What Is Medical Assistance (Medical Access) and Why Should I Apply For It?

In Pennsylvania, Medical Assistance (MA) provides free medical and mental/behavioral health coverage to people with low incomes or with disabilities.  Medical Assistance has the broadest coverage of medical and mental health services of any insurance plan for persons under the age of 18. It covers services rarely covered by employer provided insurance. Medical Assistance can be a child’s only insurance or it can be a secondary to primary insurance covering those services or equipment not covered by the child’s primary insurance.

I think I make too much money to qualify for this…

Medical Access, Medical Assistance, or Medicaid (MA) is most commonly known as a low-income program, HOWEVER

Almost ALL children in PA with identified disabilities (ADHD, Autism, Down Syndrome, and other mental health/behavioral health diagnoses, etc.) qualify for Medical Access.  If you are applying for a child with a disability, then…

• Parental income and/or child support DOES NOT COUNT

• Income in the child’s name (trust fund) DOES NOT COUNT

• SSDI benefits DO NOT COUNT

• Private insurance WILL NOT make the child ineligible, but the private insurance must be used first when accepted by providers.

What is covered?

• Care by the following practitioners: physician, podiatrist, optometrist, dentist, or home-care nurse. 

• Lab work and X-rays

• Inpatient and outpatient hospital care, including care in the patient's home if medically needed. 

• Mental health/behavioral health care

• Wrap around services, including behavioral specialists and TSS workers

• Prescription medication and nutritional supplements

• Vision care and glasses

• Dental care

• Physical, occupational, and speech therapy 

• Augmentative communication devices and FM listening systems

• Wheelchairs 

• Personal care/home health services/skilled nursing

• Prostheses 

• Case management

• Psychiatric care in clinics and hospitals 

Please review this Medical Access Pamphlet Guide