305.4 General Assistance (GA)-Related Categories

GA-related categories are assigned to non-citizen individuals who do not meet the eligibility requirements for any other category of MA. Non-citiens assigned to GA-related categories are:

• Permanent residents subject to the 5-year bar who have not yet met the 5-year bar

• Temporary residents

Individuals assigned in GA categories must meet one of the GA eligibility requirements detailed in Section 305.41 through Section 305.45.                  

 55 Pa. Code § 178.11(6)

305.41 Eligibility for PD Categories

Each applicant must provide proof of PD eligibility before authorization.

For the GA-related (PD) applicant who establishes eligibility, MA benefits will be approved as of the date all conditions of eligibility are proven.

Specific verification requirements are listed under each criterion. The CAO will record the verification of eligibility for PD. The CAO will help the individual get proof if they cannot get it alone.          

Pa 55 Code § 141.61(c)

Pa 55 Code §  201.3

NOTE:  For PD, the date on which possible coverage would begin is the date all eligibility conditions are met and verified. The period when someone can receive coverage for time that has already passed starts on the first day of the third month before the month when the individual applies. The period between when someone applies and when possible coverage begins is also considered to be in the retroactive period.

Example: An individual applies March 15. All conditions of PD are met as of April 2. The individual provided medical bills for December 3, January 5, January 18, February 24, March 5, and March 17. The PD retroactive period is from December 1 through April 1.

305.411 Two-Parent Applicant/Recipient Group (“F” Target Type)

Individuals who are parents living in a two-parent household with their child who is either under age 13 or age 13 or older and proven to be disabled may be eligible for GPD if the child does not qualify for TANF.                                                                                                                                                                                                                                                                                                        

  55 Pa. Code § 141.61(c)(1)(ii)

NOTE:For purposes of this section, a disabled child is a child who gets Social Security disability benefits or Supplemental Security Income (SSI).

 62 P.S. 432(3)(i)(B)
 

The two parents and child do not all need to apply for PD. One parent may apply for PD if (a) the child is not eligible for TANF on the basis of a deprivation factor and (b) the child does not meet the requirements for citizenship or refugee status. Another choice is for one parent to apply along with the child.

NOTE:  The two-parent guidelines for PD apply to both parents, whether or not they are married, as long as paternity has been established for the child in a two-parent household. The income of both parents must be considered in the eligibility determination.

305.412 Physical or Mental Disability ("D" Target Type)

An individual is PD if they have a temporary or permanent physical or mental disability that:          

 55 Pa. Code § 141.61(c)(1)(iii)

• Permanently prevents the individual from working in any job in which they will earn a salary.

• Temporarily prevents the individual from working in any job in which they will earn a salary
  .

NOTE:  If the medical provider believes that an individual can work only by using a health sustaining medication for a medical condition, the individual is considered PD eligible. A medical provider must give information about the condition and the name of the drug. The medicine can be an over-the-counter medicine.

NOTE:  If the disability involves drug or alcohol addiction, the CAO must first determine PD status under this section.

NOTE:  An individual with a temporary disability must seek the correct treatment to be considered eligible, unless the individual has good cause for not seeking treatment.            

 55 Pa. Code § 141.61(c)(1)(iii)(F)     

62 P.S 432(3)(i)(C).

Reminder: An individual who cannot work at a job because of a disability must apply for SSI to be eligible for PD, unless the disability is not expected to last. An individual with a disability that is permanent or expected to last for 12 months or longer more must apply for SSI/RSDI. The CAO will refer the individual to the Disability Advocacy Program (DAP), unless the only diagnosis is drug addiction or alcoholism. (Supplemental Handbook, Chapter 820, Disability Advocacy Program.)

305.4121 Documentation of Disability

The CAO must determine PD status based on a physical or mental disability from the information in one of the following forms:

• Employability Assessment Form (PA 1663)

• Temporary Disability Reassessment Form (PA 1664)

• Health-Sustaining Medication Assessment Form (PA 1671)

NOTE:  The PA 1671 is given to the applicant to fill out if the individual says that they are taking medications for a medical condition but can still work at a job. (See Appendix A for guidelines.)          

55 Pa. Code 141.61(c)(1)(iii)(B)

These forms must be completed by a psychologist, a medical doctor, or a medical professional who is under a doctor’s supervision and control (for example, a physician’s assistant or certified registered nurse practitioner).

