I went to our local Social Security office today to file for Social Security Disability Benefits for Bekah. I knew we wouldn't qualify under the income determination guidelines, but she does however qualify medically according to their Disability guideline for children with Cerebral Palsy. Had we qualified for SSD, she could have qualified to receive a few hundred dollars a month in SSD benefits.
Having the extra money every month would have been nice to help pay for Bekah's care, but that was not my main goal for applying for the SSD. I knew we would be denied, and that's exactly what I needed in order to get Bekah qualified for Medical Assistance in the state of Pennsylvania. Normally, we would not qualify for Medical Assistance because of our income, however there is a loophole in PA known as the PH95 loophole that would allow Bekah to be covered under Medical Assistance regardless of our income or her assets. Applying for Medical Assistance will require you to go through the process of applying for Social Security Disability Benefits. In the end, if you do not qualify on an income basis (not disability basis) you can include the denial letter in your application for Medical Assistance.
We do carry full medical, dental and vision insurance through my employer, but we are still responsible for our individual deductibles, family deductibles and 20% of all services on an annual basis. If you know anything about the costs of Physical Therapy, Specialists, and the MRI's that we have had to go through for diagnosis - you'd know that those bills would add up fairly quickly. Not to mention the fact that I've had to pay for having a baby this year in addition to all of Bekah's medical care, it's a huge financial strain on us right now. Thankfully, Medical Assistance can be retroactive up to 3 months, if approved.
The PH95 loophole would allow my daughter a secondary insurance to pick up co-pays and parts of our deductible from our primary insurance. The qualifications follow the definitions for applying for Social Security, as far as medical disability goes. It also includes children with Autism (see here for more info: http://www.autismhandbook.org/index.php/Medical_Assistance_PH-95_Loophole_Coverage).
For more information on the PH95 loophole and what it covers, you can view the "cheat sheet" online here: http://www.drnpa.org/File/publications/getting-medical-assistance-for-a-child--under-18--with-a-severe-disability--mental-illness-or-behavioral-health-disorder-under-the---loophole--.pdf
To read the Medical Assistance Eligibility Handbook in the Children with special needs section, click here: http://services.dpw.state.pa.us/oimpolicymanuals/manuals/bop/ma/index.htm
To apply for Medical Assistance in PA, you can file in person or online at the COMPASS website: https://www.humanservices.state.pa.us/Compass.Web/CMHOM.aspx
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