Medical Assistance for Children and Adolescents with Autism
What is Medical Assistance?
- Medical Assistance (MA) is healthcare insurance for children and adolescents up to 18 years of age who live in Pennsylvania
- MA might pay for things your regular health insurance doesn’t pay for, such as some therapies, including wraparound services
How do I apply for Medical Assistance for my child?
Step 1: Apply for Supplemental Security Income (SSI).
- See How to Apply for SSI.
- Apply for Medical Assistance at the same time you apply for SSI.
- If your child gets SSI, he or she automatically gets Medical Assistance. You do not have to complete the application process for MA.
- If your child is denied SSI, he or she may still qualify for Medical Assistance. Look for the statement in the denial letter that says your child may still be eligible for MA based on disability (in the fine print).
There are a couple of different ways to apply for Medical Assistance. We recommend that you fill out a paper application as indicated in step 2. Other options are available. Visit the Pennsylvania Department of Public Welfare website, or the nearest DPW office, to find out how to apply
HINT: Get a big envelope, a notebook, or a folder with pockets to keep all your papers organized.
Step 2: Answer every question. Fill out every part.
- Fill out a paper application.
- Check the “YES” box that asks: “Are you applying for this person?”
- On each page, write “MA FOR DISABLED CHILD HANDBOOK SECTION 355.4” in the top margin
- For help completing the application call:
- PA Health Law Project: 1-800-274-3258
- Public Citizens for Children and Youth 215-563-5848, ext. 17
- Department of Public Welfare: 1-800-692-7462
- Make a copy of everything and keep it in a safe place at home
Step 3: Take the application to the County Assistance Office for an interview.
- Bring these things to your interview. (Get there when the office opens in the morning to reduce your wait time.):
- The completed Medical Assistance application
- Your child’s original birth certificate
- Your child’s Social Security card
- The original SSI rejection or approval letter
- The report from your doctor, psychologist or school evaluation team (IFSP Individual Family Service Plan or IEP Individual Education Plan), that says your child has a disability
- Two most recent pay stubs
- Your Pennsylvania driver’s license or other photo ID
- Proof that you live in Pennsylvania (a rent or utility bill with your name and address on it)
- You don’t have to bring your child to the interview
- Keep track of the papers you get
- If your child is found eligible for medical assistance, you will be issued a temporary ACCESS card. You can use it immediately to pay for services for your child. The permanent card will come in the mail.
Most of the time children with physical or mental disabilities get Medical Assistance. If you are rejected, you can appeal.
Step 4: Choose your managed health care organization. (For example: Keystone First, United Health Care Community Plan, Aetna Better Health, etc.)
- Call your Primary Care Physician (PCP) to find out which health plans he or she is considered in network with (in which health plans does your child's pediatrician participate).
- Write down the Member Service unit number. Save it with your other papers.
- If you need BEHAVIORAL health services, call the providers in your county.
- Call the number on your access card and ask who provides Behavioral Health Services in your county. This is the same place to apply for wraparound services.
- Ask to get a Member Handbook. Among other things, the Handbook tells you what to do if you have a complaint.
Step 5: Use your Commercial Health Insurance and Medical Assistance to pay for services
- Bring all insurance cards with you to medical and behavioral health appointments.
- You may be able to use MA for services your commercial health insurance doesn’t cover
- SOMETIMES, you might be able to use the card to pay for services provided three months before you got Medical Assistance. Ask if you have “retroactive coverage.”
IMPORTANT: You must re-apply for Medical Assistance every year. You have to re-apply before your current Medical Assistance expires; otherwise you will have to begin all over again.
Reviewed: Dec. 2013