Updated February 2013 Overview of Public Benefits

Updated February 2013

Overview of Public Benefits Major Programs run by the Pennsylvania Department of Public Welfare (DPW) – Cash assistance (TANF and GA) – SNAP (food stamps) – Medical Assistance / Medicaid

There are now 12 County Assistance Offices in Philadelphia. Hill + Ogontz = Chelten Alden + Lehigh = Glendale North + Center = Liberty Ridge + Tioga = Ridge Girard + Kent = Somerset Apply at the office that serves your address. To find that office, call (215) 560 -7226. Can also apply online at compass. state. pa. us

Medical Assistance / Medicaid • There are many different categories of MA. • Generally, poor families, people with disabilities, and people over 65 can receive MA.

Cash Assistance-Related Medical Assistance • Clients with very little household income may receive Medical Assistance if they have: – Minor children. – OR disabilities that last longer than 30 days. • They may receive Medical Assistance if they need health sustaining medications. • GA cash is gone, but GA-related MA remains for people with low incomes and disabilities. Income Limits* 1 $ 205 2 $ 316 3 $ 403 4 $ 497 5 $ 589 6 $ 603 * $250 resource limit for single adults; $1, 000 for everyone else.

Healthy Beginnings • MA for children and pregnant women. • Income limits are pretty high: – 100% FPIG for kids 6 -18, – 133% FPIG for kids 1 -5, – 185% FPIG for kids < 1 and pregnant women. • If not eligible for MA, children should get CHIP (any form is a good form). • Pregnant women are eligible through 60 days post-partum.

Healthy Horizons Medical Assistance • Clients with more income may receive Medical Assistance if they have disabilities that last for twelve months or longer: need form completed by doctor. • If they qualify for Healthy Horizons, they will be required to apply for SSI. Income Limits* 1 $ 958 2 $ 1, 293 * Plus a $20 disregard; $2, 000 resource limit.

EAF (PA 1663) Page 1. Make sure doctor checks box 1 or 2!

What Counts as a 12 -Month Disability? • Up to the doctor. DPW will not secondguess his/her judgment. • Some rules of thumb: – Any condition that if left untreated would affect the patient’s employability. – Any chronic condition requiring ongoing treatment. • Disability start date can be in the past (e. g. , today could say 4/15/12 – 4/15/13).

Medical Assistance for Workers with Disabilities • Clients with significantly more income may receive Medical Assistance for Workers with Disabilities (MAWD) if: – They have disabilities that last for twelve months or longer. – AND they work at least one hour per week. – AND are under age 65. Income Limits* 1 $ 2, 394 2 $ 3, 232 • Count only half of earned income after deducting first $85. • $10, 000 resource limit. • They will be required to pay a premium based on income – usually $40 -60 per month.

Miscellaneous MA categories • Breast and Cervical Cancer Prevention Program (BCCPT) • MNO spend-down for people working 100 hours/month • Extended Medical Coverage for families leaving TANF (1 year) • Medicare Buy-in (pays Medicare Part B premium for people with income < 135% FPIG)

MA for Immigrants • Only “qualified” immigrants can get regular MA. – Exception: Children and pregnant women can get MA if “lawfully residing” in the US. • Includes people with TPS, some asylum applicants, anyone with work authorization • Not all qualified immigrants get MA: some are only eligible after being “qualified” for 5 years.

Exceptions to the MA 5 -Year Bar • Children under age 21 • Pregnant women (60 days post partem) • Refugees and Asylees (even if they now have a Green Card – must check the category code) • Many other smaller categories (Cubans, Victims of trafficking…)

Who is Affected by the 5 Year Bar? • Adult family-based LPRs – those who came to the U. S. through a family sponsor • Employment-based LPRs • VAWA petitioners • Adult immigration lottery winners

Options for People Affected by the MA 5 -Year Bar • State-funded MA (for people with very low incomes): – General Assistance (GA) Related MA – Medically Needy Only (MNO) – TANF (State Funded) • Emergency Medical Assistance

Emergency MA • “Time limited” coverage for those whose immigration status prevents eligibility for regular MA, including those who are subject to the 5 year bar. – Only for people with emergency medical condition. • No SSN or immigration status required. • Must meet all other MA eligibility criteria. – category – income/resource

What is an Emergency Medical Condition? A condition with acute symptoms of such severity including severe pain, that without immediate attention, the result may be: the patient's health is in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any body organ or part. *Definition from the MA Eligibility Handbook (PA Dept of Public Welfare) Section 322. 32

Documenting EMC • Need strong letter from medical provider: – Describe the EMC - as defined by the Medical Assistance Eligibility Handbook. – State immediate treatment necessary because health is in jeopardy. – Treatment is “time-limited. ” Must have an end date

More components of strong EMC letters • Include what will happen without immediate treatment • Describe acute symptoms • Focus on HARM

Steps to Obtaining EMA Step 1: Determine appropriate MA category as you would for regular MA. (If disabled, fill out EAF) Step 2: Establish EMC Step 3: EMC letter from provider

For People Unable to Get MA • Network of City Health Centers and Federally Qualified Health Centers for primary care. • Some obscure specialized programs (e. g. , for HIV and schizophrenia medicines). • Emergency rooms: hospital has obligation to stabilize before discharge. – If admitted, cannot discharge without a plan. Family members may refuse to accept people they cannot care for. • Charity care – both hospitals and pharmaceuticals.

Tips for Welfare Advocates • Keep a copy of anything you give the CAO, & get a receipt • Know the rules: www. dpw. state. pa. us Search for “Policy Handbooks & Manuals” • Keep calling! • Go up the chain of command • Keep good records

Tips for Welfare Advocates cont’d • Try another route E. g. , Customer Svc Center, (215) 560 -7226 Community Services, (215) 560 -2547 • Put things in writing • Develop a relationship • Appeal! • Contact Community Legal Services or the Welfare Law Line (215 227 -6485)

Fighting the System • Our motto: APPEAL NOW, THINK LATER Why? • Get a neutral decision if can’t work things out • Buy time! Can submit proof CAO wants any time until scheduled hearing. Have time to get the paperwork and/or legal help.

Appealing Welfare Actions • Appeal deadlines differ, depending on the situation: • 13 days for continued benefits pending hearing. • 30 days for TANF MA, special allowances. • 90 days for SNAP (food stamps). • APPEAL NOW, THINK LATER.

Appealing Welfare Actions (2) • Fill out form that came with notice. • Keep a copy of the appeal, and get a receipt. • File an appeal even if you do not receive a notice. (Front desk should have blank, or just write a letter labeled APPEAL. ) • Send client to CLS if you can’t fix it.