• Information from a chiropractor is not acceptable medical proof.

• Information from a podiatrist is not acceptable medical proof.

• Information from an oral surgeon is not acceptable medical proof.
  

If the medical provider allows it, the applicant can send information along with the form that helps prove that they have a disability.

Records from other sources including, but not limited to, the Social Security Administration (SSA), the Department of Veterans Affairs (DVA), and DHS’s Medical Review Team (MRT) can also be accepted. The PA 1663, PA 1664, or PA 1671 must still be used if records from another source are not available, are not complete, or do not show how the individual’s disability is related to their ability to work at a job. If any of these records is six months old or older and does not show that the applicant has a permanent or ongoing condition, then the individual needs a new evaluation.        

 55 Pa. Code 141.61(c)(1)(iii)(B)

A disability that is found by the DVA can be used to establish PD only if the disability is 50 percent or more. If the disability is less than 50 percent, the individual needs to have a more complete medical and employment evaluation.

NOTE:  If DVA hospitals or DVA outpatient centers do not complete the PA 1663, PA 1664, or PA 1671, a veteran must get the information from another source using DHS forms. If necessary, the CAO must help the veteran find another medical provider to give the information.

The individual must provide proof of the disability and its effect on their ability to work as follows:

• For applicants, proof must be provided before eligibility for PD status can be determined.

• For recipients, proof must be provided within 30 days of the renewal or change in circumstances.      

     55 Pa. Code § 141.61(c)(1)(iii)(A)  
 

NOTE:  The CAO must make a referral to the Disability Advocacy Program (DAP) if the worker believes that the individual cannot get the documentation that is needed because of a mental disability.

If an applicant cannot provide proof of disability, the applicant is ineligible for PD and remains ineligible until proof of a disability is provided. Category TD with program status code 55 may be approved as a noncontinuous eligibility (NCE) for 30 days until proof of a disability is provided. Additional 30-day NCE periods may be approved if the applicant could not make medical appointments that are needed to get required medical documentation in the first 30-day period.

NOTE:  The CAO must issue an interim ACCESS card that the individual can use to pay for the medical assessment.     

    55 Pa. Code § 141.61(c)(1)(iii)(C).  

NOTE:  An individual can be determined eligible for MA benefits for a period that has already passed beginning with the first day of the third month before the month when the individual applied, if the provider has indicated the criteria for PD was met during the period requested, all other eligibility requirements for PD are met including meeting income and resource limits and the individual meets the retroactive NMP guidelines.  Section 368.3.

If the PA 1663 or PA 1664 says that the individual has a temporary disability, then the eligibility period for PD is only the period that the medical provider indicates.

If the PA 1663 or PA 1664 says that the individual can be employed, then the individual is ineligible for PD benefits.

The CAO records any change in status in the case record.

The CAO will review and verify the disability when the application is first turned in. The disability information must be reviewed again when the individual reapplies only if a medical provider noted that there might be a change in the individual’s condition or if their circumstances or DHS's regulations have changed.

It is not necessary to go through the renewal process to prove an individual’s disability as long as they continues to get SSA or DVA benefits based on disability.        

    55 Pa. Code §§ 133.23(a)(2)(ii)(L) & (3)(i)

If the individual’s disability is drug or alcohol addiction, the CAO must deny or stop benefits if the individual does not follow a treatment plan, unless they have good cause for not following it. (Section 305.44.)

An individual with a disability that is permanent or expected to last for 12 months or longer must apply for SSI/RSDI. The CAO will refer the individual to the Disability Advocacy Program (DAP). If the only diagnosis is drug addiction or alcoholism, the CAO will not refer the case to the DAP.

NOTE:  Disabilities of Mental Health (MH) or Intellectual Disabilities (ID)  rarely change, even though the type of job that a individual with one of these conditions can get and keep may change. Also, some applicants and recipients with MH or ID disabilities may have a hard time finding medical providers. Therefore, applicants and recipients with these types of disabilities may find it hard to get medical proof of their MH or ID disability. Every effort must be made to help these people get the required medical proof. The CAO will refer a individual to the Disability Advocate if the CAO believes that they cannot get the proof because of a mental disability.  (Supplemental Handbook, Chapter 820, Disability Advocacy Program.)

