Medical Assistance PH-95 Loophole Coverage

From Autism Transition Handbook

If your child has a disability but your household income is too high to receive family coverage, your child may still be eligible for Medical Assistance. The program is called PH-95 or “loophole” and uses only your child’s income to determine eligibility. If your child is under 18, and has an income of less than $851.00 per month, and has a diagnosis of ASD, he or she may be eligible for Medical Assistance. If your child is eligible, they remain eligible until the end of the month of his/her 18th birthday. You must complete an annual reapplication, and keep the County Assistance Office notified of any address change. When your child turns 18, a new application must be filled out and begin the application process. You will have to provide a parental contribution letter at this point, stating that you do not provide financial support to your child. This does not mean that you do not provide your child with food and shelter; it only means that you do not give your child money to use at his discretion. When your child turns 21, again, a new application will need to be filled out. At this point, an applicant’s resources, as well as his income, will be counted toward eligibility. Also, the applicant will need to have his doctor fill out an Employability Assessment Form. This assessment acknowledges that your child has a disability that prevents him from working.

See Also

Pennsylvania's Health Law Project discussion of this coverage. PHLP's Steps for Applying for Loophole Coverage