Quakertown Community School District
Applying for Medical Assistance for a Child
with a Disability
What is Medical Assistance?
Medical Assistance (also known as MA or Medicaid) provides government funded
health care coverage for eligible individuals. People can qualify for Medical
Assistance in various ways. This document is regarding Children with Disabilities.
In Pennsylvania, children with some disabilities may qualify for Medical Assistance,
regardless of parental income. This is referred to as PH95 (or often called
‘loophole’).
 Child with eligible disability = parental income and resources are not
considered in the application process
How Can Medical Assistance Help My Child?
If your child’s application for Medical Assistance coverage is approved, he or she
will be eligible for a broad range of medical and mental health services. Many of
these services are not available through employer provided health insurance
plans. One example is behavioral health services (commonly referred to as ‘wraparound’ or BHRS). Medical Assistance can also be a secondary coverage and can
cover the costs of co-pays and other services that are not covered by employer
provided insurance. There are no lifetime limits to medical services like there are
with some other types of insurance.
Can my child have Medical Assistance AND another insurance?
Yes, your child can have a primary insurance with Medical Assistance as a
secondary insurance. In this case, the MA would cover the services (and copays)
that are not covered by the primary insurance. Medical Assistance can also be a
child’s only insurance coverage.
How does my child qualify for PH95 (loophole)?
Many children with a severe disability will qualify for Medical Assistance under
PH95. However, it is important to understand that not all disabilities or diagnoses
make a child eligible for MA. Just because a child has an IEP, that does not mean
that he or she is automatically eligible.
In general the criteria are:
 “a child under age 18 will be considered disabled if he or she has a medically
determinable physical or mental impairment or combination of impairments
that causes marked and severe functional limitations”
 “can be expected to cause death or that has lasted or can be expected to last
for a continuous period of not less than 12 months”
Because of the above criteria, it is important to have medical documentation to
demonstrate the nature and severity of the child’s disability. This should include
any records that you have, such as recent medical information from a physician,
which includes diagnosis, prognosis, treatment plan, and any medications (if
applicable). A current IEP (an IEP alone is not usually sufficient). Any reports that
list your child’s diagnosis, symptoms, and how these symptoms affect your child’s
daily life. Any reports from therapists and counselors documenting your child’s
limitations in motor skills, communication skills, personal and social skills.
What you will need to complete a (PH95)
Medical Assistance application for your child
It is helpful to gather the following information prior to starting
your application:
1. Child’s birth certificate
2. Child’s Social Security number & card
3. For non-citizen applicant - proof of immigration status
4. Proof of address (such as parent’s driver’s license, utility bill)
5. Documentation of child’s income (if child has income)
6. Documentation of the child’s disability (as stated on previous page)
7. Documentation of parental/guardian income for the past 30 days
(current paystubs or signed letter from employer). You need to
submit this information, even though it does not count toward
eligibility for PH95
8. Information on any current health insurance coverage for your child:
group and policy numbers
9. Documentation on any unpaid medical bills for the past three
months for the applicant, if any
10.
Car insurance policy number and provider name
Please Note: You may also need to show proof that your child does
NOT qualify for SSI (Supplemental Security Income).
In order to do that:
Call the Social Security office at 1-800-772-1213 to set up an appointment
for an SSI eligibility screening over the phone. Ask for written
confirmation of this pending appointment to be sent to you as soon as
possible. You may need to have this confirmation of pending
appointment, or SSI denial letter, in order to apply for Medical
Assistance. Include this with your MA application documentation.
What is SSI?
Supplemental Security Income (SSI) is a program that is run by Social
Security. Eligible people will receive a monthly check AND will receive
Medical Assistance. If you think your child may be eligible for SSI, you
should apply for SSI first.
Please read the How To Guide here to find out how to apply for SSI.
How To Apply for Medical Assistance (PH95)
Once you have gathered all of the information you need, you can begin the
application process. You can apply for Medical Assistance online or by using a
paper copy of the application.
 For online applications:
https://www.compass.state.pa.us/compass.web/cmhom.aspx
You will need to send in supporting documentation (such as proof of disability, etc)
 For paper applications:
You can find the paper application to download and print here:
http://www.dhs.state.pa.us/cs/groups/webcontent/documents/form/p_014338.p
df
After completion, you will have to mail it (and supporting documentation) to your
local county office.
Bucks County
Assistance
Office
1214 Veterans
Highway
Bristol, PA 190072593
Phone: 215-781-3300
Toll Free: 1-800-362-1291
LIHEAP 215-781-3393
or 1-800-616-6481
FAX: 215-781-3438
After reading this guide, if you need help or have any questions about applying, please contact
me (if you have students attending the Quakertown Community School District)
Kirsten Cochran, Social Worker (kcochran@qcsd.org)