The CAO will consider the age of each individual when deciding on his or her MA category. Depending on the individual’s age, the CAO must approve benefits in one of the following categories if all eligibility rules for that category are met:
PH (Healthy Horizons): This category is used if the child meets disability conditions.
NOTE: PH-00 is the first category of review for a child who meets disability conditions. MA for Children with Special Needs (PH-95) must be considered only if the child does not qualify for any other category of MA.
PJ/TJ: This category is used if the child meets disability conditions.
MG (MAGI-related MA).
PC: This category is used if the child is placed into Foster Care or receives adoption assistance.
TC/TU: This category is used if the child does not meet disability requirements for PH00 and is not eligible for MG (MAGI-related MA).
PH-95 (MA for Children with Special Needs). This category applies only if a disabled child does not qualify in any other category of MA.
An individual meets this age requirement until they reach the end of the month of their 21st birthday.
PH (Healthy Horizons): This category is used if the individual meets disability conditions.
NOTE: PH-00 is the first category of review for an applicant who meets disability conditions. A child under age 18 must be reviewed for MA for Children with Special Needs (PH-95) only if the child does not qualify for any other category of MA.
PJ/TJ: This category is used if the individual meets disability conditions.
MG (MAGI-related MA).
PC: This category is used if the child is placed into foster care or receives adoption assistance.
TC/TU: This category is used if the individual does not meet disability requirements for PH00 and is not eligible for MG (MAGI-related MA).
NOTE: For category TC, an individual meets the age rules through the end of the month of his or her 21st birthday if that birthday falls on or after the third day of the month.
55 Pa. Code § 141.81 (c) (3) (ii) (A)
PH-95 (MA for Children with Special Needs Category): This category applies only to individuals under age 18.
PW/PI: Medical Assistance for Workers with Disabilities (MAWD) gives individuals with disabilities the chance to enter and stay in the work force while getting MA coverage. To keep getting MA coverage under MAWD, an individual must pay a monthly premium to DHS.
PH/PG (Healthy Horizons): This category is used if the individual meets disability conditions.
PJ/TJ: This category is used if the individual meets disability conditions and is not eligible for Healthy Horizons.
PM: This category is used if the individual meets blindness conditions and is not eligible for Healthy Horizons.
MG (MAGI-related MA).
TC: This category is used if the individual does not meet MG (MAGI-related MA) criteria but is one of the following:
A specified relative who has care and control of a child who meets the TANF age rules.
A pregnant individual, unless they are a member of a two-parent household whose income after allowable deductions is less than the TANF-related MNO income limit.
NOTE: For TC an individual meets the age rules through the end of the month of his or her 21st birthday if that birthday falls on or after the third day of the month.
55 Pa. Code § 141.81 (c) (3) (ii) (A)
TU: This category is used if the individual does not meet MG (MAGI-related MA) criteria and is one of the following:
A parent in a two-parent household whose income after allowable deductions is less than the TANF-related MNO income limits. The parent must have care and control of a child who meets TANF age rules.
NOTE: The TU category applies to both parents.
A pregnant individual with no other children who is living with and married to the unborn child's father if the household income after deductions is less than the TANF-related MNO income limit.
NOTE: The spouse of a pregnant individual with no other children may qualify for TU.
PD/TD: This category is used if the individual meets the rules for GA-related MA and is a non-citizen who is either a permanent resident subject to the 5-year bar or a temporary resident.
NOTE: Certain permanent residents subject to the 5-year bar and temporary residents are eligible for other MA categories. See Section 322.312, Qualified Non-Citizens Exempt from the Five-Year Bar and Section 322.32 Lawfully Present Children Under Age 21 and Pregnant Women for more information.
PH/PG: This category is used if the individual meets the rules of the Healthy Horizons program.
PA/TA: This category is based only on age. An individual who is age 65 or older and who qualifies as either a specified relative or a disabled individual must be coded PA/TA because age is considered before all other factors.
PD/TD: This category is used if the individual meets the rules for GA-related MA and is a non-citizen who is either a permanent resident subject to the 5-year bar or a temporary resident.
NOTE: Certain permanent residents subject to the 5-year bar and temporary residents are eligible for other MA categories. See Section 322.312, Qualified Non-Citizens Exempt from the Five-Year Bar and Section 322.32 Lawfully Present Children Under Age 21 and Pregnant Women for more information.
An individual meets the age rule on the first day of the month of his or her 65th birthday.
PSF (Family Planning Services): This program provides family planning services to all non-pregnant individuals of any age or gender who are not eligible for MA or meet a Good Cause exception and have income less than or equal to 215 percent of the Federal Poverty Income Guidelines (FPIGs) using MAGI income and resource rules.
Under age 21:
Can be reviewed even if a parent/guardian does not sign the application, although not eligible for full MA without parent/guardian signature on application.
Can be reviewed even if household information is not provided, although not eligible for full MA without household information provided.
Can be reviewed on a solitary budget if MAGI household income is over 215% FPIG.
Updated April 24, 2025, Replacing June 6, 2024