NOTE:  If an individual enters a training program or starts a job, it does not always mean that they are no longer disabled. If the CAO suspects a change in an individual’s medical condition, the CAO must get proof. For an individual active with OVR or an MH/ID Base Service Unit (BSU), the CAO must get proof in writing from an OVR medical consultant or the BSU’s psychologist or medical doctor. The individual giving the proof must know (a) what the individual’s physical or mental disability is and (b) how it affects their ability to get or keep a job.

305.413 Caring for a Child or Individual Who Is Ill or Disabled ("C" Target Type)

An individual is eligible for PD if they (a) cares for a child under age 13 but is not a parent of that child or (b) cares for another individual in the home who is ill or disabled. This includes a single individual who is providing foster care for a child under age 13.

           55 Pa. Code § 141.61(c)(1)(iv)     

62 P.S. 432(3)(i)(D)

The CAO will verify the age of the child or the medical condition of the ill or disabled individual. Age can be verified through SDX.     

55 Pa. Code § 145.44(a)      

The applicant or recipient must prove the need to stay home to care for an ill or disabled individual. The proof must be from a licensed psychologist or medical doctor explaining the following:

• The individual’s disability

• The need for a caretaker

• How long the disability is expected to last
  

The CAO will review these factors at renewal or when the individual’s situation changes.

NOTE:  The child or adult who is ill or disabled does not have to be a member of the applicant/recipient group, but must be a household member. When determining whether the caregiver can qualify, the CAO must decide if someone else in the household can provide the care without requiring PD.

305.414 Undergoing Treatment for a Drug or Alcohol Problem ("A" Target Type)

A individual who is undergoing active treatment for substance abuse in a drug- or alcohol-abuse program is eligible for PD if the treatment program does not allow employment during treatment. The treatment program must be licensed or approved by the Department of Health or administered by an agency of the federal government.           

55 Pa. Code § 141.61(c)(1)(v)       

62 P.S. 432(3)(i)(E)

Because abuse of drugs or alcohol may result in a serious physical or mental disability, the CAO must determine PD eligibility due to a disability by following the procedures under Section 305.42.

The CAO must confirm that taking part in a treatment program does not allow for employment. The CAO must also verify the individual is going to the treatment program. Acceptable proof includes, but is not limited to, a written statement from the program director or staff and official attendance records.

NOTE: The CAO's need to make an eligibility decision as quickly as possible in this situation.

A individual may be PD and in a treatment program for no more than nine months in their lifetime, even when in treatment at the end of the nine months.

This time-limit rule must be used only if there is no longer-term PD eligibility criteria.

The CAO will review the case record and the eCIS to see if the individual ever got GA cash assistance before. If they never did, or if any time remains from a previous approval, the CAO will approve PD for the correct number of months.

If the individual says that they are taking part in a treatment program, then they will sign a Drug and Alcohol Treatment Information Form (PA 1672). The individual will have the treatment center complete the form and then return it to the CAO with the proof needed. The CAO must determine eligibility for GA using information from the treatment center based on when the individual began treatment and how long the individual is expected to need it.

NOTE  GA and PD will not be approved until the completed form is returned to the CAO.

The CAO will track the individual’s progress and note their continued treatment. The caseworker will send a PA 1672 to the treatment center at the end of the individual’s first month of benefits to ask for information about the individual’s status.

After that, contacts will be made every three months using either the DHS form, a phone call, a written statement, a copy of official attendance records from the director or professional case-management staff of the program, or another form of proof. If the individual lives at the treatment center, the proof must show that the individual is still taking part in the treatment program. If treatment ends early, the treatment center may let the CAO know.

NOTE:  The treatment center does not need to let the CAO know about the individual’s status. It is the CAO's responsibility to make sure that the tracking continues. Caseworkers will narrate telephone contacts into the case record and keep forms.

The individual still must let the CAO know of any changes in circumstances that may affect their eligibility.

The individual cannot get benefits if they do not follow the treatment program, unless there is a good reason for not doing so. When sending an advance notice (PA/FS 162-A) to stop benefits for this reason, the CAO must use the following citation:

 “PA. Drug and Alcohol Abuse Act, 71 PS 1690.109(a)(d).”

