This chapter contains general policy on medical benefits and related Medical Assistance (MA) programs. See the Medical Assistance Eligibility Handbook for more specific policy information.
An individual who is eligible for MA receives an ACCESS card. The card is issued automatically only for individuals who do not have an Individual Number and for inactive individuals known to the system but who have never received an ACCESS card. Eligibility for Cash and MA is now evaluated independently for most categories, and both Cash and MA budgets are authorized for both programs. If an individual is eligible for Cash Assistance, then they must be reviewed for MA unless individuals specifically request to not be reviewed for MA or if the Cash program explored does not require an MA request.
55 Pa. Code § 101.1(e) & 55 Pa. Code § 141.71(b)
Some medical services for certain adult MA individuals are limited. See Medical Assistance Eligibility Handbook, Chapter 338, for more information.
The CAO must prepare and issue an interim medical card from the county office if an individual needs medical services but does not have an ACCESS card. See Medical Assistance Eligibility Handbook, Chapter 380. Review the need for a replacement card during application and renewal interviews.
An applicant for Cash Assistance may be eligible for retroactive MA coverage for any one or all three of the calendar months preceding the month of application.
55 Pa. Code § 141.71(f) & 55 Pa. Code § 141.71(g)
The CAO must explore eligibility for retroactive medical benefits and determine NMP eligibility for each month the person incurred an unpaid expense. If the person is ineligible for NMP, determine eligibility for MNO.
See Medical Assistance Eligibility Handbook, Chapter 338.3, for details on retroactive MA authorizations.
Revised August 5, 2024, replacing October 7, 2013