315.1 General Policy

DAP/MRT Referral for Disabled Child, PMA18939315 (Published July 26, 2018)

PMB18517315 -Removal of minimum age requirement for participation in the Office of Developmental Program’s (ODP) Person/Family Directed Support (68) and Consolidated (77) Waivers- May 31, 2017


The Children with Special Needs Category provides full Medical Assistance (MA) benefits to children up to age 18 who meet disability requirements and do not receive Supplemental Security Income (SSI) benefits under Title XVI of the Social Security Act.


The Children with Special Needs category is authorized only after eligibility for all other MA categories has been explored.

315.11 Eligibility Requirements

The County Assistance Office (CAO) will determine eligibility for Children with Special Needs based on the requirements in this Chapter and the following chapters:                           55 Pa Code  § 140.21


315.12 Benefits

The Children with Special Needs category provides the following benefits:

315.13 Presumptive Eligibility

A child should be authorized presumptively when:

Acceptable disability verification for presumptive eligibility includes, but is not limited to:

There is no presumptive eligibility for retroactive MA for the Children with Special Needs category.

315.14 Verification

The CAO will verify the following:


Explain the use of the Authorization for Information (PA 4) when collateral contacts are necessary. Complete the form only if the collateral contact requires written consent from the individual for the verification to be released.  (Section 378.4, Collateral Contacts)                                                                                                                                                                                          

    55 Pa. Code § 201.4(2)(ii)


Updated July 26, 2018, Replacing April 12, 2018