After nine months, the individual can no longer be considered PD on this basis even though the treatment for drug or alcohol abuse may continue. If the individual does not qualify on any other basis for PD after nine months, the CAO must send the recipient an Advance Notice and use the following statement as the reason for the closing:

"You are eligible for Medical Assistance (MA) because you are receiving treatment in a drug or alcohol program. Receipt of benefits on this basis is limited to a maximum of nine months within your lifetime, and you will have exhausted this time limit on [effective date of the closing].

 55 Pa. Code § 141.61(c)(1)(v)”

The individual will no longer be PD eligible on this basis if the treatment ends before the nine months are up or if he or she becomes able to work. The individual may still be PD eligible if he or she meets one of the other PD criteria.

305.415 Victims of Domestic Violence ("V" Target Type)

An individual who is a victim of domestic violence may qualify for PD. Someone getting PD for this reason is eligible for up to nine months in their lifetime. The time-limited factor must be used only if there is no other basis on which the individual could get PD. A domestic-violence victim may qualify for PD for only up to nine months in their lifetime even though the protective services continue after the nine-month time period has ended.

55 Pa. Code § 141.61(c)(1)(vii)    

62 P.S. 432(3)(i)(G)

The victim must be trying to get or getting protective services as described below:

• If they are getting protective services, there must be proof of these services before GA can be approved. Proof can come from:

• A domestic violence center.

• A district magistrate office.

• Law enforcement records.

• Types of proof include the following:

• Phone contact with a domestic violence center.

• Written proof from a domestic violence center.

• Police records.

• Court records (a restraining order, for example).

The CAO must narrate the type of proof and where it came from in the case record.

There are several kinds of protective services, including, but not limited to, services for the following situations:

• The victim of domestic violence is living in an emergency shelter or emergency housing for abuse victims.

• An individual is eligible for cash and MA benefits as long as the benefits are needed, but the benefits given because an individual is a victim of domestic violence will be available only for nine months in the individual’s lifetime. Proof must be given each time the individual moves from the abusive situation into a protective shelter or begins to use other forms of protective services
  
  The victim is getting supportive counseling from an abuse program.

• The victim is getting services to prevent further potential abuse.

• The victim is getting services that let them remain at home.

• The victim is getting services at a police department or is filing assault or battery charges against the abuser.

• The victim is getting a restraining order or a peace bond against the abuser.

• The victim is getting any service by any branch of government (including the courts or the police) or agency that counsels or protects them from abuse. It is not necessary for the service to be continuous or provided every day, every week, or even every month.

NOTE:  The facts and information surrounding domestic violence must adhere to Supplemental Handbook 930, Safeguarding Information. Once it has been proven that the individual is getting protective services, it does not have to be proven again.

305.42 Eligibility for TD Categories

TD is the GA-related category for an individual who:      

62 P.S. 442.1

• Is age 21or over.

• Meets residency requirements; AND one of the following:

• Is a custodial parent or stepparent who is caring for and responsible for a dependent child (natural or adoptive) under 21 years of age.

55 Pa. Code § 141.81(c)(3)(v)  

NOTE: A parent or stepparent can qualify for TD as a custodial parent of a child under 21 who is attending college away from home if (a) the child maintains legal residence at the parent’s home and (b) the child is under the care and control of the parent.

NOTE: An individual or couple who is providing foster care for a child does not qualify for TD as a custodial parent. However, a foster parent can qualify for PD under the nonparental caretaker provisions of Section 305.43.

Reminder: When both parents of the child live in the household, an unmarried custodial parent can receive TD (MNO) no matter how much income the other parent has.

• Be age 59 or older.

• Be between ages 21 to 58 and show that they  are working at least 100 hours per month and earning at least a total of the minimum wage times 100.

NOTE: The amount that must be used is either the federal minimum wage or the state minimum wage, whichever is higher. Federal law allows states to require a minimum wage that is more than the federal minimum wage.

NOTE: For smaller employers with ten or less employees, all considered full-time and each works less than 40 hours a week as part of the employer's usual practice, use the real amount the employer pays to determine eligibility.      

     55 Pa. Code § 181.1(b)

NOTE: A third party who knows the self-employed individual’s business must verify the individual is working the number of hours that they claim. If no one is available to verify that, then the individual’s word may be used. After counting the gross receipts and cost of doing business, the individual’s average monthly profit when divided by the average hours worked (which must be at least 100 hours per month) must equal at least the hourly minimum wage.

