I used to be a caseworker for the Department of Public Welfare in PA. I have written some comments in a few diaries about PA Medicaid (Medical Assistance/MA) and brief descriptions about how it is and ways to interact with it. They tend to be well received, so I thought I would write a diary to be a little more detailed. I plan to cover how to apply and what you will need to get started. By no means is this absolute, or the final word, but I hope it helps. If this is popular or people request it, I can start another one on the different MA programs are available based on situation.
To start out, I want to include a quick link to the OIM (Office of Income Maintenance) website with the DPW handbook. These are easier to read then the real regulations they are based on, and are available to the public.
http://www.dpw.state.pa.us/...
To see Medicaid, click Medicaid. That link also provides the handbooks for TANF and Food Stamps, but I will not address them in this diary.
First, how to apply. You can apply at a County Assistance Office by going in person and filling out the application (addresses: http://www.dpw.state.pa.us/... If you fill out the application that day, you may be seen the same day (depends on office, some do NOT take walk ins). You can also apply online (https://www.humanservices.state.pa.us/compass/CMHOM.aspx). With medicaid applications, you do not need to be seen in person, and all correspondence can be done through the mail, on the phone, and with faxes. It is the only DPW program where you do not have to go in at least once for a face to face interview.
With this application, you will need to provide alot of info in order to get approved. While the application only requires a name and address to start the process, you actually need alot more for approval. I highly recommend that you answer all the questions. It seems that more times then not people left it blank not because they didnt know, but because they were evading. If you are working, even only for a very small amount, write it down. Anything that is not under the table is reported in PA to the Department of Revenue which then gives it over the computer to the Department of Welfare. If you are reported as having a job and you say you dont, you need to prove that you dont work for that employer. When you fill out the "people" section of the application, write in everyone in the hosue. If you are not applying for them, check the NO box in "applying?". This is important. Parental income counts for children, and not providing the whole family structure can slow down processing, or hinder you in the future if you need to apply for others in the same house.
What do you need to provide? Federal law requires that anyone applying for Medicaid (those who have "yes" checked) be able to provide proof of citizenship and identity. The ONLY form that does both is a VALID NON EXPIRED US passport. Otherwise you will probably be providing a drivers license or state ID for identity. Citizenship is proved with a birth certificate (if you dont have yours, there are ways to get it). If you cannot provide those 2 pieces of info, you are denied. Next, you will need proof of income/employment. This can be a paystub (must be within 30 days of application) or a letter from the employer. Next will be proof of residence to show you live within the county you are applying in. The worker will tell you other stuff you need to provide (and give you a PA253 form with a checklist). If you dont give all of that stuff, you will be denied. If there is a child under 21 who is under the care of one of the adults in the application, then resources are excluded (this depends on the situation, but is almost always true). The next most important form is the PA4, which is the Authorization for Request of Information. THIS MUST BE SIGNED if you want benefits. If you dont sign it, but you fill it out, your case can be rejected for this. This form allows the case worker to contact employers, banks, etc for information about you, and this is the authorization from you to get that info.
If you have children, they may get accepted onto Medicaid and the adults might not. Income limits are different for children based on the age of the child. It is the easiest for an infant under age 1 to get on Medicaid then a 6 year old, and still harder for a teenager. This is important to keep in mind, since the determination letter will list who will receive Medical Assistance (MA). If you receive a rejection letter, it will list who is rejected. You may receive BOTH of those letters depeneding on situation.
If you do not have children, and you think/know you are disabled, the caseworker will give you what is called a PA1663 form to take to a doctor, and TEMPORARY MA called TD55. This will pay for 1 physical for a Medicaid accepting doctor to perform and fill out the form. The form has 4 boxes (permanent disabled, temp disabled 12 months or more, temp disabled 12 months or less, not disabled), a line for his MA provider number, and space to write the diagnosis, and finally, a place to put the disability timeframe (if there is one). It is very important that the doctor fills out ALL of that info, since it is your responsibility to have the form filled out. Without all that info, your claim will be rejected for insufficient info. Say the doctor says you are temporarily disabled, but puts no end date. That is INCOMPLETE, and the form will be rejected.
Finally, you have 30 days from date of application to provide all info. They can reject you after 10 for insufficient info, or immediatly if you provide info showing you are ineligible. If you are rejected, you will receive a form PA162 listing the reason you are rejected. You always have the right to appeal any decision made about your case (even positive ones). You will have the opportunity to state your case to an Administrative Law Judge, and the caseworker will list what they did and why. I recommend you work this out ahead of time. If you are rejected for insufficient info, the appeal is not the place to settle it, provide that info before hand, and let the worker know when you do.
Finally, please list any questions about the application process, or how to apply below. I can edit the diary to explain topics with more detail, and change the paragraph structure for clearer reading. I will leave the different programs to another diary, since there are over 20 of them. I apologize before hand if this is hard to follow, or seems rambling.