Medical Assistance (MA) Continuous Eligibility for Children under Age Four, OPS180301 (Published March 13, 2018)
There are two major MA coverage programs:
The (Nonmoney Payment (NMP) program offers the most complete benefits. It covers many types of services, including prescriptions.
The Medically Needy Only (MNO) program allows payment for fewer services and items than NMP.
The two programs cover the same types of services or items for anyone under age 21. These children can receive the full range of MA benefits.
Children should meet financial and nonfinancial eligibility rules in each coverage group.
The following sections of this handbook have information for both coverage groups:
Appendix A contains a complete list of covered services.
The following MA coverage groups are available to children under the NMP program:
Categories J and M cover children who receive Supplemental Security Income (SSI) cash benefits. They also cover children who lose their SSI cash payment because of federal cost of living adjustments (COLAs). (For more information, see Chapter 387, SSI.)
Category PJ covers a child who lost SSI cash payment due to change in the meaning of disability enacted by PRWORA of 1996. The BBA of 1997 gave this group the right to receive MA up to age 18.
Categories C, U, and D cover children who receive Temporary Assistance for Needy Families (TANF) or General Assistance (GA) cash benefits. (For more information, see (Cash Assistance Handbook, Chapter 105, Category.)
Categories PC and PU cover children in families whose cash assistance benefits end because a family member begins receiving income from a job or from support. (For more information, see Chapter 339, EMC, and Chapter 338, Medical Assistance Benefits, Section 338.44.)
Categories PH, PJ and PM cover children who meet the eligibility rules for a blind or disabled category of NMP. (For more information, see Chapter 368, Determining Eligibility for NMP.)
Categories PC and PD cover children who are in or not in families that meet the eligibility rules for a TANF-related or GA-related category of NMP. (For more information, see Chapter 368, Determining Eligibility for NMP.)
Categories PS and PC cover a child up to age one; a child born to a woman who qualifies for MA automatically qualifies for MA coverage from the date of his or her birth until age one. (For more information, see Section 309.32.)
Category PS covers children age one to six. It also covers children age six and older who were born after September 30, 1983, and meet the income rules for infants and children. (For more information, see Chapter 318, Healthy Beginnings.)
Financial and nonfinancial eligibility rules should be met for all groups that are covered.
For categories C, U, J, and M the financial eligibility rules are described in the Cash Assistance Handbook. The nonfinancial eligibility requirements are described in Chapter 387 of this handbook.
The following MA coverage groups are available to a child under the MNO program:
Categories TJ and TM cover children who meet the rules for a blind or disabled category of MNO. (For more information, see Chapter 369, Determining Eligibility for MNO.)
Categories TC, TU and TD cover children who are in or not in families that meet the eligibility rules for a TANF-related or GA-related category of MNO. (For more information, see Chapter 368, Determining Eligibility for NMP.)
Waiver programs allow the Department of Human Services (DHS) to provide medical benefits to a child who may not qualify for MA. A waiver program may include services that are not usually covered by MA programs.
The following waiver programs are available to children who receive SSI, Cash Assistance, or MA:
The MA 0192 Waiver for Persons with AIDS or Symptomatic HIV Disease.
This program is an alternative to hospital care. An individual who has AIDS or has HIV disease with symptoms can stay in his or her home as long as it is expected to cost less than receiving care in a hospital or another place.
Consolidated Waiver.
This program is for children who would need care in an Intermediate Care Facility for individuals with intellectual disabilities if similar services were not available in the community.
For more information about waivers, see LTC Chapter 489, Waiver Programs.
Services are available to children who are put into out-of-home placements by the County Children and Youth Agency (CCYA). The Department of Human Services (DHS) provides money to help with the following:
Placement Maintenance.
This covers foster care placement under Title IV-E of the Social Security Act. Children who received or could have received TANF cash assistance when they were removed from their family home can receive this money. (For more information, see (Supplemental Handbook, Chapter 850, Foster Care and Adoption.)
Title IV-E Adoption Assistance.
This covers certain costs related to the adoption. It also can be used for children with special needs who have been legally adopted by new parents. A child who qualifies for Title IV-E adoption assistance automatically qualifies for MA.
State Adoption Assistance.
A child who does not qualify for Title IV-E adoption Assistance can receive adoption assistance under the State Adoption Opportunities Act. The County Assistance Office (CAO) will determine eligibility for MA for children who qualify for state adoption assistance.
Out-Of-State Placements—COBRA 1985.
A child who receives placement maintenance or Title IV-E adoption assistance automatically qualifies for MA even if the child moves to another state.
Placement in Pennsylvania by Another State.
A child who receives Title IV-E placement maintenance or federal adoption assistance from another state and lives in Pennsylvania is approved for MA by the CAO where the child lives
Placement by Pennsylvania in Another State.
A child who receives Title IV-E payments and is placed out of state can no longer receive MA. The CCYA sends a notice to the Bureau of Income Maintenance Operations (BIMO), and then BIMO sends a notice to the CAO where the child lived. At that time, the CAO will let the child know that his or her MA has stopped.
NOTE: For more information, see (Supplemental Handbook, Chapter 850, Foster Care and Adoption)
Updated August 21, 2018, Replacing February 14, 2012