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You can apply for Medicaid in many ways in Pennsylvania. The PH-95 Category is one way. The PH-95 Category is for children (under 18 years old) with disabilities, like autism. Family income does not affect PH-95 eligibility. Even if you make too much money, your child can still get Medicaid in the PH-95 category. This checklist tells you what you might have to give with your Medicaid application if you are applying for your child with a disability.
Note: This checklist is a guide. Your County Assistance Office (CAO) might ask you for other documents. If you are having trouble getting the documents or need other help, please call PCCY’s Child HealthWatch Helpline at 215-563-5848 ext. 17 (www.pccy.org/resource/child-health-watch-helpline/). You can also call or email the ASERT Resource Center (877-231-4244 or email@example.com).
To apply for Medicaid, you can complete either a paper application, or apply online. When completing either application, use the helpful tips below:
Paper Application:Write in large print on the cover the application “Child with Disability Category PH-95.”
Online Application:Type “Child with Disability Category PH-95” in the comment/notes section. You can do the application online on the COMPASS website: www.compass.state.pa.us.
Note: There is a question on the application that asks if anyone in your household is “disabled, seriously injured, or in need of medical attention”. You must choose yes. Then, in the spaces provided, write the full name of your child with a disability and their diagnosis.
Signed papers from a doctor or licensed clinician (like an evaluation report, treatment plan, or IEP) that has:
Note: Evaluations should be from the past 6 months. PH-95 uses the Social Security Guidelines to say if a child can get Medicaid because of their disability. Give as much information as you can.
Sometimes CAOs will ask you to go through the screening process for SSI for your child. After being screened for SSI, you should get either:
(To learn about the SSI screening process, visit www.paautism.org/SSI-PH95).
If your child has other health insurance (like from your job): Give the health insurance policy numbers for your child’s primary health insurance (this number will be on the insurance card).
This shows the county that your child still needs PH-95. Renewing Medicaid is like the first application. Most of the information about your child is saved from last year if you are going to apply online. If you are doing the paper application, your CAO will send you an application with some of last year’s information already filled in.
If your child loses Medicaid because of your income changing, make sure that you re-apply using this PH-95 checklist. Your child can still get Medicaid using the PH-95 category even if you make too much money for Medicaid.
This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.