
• For help completing the application call:
  • Department of Human Services (formerly Department of Public Welfare): 1-800-692-7462
  • PA Health Law Project: 1-800-274-3258
  • Public Citizens for Children and Youth 215-563-5848, ext. 17
• Make a copy of everything and keep it in a safe place at home

Most of the time children with physical or mental disabilities get Medical Assistance. If you are rejected, you can appeal.

Step 3: Take the application to the County Assistance Office for an interview.

• Bring these things to your interview (no appointment is necessary, but there could be a wait time):
  • The Medical Assistance application you filled out
  • Your child's original birth certificate
  • Your child's Social Security card
  • The original SSI rejection or approval letter
  • The report from your doctor that says your child has a disability
  • Your most recent pay stub
  • Your Pennsylvania driver's license
  • Proof that you live in Pennsylvania (a rent or utility bill with your name and address on it)
• You don't have to bring your child to the interview
• Keep track of the papers you get
• If your child is found eligible for Medical Assistance, you will be issued a temporary ACCESS card. You can use it immediately to pay for services for your child. The permanent card will come in the mail.

Step 4: Choose your managed health care organization. Contact your behavioral health plan.

• Call your Primary Care Physician (PCP) to find out which health plans he or she is considered in network with (in which health plans does your child's pediatrician participate).
• Write down the Member Service unit number. Save it with your other papers.
• Call the BEHAVIORAL health services providers in your county.
  • Call the number on your access card and ask who provides Behavioral Health Services in your county. This is the same place to apply for wraparound services.
  • You can ask for a different therapist if the first one doesn't work out for your child.
• Ask to get a Member Handbook. Among other things, the Handbook tells you what to do if you have a complaint.

Step 5: Use your ACCESS card to pay for services

• SOMETIMES, you might be able to use the card to pay for services provided three months before you got Medical Assistance. Ask if you have "retroactive coverage."
• Use your ACCESS card to pay for services your regular insurance doesn't cover.

IMPORTANT: You must re-apply for Medical Assistance every year. You have to re-apply before your current Medical Assistance expires; otherwise you will have to begin all over again. Related Articles:

• How To Apply For Medical Assistance In Pennsylvania
• Supplemental Security Income For Children With Disabilities
• Children's Health Insurance Program
• Obtaining Wrap Around Services For Your Child