The CAO will determine eligibility for Healthy Horizons based on the Healthy Horizon family’s income and resources.
55 Pa. Code § 140.232 55 Pa. Code § 140.301(a)
NOTE: The Healthy Horizons Applicant/Recipient (AR) group is made up of the individuals who are applying for or receiving MA benefits. The Healthy Horizons family is made up of the individuals whose income and resources are counted in determining the AR group’s eligibility.
The CAO must include the following family members, who live in the household with the Healthy Horizons applicant or recipient, and count their income:
The Healthy Horizons applicant or recipient.
The spouse who lives with the applicant or recipient, unless the spouse receives TANF, GA, SBP, SSI or Special SSI Recipient Status (PA/PJ/PM 85).
The unborn child of a Healthy Horizons applicant or recipient or spouse.
The biological or adoptive parent of a Healthy Horizons child.
NOTE: Income is not deemed from a parent to a child between the ages of 18 and under the age of 21 in the PH_00 category.
NOTE: Healthy Horizons children (PH 00) and children with disabilities (in the past referred to as Loophole PH 95) are two separate MA eligibility groups and covered by separate sections of the MA state plan. Different eligibility rules apply to each group. When determining eligibility for the Healthy Horizons child, the parents are mandatory members and their income is counted. The PH 95 category is a category of last resort. Eligibility for all other categories of MA must be considered, including Healthy Horizons PH 00, before evaluating eligibility for PH 95. When determining eligibility for this group, the parents’ income is not counted.
The CAO may include the following family members, who live in the household with the Healthy Horizons applicant or recipient, and count their income, if it will benefit the individual:
Any natural or adopted child or stepchild under 21 years of age.
NOTE: If the Healthy Horizons applicant or recipient chooses to include a natural or adopted child or stepchild, then the child’s income is also counted. (This includes TANF, GA, SBP, or SSI income.) The CAO must let the applicant or recipient know how a child’s income will affect eligibility.
Any child under age 21, if the Healthy Horizons applicant or recipient is exercising care and control of the child.
NOTE: If the Healthy Horizons applicant or recipient chooses to include a child under age 21 of whom he or she is exercising care and control, then the income of the child is also counted. (This includes TANF, GA, SBP, or SSI income.)
Any individual exercising care and control of a Healthy Horizons child.
The stepparent of a Healthy Horizons child.
The CAO may not include the following family members:
A spouse who receives Cash Assistance, SSI, Special SSI Recipient Status (PJ/PA/PM 85), or NMP for the Family (PC/PU 27).
Any sibling of a child who is a Healthy Horizons applicant or recipient.
The CAO must count the income and resources of a spouse for the Healthy Horizons applicant or recipient.
NOTE: If the spouse is under age 21 or pregnant or the family has children under age 21, resources are excluded for the entire family. This also applies to an applicant or recipient who is exercising care and control of a child under age 21.
Updated February 14, 2012, Replacing June 3, 2008