How to Apply for Medical Assistance for Your Child with Autism Building a support team around your child is the real first step.
Step 1: Apply for Social Security’s Supplemental Security Income (SSI) Why must you apply for SSI? Medical Assistance (MA) will pay for many of the services your child will need and in order too become eligible for Medical Assistance, you must first show proof that you applied for federal aid via SSI. "Proof" is in the form either of acceptance documents from SSI or a rejection letter.
You can apply for SSI online, by phone or in person. If you apply in person at your local Social Security office, you will need to bring your child’s Social Security card, original birth certificate, and "medical evidence" of your child’s diagnosis from a qualified physician (neurologist, psychiatrist, developmental pediatrician or PA certified psychologist). You will be asked for information on your family’s assets. If your assets exceed allowable SSI limits (regardless of your child’s diagnosis) you may be immediately "rejected." Ask the Social Security staff person to issue an official rejection letter immediately. If a letter cannot be issued while you wait, ask to have it mailed it to you. You will need the original rejection letter. Make a copy of the rejection letter for your own records.
Apply for SSI phone at: 1-800-772-1213 or online. If your child is found eligible for SSI, he or she is automatically eligible for Medical Assistance. See note on bottom of page for more information.
Step 2: Obtain the Correct Medical Assistance Application You can apply for Medical Assistance online using COMPASS. You can also request a "General Benefits Application 600C" for Medical Assistance (PDF download): Application for Health Care Coverage You can also obtain this application from your County Assistance Office (CAO) or your local elected official’s office.
Step 3: Complete the Entire Application Complete a printed version even if you apply online, as it will help you through the process. If you intend to mail your application, fill out the application completely, including income information. Fill out all sections, even portions you think may not apply to your child. Make a copy of your completed application. You will need this in case your application is lost, and it will be a useful reference when for the required annual renewal applications.
impairments). You can also call your County Assistance Office. The Pennsylvania Health Law Project can help walk you through filling out the application.
On page 4 of the application, write YES next to your child’s name in the column marked "Are you applying for this person?" Also write on page 4 at top: "MA FOR DISABLED CHILD HANDBOOK SECTION 355.4." This note flags your application as one for a child with autism.
Step 4: Bring the Required Documents to Your Local County Assistance Office (CAO) for an Interview An interview can be done in person at your County Assistance Office or by phone. Some parents have found that applying in person, especially with all the proper documents, helps build a support team. You can also mail the application and documents – or apply online using COMPASS -- and follow up by phone to arrange an appointment. Some parents report that going to their local CAO without an appointment -- and simply waiting for the next available caseworker -- is faster. Bring all of these documents for the interview:
This interview and review of your documentation should result in your child being found eligible as a child with autism. The MA system in Pennsylvania evaluates your child based upon the same criteria as SSI, but without considering the family’s financial situation. If your child is found eligible on a provisional basis, you will be issued a Medical Assistance Identification Number. Write this down, along with the name and phone number for your assigned caseworker. You should also request a temporary, or interim, ACCESS card, if it is not provided. This card can be used immediately with health care and behavioral health care providers. A permanent card will be mailed to you.
Step 5: Prepare to Renew Your Application Every Year You will need to complete a re-application once a year. A notice will be mailed to you by your CAO caseworker. You can reapply by mail or online using the Pennsylvania COMPASS system .
Step 6: Once Your Child is Eligible for MA and Assigned an MA Identification Number, You Must Make Two Choices:
First, using the online Pennsylvania Medical Assistance Enrollment Service, choose a physical health services provider in your county.
Once you have chosen a physical health services provider, you will receive a Member ID card. Bring this card and your ACCESS card to all medical appointments for your child. Also, bring these cards to your preferred pharmacy, so that they can put your child’s information in their system.
Each plan provider has a Member Services unit, and a Special Needs unit. Write these numbers down with your other important numbers. Depending on your county of residence, other services, including transportation to medical appointments, may be available.
Second, find out which behavioral health care provider serves your county. You will not have choice to make: each county has a contract with behavioral health care provider. If you plan to obtain behavioral health services, you will need to contact a local direct-care wraparound agency and proceed with the intake process. These agencies are responsible to the care provider mentioned above contracted by your county.
Complaints
You should have a copy of the process for complaining in your county Health Care Plan Provider’s "Member Handbook," mailed to you when you signed up for physical and behavioral health services
If you need a handbook, call your county Plan Provider to have them send you one. For Medical Assistance services, there is a grievance system to protect your rights. Each Plan Provider is required to have a formal process to help resolve client issues. In order to invoke those rights, you must use the complaint system.
Comments
The Department of Public Welfare welcomes constructive feedback about Medical Assistance services provided to families with autism. Use the DPW Online Feedback Page to give us your feedback. Resource -- WPPC.com
Step 1: Apply for Social Security’s Supplemental Security Income (SSI) Why must you apply for SSI? Medical Assistance (MA) will pay for many of the services your child will need and in order too become eligible for Medical Assistance, you must first show proof that you applied for federal aid via SSI. "Proof" is in the form either of acceptance documents from SSI or a rejection letter.
