Special Programs to Qualify for Full MA Benefits

Healthy Beginnings and Healthy Horizons are MA programs that give full benefits to certain categories of people at much higher income levels than are otherwise allowed. Apply for these programs at the Welfare Office, just as for any other type of MA coverage.

HEALTHY BEGINNINGS: FOR CHILDREN AND PREGNANT WOMEN

Children and pregnant women (through delivery and 60 days post-partum) are eligible for full MA benefits at much higher income levels, depending on the child's age. For applicant group size in this table, the unborn child of a pregnant woman counts as another person. The general income guidelines are below but depending upon the circumstances, all of your income may not count.

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HEALTHY BEGINNINGS ELIGIBILITY LEVELS

THERE ARE NO RESOURCE LIMITS FOR HEALTHY BEGINNINGS.

In the case of a disabled child, DPW does not count parental income. Therefore, almost all disabled children will qualify for full benefits because few of them have any income of their own. Many people refer to this as "loophole" coverage.

CHILDREN WHO MEET THE SSI DISABILITY TEST, BUT WHO CAN'T GET SSI BECAUSE THEIR PARENTS' INCOME IS TOO HIGH, ARE ELIGIBLE FOR FULL MA REGARDLESS OF THEIR FAMILY'S INCOME.

HEALTHY HORIZONS: FOR SENIORS AND DISABLED PEOPLE

People aged 65 and over, and disabled people can also qualify for full MA benefits at higher income levels. If you get SSD checks, or are disabled and get some other type of income such as VA benefits, worker's compensation, or early retirement social security, you can also qualify if your doctor fills out a DPW Employability Assessment Form. If you get SSI checks, you automatically qualify for full MA benefits and don't need Healthy Horizons.

Those who are eligible for Medicare have their premiums paid for by the state under Healthy Horizons. If your income or resources are slightly higher than the limits, you should check if you are eligible to have the state pay your Medicare Part B premium, or if you are eligible for cost-sharing benefits or payment of your Medicare coinsurance.

Important things to remember:

• Choosing an HMO. Choosing the right HMO is extremely important because each HMO provides slightly different services and has a different network of doctors. Certain doctors are only members of a specific HMO. It may make sense to choose a doctor (Primary Care Physician - PCP) and then enroll in the HMO where your doctor is a member. Call the Benova Hotline at (800) 440-3989 for help in choosing your HMO.
• In addition to the Health Choices program described here, you may be eligible for Healthy Horizons and Healthy Beginnings. They are described in their own sections below.
• Primary Care Physicians (PCP). This is the doctor, or in some cases where permitted, the certified nurse practitioner, whom you will see for care. A PCP is responsible for providing primary and preventive care; recommending and arranging for care; maintaining continuity of your health care; and making referrals for specialty care and other medically necessary services both in and out of plan.

Extended Medical Coverage - for people leaving Welfare (TANF) for work

Families who lose TANF because their earnings from a job are too high are usually still eligible for Medical Assistance for one year under the Extended Medical Coverage (EMC) program. For the first 6 months after TANF stops, a family is eligible for EMC regardless of income. For the second 6 months, the family is eligible as long as their monthly income is below 185% of the poverty level, (See poverty guidelines at the end of the book.)

If you are eligible for cash assistance (TANF, GA, or SSI), then you are automatically eligible for full MA benefits, including doctor bills, hospitalization, and prescriptions. If you receive TANF, or SSI, you get dental care and medical supplies as well. This coverage will pay your medical bills from up to three calendar months before you applied.

To get Extended Medical Coverage you must let your case worker know you are leaving welfare for work.

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