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Health Coverage

Medical Assistance

Medical Assistance (MA), or Medicaid, helps low-income adults, families with children, seniors and disabled children pay for doctors, hospital visits, and most other medical expenses. This program is run by the Pennsylvania Department of Public Welfare (DPW). You do not have to qualify for welfare in order to qualify for MA, but you must meet certain eligibility and financial requirements.

There are a number of different Medical Assistance programs levels:

• Full MA benefits for families on welfare, disabled people or with low incomes and small children
• Limited MA benefits or Medically Needy Only (MNO) for the disabled and victims of domestic violence,
• Persons who need to be hospitalized or have high medical bills

Eligibility

To be eligible for Medicaid, you must meet the following requirements:

• Citizen or lawfully admitted alien
• Resident of Pennsylvania
• Meet income and resource guidelines. Income guidelines are determined by Federal Poverty Level and vary by program.

Applying For Medical Assistance

You can apply for Medical Assistance at your local County Assistance Office (see page 52 for list of offices). You can go into the office without an appointment for the preliminary application to get the process started. You need the following things to be approved for MA. If you bring them the first time you go it should speed up the process.

• proof of this month's income (pay stubs, child support checks, unemployment checks and social security checks)
• recent bills with your name and address on them to prove where you live
• all health care cards you may already have
• copies of social security cards for everyone in your household
• copies of birth certificates for everyone in your household
• any old unpaid medical bills or medical bills you have recently paid
• your doctor's phone number, if you do have a doctor
• the phone number of the health center nearest you if you don't have a doctor
• an up-to-date residence card (green card) if you are not a citizen

If you are told that you are not eligible in the pre-screen and there is any doubt in your mind, then you should insist on filing a full application. You have the right to apply and get a written decision of eligibility.
After you are pre-screened, you are scheduled for an interview with a caseworker who determines whether or not you qualify for MA. The interview should be within 5 days of the pre-screen. DPW must tell you within30 days whether or not you qualify for MA.

• Deciding if you qualify. There are many different programs for people in different situations. If you do not qualify under one category, you may qualify under another. If someone at the Welfare department tells you that you do not qualify under a particular category, be sure to ask about the others. Broadly, the categories can be divided into full MA benefits and limited MA benefits
• If you are told you are not eligible. If you are rejected for MA, it doesn't necessarily mean you are out of luck. Sometimes caseworkers overlook ways for you to qualify. You may be able to qualify for a temporary card, or to have past bills paid. You can always appeal the decision if you are told you are ineligible. It is usually better to ask for a face-to-face hearing so that you can explain your situation in person. You can always drop your appeal if you decide not to go forward with it.
• If you are told you qualify for MA. Once you are determined eligible for Medical Assistance you will be required to enroll in HealthChoices, an HMO. The HMOs available to Medicaid recipients in Philadelphia, Bucks, Montgomery, Chester, and Delaware County are Health Partners (HP), Health Management Alternatives (HMA), Keystone Mercy Health Plan (KMHP).