You can apply for SSI online, by phone or in person. If you apply in person at your local Social Security office, you will need to bring your child’s Social Security card, original birth certificate, and "medical evidence" of your child’s diagnosis from a qualified physician (neurologist, psychiatrist, developmental pediatrician or PA certified psychologist). You will be asked for information on your family’s assets. If your assets exceed allowable SSI limits (regardless of your child’s diagnosis) you may be immediately "rejected." Ask the Social Security staff person to issue an official rejection letter immediately. If a letter cannot be issued while you wait, ask to have it mailed it to you. You will need the original rejection letter. Make a copy of the rejection letter for your own records.
Apply for SSI phone at: 1-800-772-1213 or online. If your child is found eligible for SSI, he or she is automatically eligible for Medical Assistance. See note on bottom of page for more information.
Step 2: Obtain the Correct Medical Assistance Application You can apply for Medical Assistance online using COMPASS. You can also request a "General Benefits Application 600C" for Medical Assistance (PDF download): Application for Health Care Coverage You can also obtain this application from your County Assistance Office (CAO) or your local elected official’s office.
Step 3: Complete the Entire Application Complete a printed version even if you apply online, as it will help you through the process. If you intend to mail your application, fill out the application completely, including income information. Fill out all sections, even portions you think may not apply to your child. Make a copy of your completed application. You will need this in case your application is lost, and it will be a useful reference when for the required annual renewal applications.
impairments). You can also call your County Assistance Office. The Pennsylvania Health Law Project can help walk you through filling out the application.
On page 4 of the application, write YES next to your child’s name in the column marked "Are you applying for this person?" Also write on page 4 at top: "MA FOR DISABLED CHILD HANDBOOK SECTION 355.4." This note flags your application as one for a child with autism.
Step 4: Bring the Required Documents to Your Local County Assistance Office (CAO) for an Interview An interview can be done in person at your County Assistance Office or by phone. Some parents have found that applying in person, especially with all the proper documents, helps build a support team. You can also mail the application and documents – or apply online using COMPASS -- and follow up by phone to arrange an appointment. Some parents report that going to their local CAO without an appointment -- and simply waiting for the next available caseworker -- is faster. Bring all of these documents for the interview:
- A completed MA Application
- Your child’s original birth certificate
- Your child’s Social Security card
- The original SSI rejection letter (if you have received a rejection)
- A document containing your child’s diagnosis of autism from a physician qualified to diagnose autism
- Recent pay stub (or most recent IRS Form 1040 if self-employed)
- Your Pennsylvania driver’s license
- Evidence of your Pennsylvania residency (example: a utility bill containing your name and Pennsylvania address)
This interview and review of your documentation should result in your child being found eligible as a child with autism. The MA system in Pennsylvania evaluates your child based upon the same criteria as SSI, but without considering the family’s financial situation. If your child is found eligible on a provisional basis, you will be issued a Medical Assistance Identification Number. Write this down, along with the name and phone number for your assigned caseworker. You should also request a temporary, or interim, ACCESS card, if it is not provided. This card can be used immediately with health care and behavioral health care providers. A permanent card will be mailed to you.
Step 5: Prepare to Renew Your Application Every Year You will need to complete a re-application once a year. A notice will be mailed to you by your CAO caseworker. You can reapply by mail or online using the Pennsylvania COMPASS system .
Step 6: Once Your Child is Eligible for MA and Assigned an MA Identification Number, You Must Make Two Choices:
First, using the online Pennsylvania Medical Assistance Enrollment Service, choose a physical health services provider in your county.
Once you have chosen a physical health services provider, you will receive a Member ID card. Bring this card and your ACCESS card to all medical appointments for your child. Also, bring these cards to your preferred pharmacy, so that they can put your child’s information in their system.
Each plan provider has a Member Services unit, and a Special Needs unit. Write these numbers down with your other important numbers. Depending on your county of residence, other services, including transportation to medical appointments, may be available.
Second, find out which behavioral health care provider serves your county. You will not have choice to make: each county has a contract with behavioral health care provider. If you plan to obtain behavioral health services, you will need to contact a local direct-care wraparound agency and proceed with the intake process. These agencies are responsible to the care provider mentioned above contracted by your county.
Complaints
You should have a copy of the process for complaining in your county Health Care Plan Provider’s "Member Handbook," mailed to you when you signed up for physical and behavioral health services
If you need a handbook, call your county Plan Provider to have them send you one. For Medical Assistance services, there is a grievance system to protect your rights. Each Plan Provider is required to have a formal process to help resolve client issues. In order to invoke those rights, you must use the complaint system.
Comments
The Department of Public Welfare welcomes constructive feedback about Medical Assistance services provided to families with autism. Use the DPW Online Feedback Page to give us your feedback. Resource -- WPPC.com
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