NOTE: Although “income-in-kind” (work for free or reduced rent) is not counted as income, the hours worked are counted to determine if the individual meets the 100-hour rule. The value of the rent when divided by the hours worked for the rent must meet or be more than the minimum wage.

NOTE: For people whose eligibility is based upon the work requirement, past, present and ongoing work must be looked at to make sure that they are following the 100-hours-per-month work rule. If someone is sick or has an injury that forces  to stop working for a while, that individual is still considered to have met the work rule if it can be shown that they will return to work after recovering. The 100-hour work rule applies to each month in the six-month eligibility period. The recipient must report if they loses a job or works fewer hours.

NOTE:The Medically Needy Income Limits (MNIL) are not tied to minimum wage but are based on the State’s Family Size Allowance (FSA).  Federal regulations require the MNIL cannot be lower than the FSA and cannot be more than 133% of the FSA levels.  

305.421 Examples of How Eligibility for Benefits Is Based on Employment

• Application for Retroactive Coverage

Lisa, age 52, applies for MA on May 3rd while hospitalized for minor surgery. Lisa has worked for the last five years for 25 hours a week at minimum wage. Their employer has verified that they will return to work on June 28th.

Lisa meets the 100-hour work rule because they have a history of working 100 hours each month. They stopped working temporarily because of their illness, but it has been verified that they will return to work after they get better.

• Application for Future And Continuing Coverage

Paul, age 46, applies for MA on June1st. They work 20 to 30 hours a week at minimum wage for a total of 100 hours of work each month. They have worked at the same company for two years, which is proven by a statement from their employer and pay stubs.

Paul meets the work requirement because they work for 100 hours each month. In determining eligibility, the CAO reviewed their past work history and present condition to see if they are likely to continue to work.

• Application for Future And Continuing Coverage

Jim, age 23, applies for MA on June 14th . Jim started working at their first job on May 28th and got their first paycheck on June 6th. Their employer verifies that Jim will work 20 to 30 hours a week and will work a total of 100 hours per month. Jim receives minimum wage and does not expect a raise.

Jim meets the 100-hours-per-month work because they work for 100 hours per month and their employment will continue. Because Jim has no work history, the CAO sets up a review in three months to check on their employment. Jim understands that they must report any changes.

• Application for Continuing Coverage

Dave, age 36, applies for MA on May 30th.  Dave is employed part-time during certain times of the year. Their employer gives the following information:

• In winter months, Dave works 100 hours each month.

• In spring and summer months, Dave works 40 to 50 hours each month.

• The employer will not have work for Dave in June and July.

• The employer may have work for Dave in August.

Dave is not eligible because they do not meet the 100-hours-per month work and it is not clear whether they will have work in the future. The CAO informs Dave that they can apply in the future if things change. If Dave applies in October and their 100 hours continue for six months after that, they will meet the 100-hour rule.

• Application for Continuing Coverage

Terry, age 39, applies for MA on June 8. Terry has been employed for the last year and works 96 hours a month at minimum wage. This is proven by their pay stubs.

Terry is not eligible because they do not meet the 100-hours-per month work rule. The CAO lets Terry know that they can apply in the future if things change.

• Application for Continuing Coverage (minimum wage x 100)

Ann applies for MA on September 10. They have been employed as a child-care provider. The employer has given the following information:

• Ann earns $4.00 per hour.

• Ann works a total of 200 hours per month.

• Ann receives $800 per month gross earnings.

Ann meets the 100-hour minimum wage because their total monthly earnings are more than 100 times the minimum wage (now $7.25 x 100 = $725).

• Value of income-in-kind still considered

An applicant for MNO works for an employer who pays a very low wage but also provides free rent in exchange for working. The individual works more than 100 hours per month. They meet the 100-hour rule if (a) they work at least 100 hours and (b) the money earned plus the full value of the rent equals or is more than the minimum wage times 100.

TD with Program Status Code 55 may be approved for a 30-day NCE period if a medical assessment is needed to determine disability for GA cash, SSI-related, and GA-related MA categories (PD). TD 55 does require that the individual be issued a 30-day ACCESS card. (Section 305.421.)

Updated August 21, 2024, Replacing March 4, 2020