Applying for Medicaid for a Child with a Disability: PH-95 Category

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 info@paautism.org).

Applications:

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.

What You Should Give With Your Application

Proof of Child’s Disability

Signed papers from a doctor or licensed clinician (like an evaluation report, treatment plan, or IEP) that has:

  • Your child’s diagnosis
  • Detailed information about how your child’s diagnosis affects them
  • What treatments your child needs

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.

Financial Information

  • All pay stubs for the past month (for each job that you have)
  • Letters that say you get Social Security, Supplemental Security Income (SSI), TANF/Cash Assistance, Unemployment or Child Support
  • If you are self-employed: Most recent IRS Form 1040 (include all of the schedules that you file)
  • If you are paid in cash: Letter from your employer that says how much money you make

Proof of SSI (SSI Application Summary Letter or Letter of Denial Based on Income)

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:

  • An application summary letter that says that you are applying for SSI for your child

-or-

  • A letter saying that your child was denied for SSI because of how much money you make.
    You should ask for one of these letters to be mailed to you after the screening process. Either one of these letters should be included with your application.

(To learn about the SSI screening process, visit www.paautism.org/SSI-PH95).

You May Also Be Asked For

Proof of Identity/Where You Live

Such as:

  • Your Pennsylvania driver’s license or State ID
  • Recent mail to your address (like an electric bill)

Proof of Your Child’s Identity

  • For citizens: Your child’s social security card, original birth certificate, or U.S. Passport
  • For non-citizens: Documents showing immigration status (such as a green card or asylum/refugee papers)

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).

When You Renew Medicaid

You need to renew your child’s Medicaid every 12 months

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.

You may have to update

  • How much money you make
  • Where you live
  • And other papers that show your child’s diagnosis

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.

Download entire resource (pdf)

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.