How to apply for Medical Assistance.
When I moved from Canada to the Philadelphia area, I was a bit confused as to what services I could receive for my children. There were very little resources out there provided to my family regarding my children’s disabilities and the support that was offered was scarce. Honestly, I started to regret the move back to the States. Why did it have to be so difficult to access this information? What is the big “secret” behind getting MA? Is there a stigma attached with it that people do not want to associate themselves with for some reason?
I still really don’t know the answer to those questions. What I do know, is that it is absolutely NECESSARY for you to apply for Medical Assistance if you have a child with a disability.
Blog Owner’s note: This blog post is over 8 years old and I am updating it. The information contained in it may not apply to your state. Please contact your state’s Disability Protection and Advocacy Agency for specifics on where to go. This information applies to Pennsylvania’s disabled children, but Medicaid varies from state to state.
Why disabled children should be on Medical Assistance
With MA, you then open the doors to many opportunities for your child and your family. Opportunities that may not necessarily have available to you prior to the assistance. Many think that their coverage or spouse’s coverage from work is sufficient. Wraparound Behavioral Health Services (in PA) is one of them.
And, it might be. But here’s some food for thought: A good friend of mine has decent coverage from her spouse. However, her spouse’s union went on strike, for 2-3 months. And during a strike, you don’t get health insurance. Thankfully she has MA for her disabled child, but what if she hadn’t? This is a process. It doesn’t happen overnight. But as the old saying goes, “Better to have it and not need it, than need it and not have it.” It can be a life ring.
My own son developed his seizure condition literally overnight. One day he wasn’t having seizures, the next day he was. And one of his medications costs $85 a month. Medicaid in PA works that my son gets everything from his primary insurance (my husband’s employer) first, then everything that is not covered gets picked up by MA. If he did not have MA, that $85 co-pay would be our responsibility.
When your child is an adult and needs OVR….you don’t get OVR services unless the child is on MA.
Eligibility for MA in PA
If you have a child under the age of 18, he/she is considered “disabled” under SSA standards if he/she has a medically determinable physical or mental impairment, which; results in marked and severe functional limitations; and has lasted or can be expected to last for a continuous period of not less than 12 months.
Application Process for Medical Assistance in Pennsylvania
There are 2 ways to apply:
1. The easiest way is to apply online via COMPASS
There is also another site that explains the process in great detail that I love called MA for the Disabled Child In PA so please review it prior to applying.
2. You may also contact the Dept. of Public Welfare, Chester County Assistance Office at 100 James Buchanan Drive, Thorndale, (610)466-1149
- Bring your child’s SS Card
- Medical Evaluation(must have five axis diagnosis)
- Make a copy of SS card and
- Medical Evaluation (for the County Assistance to keep)
It may take 2-3 weeks to receive your ACCESS card. You will first receive an ELIGIBLE NOTICE paper then you will receive your ACCESS card.
**Please note** I have known MANY families who were denied the first time and appealed and received it. It seems this is becoming more commonplace. Do not get discouraged, just reapply.
Some things covered by Medicaid for Disabled Children (in Pennsylvania)
The following are some of the great benefits for having MA but are not limited to these services since it varies with each individual child:
- Covers complete medical care for the disabled child (for example, will cover co-pays from your primary insurance if your child has that)
- Therapies-OT, PT, VT, SLP
- covers respite care for the family where approved
- animal-assisted therapy
- out-patient, in-home, clinical, and in-patient
- Dental-especially if your child needs cleanings more than 2x a year
- Covers all medications for disabled child
- psychiatric care (if necessary)
- Covers evaluations-including independent evaluations at approved specialist locations (this is huge if you are battling your district over independent evals!)
- *Covers wrap-around services or Behavioral Health Rehabilitation Services-program that provides services to children in their own home and community with a strong emphasis on natural supports. This can also include services for siblings if the non-disabled sibling has “issues” due to having a disabled brother or sister.
- diapers/pull-ups after age 3
*****NOTE: As stated before, this is not limited to this list. This is just an example and can vary from case-to-case. It is also coverage UPON APPROVAL OF FACILITY/SPECIALIST.
I hope you found this helpful. I encourage you and your family to apply if you have not done so already since it will open-the-door to many more resources for your child and your family. It can be a bit cumbersome at first with the paperwork, but it is worth it to get the services you may need.
It really can be the life ring that you need.
Keep being amazing,
Blog owner’s note: This post was originally published in 2011, but was recently updated and reposted.