303.1 General Policy

The Medical Assistance (MA) Program provides quality medical and dental services to individuals who are eligible based on meeting non-financial, financial, and resource eligibility criteria. The methodologies for determining eligibility for MA are:

 

 

The Department of Human Services (DHS) makes direct payments to health professionals and vendors for services, medications  and medical supplies.

 DHS generally does not pay for new and expensive medicine or for experimental treatment.             

55 Pa. Code § 175.71

303.11 Role of the CAO

It is the County Assistance Office’s (CAO) job to explain the available MA programs.

 

The CAO will explain that only medical providers who participate with MA can use the ACCESS card as proof that an individual is eligible for medical services. The CAO must also explain that only medical providers who participate with MA can be paid by the DHS for medical services.

 

            NOTE:  The CAO can use PROMISe to identify enrolled providers for the individual. (See Chapter 338, Medical Assistance Benefits.)

 

Reviewed April 24, 2025, Replacing June 4, 2024