The County Assistance Office (CAO) must determine which category and program each Medical Assistance (MA) applicant or recipient belongs in. The program is based on the individual’s income and resources. The category for which the applicant or recipient is qualified affects how income and resources are treated.
55 Pa.
Code § 178.11
55
Pa. Code 178.12
The following categories are not Medical Assistance (MA) categories:
ACX is managed by the Office of Long-Term Living (OLTL).
EIX is managed by the Office of Child Development and Early Learning (OCDEL).
MHX is managed by the Office Mental health and Substance Abuse Services.(OMHSAS).
MRX is managed by the Office of Developmental Programs (ODP)
These categories are entered into e-CIS by the appropriate program office for billing purposes only. Individuals enrolled in these categories do not have MA benefits. CAO staff is not able to update these cases.
Individuals receiving these benefits may apply for and receive Cash, SNAP or MA benefits if the individual is non-financially and financially eligible. If an individual is found eligible for Cash, SNAP or MA, the benefits must be authorized in a new e-CIS case record number.
Supplemental Security Income (SSI)-related.
PH - (Healthy Horizons Age 65 and older or Disabled
PG - Healthy Horizons Medicare Cost-Sharing - Age 65 and older or Disabled
TA - Healthy Horizons Buy-In - Age 65 and older (Program Status Codes 65 & 67 only)
TJ - Healthy Horizons Buy-In - Disabled (Program Status Codes 65 & 67 only)
PA/TA - SSI-related Non-Money Payment (NMP) and Medically Needy-Only (MNO) - Age 65 and older
PAN/TAN - Long-Term Care Facility NMP and MNO - Age 65 and older
PAW/TAW - Home and Community Based Services (HCBS) NMP and MNO - Age 65 and older
PJN/TJN - Long-Term Care Facility NMP and MNO - Disabled
PJW/TJW - HCBS NMP and MNO - Disabled
PM - SSI-related NMP - Blind
PMN - Long-Term Care Facility - Blind
PMW - HCBS - Blind
PW/PI - Medical Assistance for Workers with Disabilities (MAWD)
Temporary Assistance for Needy Families (TANF) -related
TC/TU - TANF-related MNO
PCW - HCBS – TANF-related
PCN - Long-Term Care Facility – TANF-related
Modified Adjusted Gross Income (MAGI)-related
MG
Pregnant and Postpartum Women
Children aged 18 and under
Parents/Caretakers
Adults aged 19-64
Special eligibles.
General-Assistance (GA)-related
Other Programs:
PH 20 - Breast and Cervical Cancer Prevention and Treatment (BCCPT)
PH 95 - Children with Special Needs
PC:
Foster Care and Adoption
Former Foster Care
PC - Refugee MA (RMA)
MG 99 - Incarcerated individuals - Suspended
PC 38/39 - TANF-related - Inpatient
PD 38/39 - GA-related - Inpatient
PH 38/39 - SSI-related - Inpatient
The category of MA is based on the following criteria, which are not related to money or income (non-financial):
Age.
Temporary/Permanent and Total Disability.
Blindness.
Resident in a long-term care facility.
Individual receives home and community-based services.
Specified relatives.
Parent/caretaker.
Deprivation of support or care.
Pregnancy.
Employability.
Foster care/adoption status.
Family Planning.
Diagnosis and the need for treatment (BCCPT).
The category of MA identifies a budget group. Each member of the budget group is eligible for the same category.
An applicant/recipient group may include one or several budget groups. Separate budget groups may be set up for members of the applicant/recipient group, even if they qualify for the same category.
Individuals who are applying together, even if the CAO determines they are in the same applicant/recipient group, may not always qualify for the same category. The CAO must determine each individual’s category separately.
Updated August 21, 2024, Replacing August 19, 2019