(a)
Conditions of eligibility. To be eligible for MA, the
individual shall meet the appropriate conditions of eligibility in the
following chapters:
(2) Chapter 147 (relating
to residence).
(3) Chapter 149
(relating to citizenship and alienage). This applies only to PC.
(4) Chapter 153 (relating to deprivation of
support or care). This applies only to PC and §
153.44(a)
(relating to procedures) does not apply.
(5) Chapter 161 (relating to persons in
institutions).
(6) Chapters 177 and
181 (relating to resources; and income provisions for categorically needy
NMP-MA and MNO-MA).
(7) Chapter 125
(relating to application process).
(8) Chapter 255 (relating to
restitution).
(9) Chapter 155
(relating to enumeration).
(10)
Chapter 151 (relating to specified relatives).
(b)
Nonmoney payment
recipients. Title XIX of the Social Security Act (42 U.S.C.A. §§
1396-
1396q) provides that the benefits
of the MA program available to money payment recipients shall be available to
the following individuals described in paragraphs (1)-(6).
(1) Persons who are ineligible for
TANF and
GA payments only because of their failure to satisfy an eligibility condition
or other requirement prohibited by Title XIX of the Social Security Act
(42 U.S.C.A. §§
1396-
1396q) especially Subparts C and
D. (See Subparts C and D.) Also included are persons who, though eligible for a
money payment, decide they do not want the payment, but do want medical
care.
(2) Persons in a medical
institution whose incomes exceed the allowance for their personal care items
but are less than the amount they would need to provide for their living
requirements on an assistance level if they were outside the
institution.
(3) TANF families
whose assistance was discontinued because of increased income from, or
increased hours of, employment if the family received TANF in at least 3 of the
6 months immediately preceding the month in which assistance was discontinued.
NMP will continue for 4 calendar months beginning with the effective date on
which assistance was discontinued as long as any member of the family is
employed and all other eligibility criteria continue to be met during the 4
month period. A determination of resources as set forth in Chapter 177 and need
as set forth in Subpart D (relating to determination of need and amount of
assistance) may not be required. In those instances where a person's TANF
payments are discontinued retroactively because the client failed to report
changes in a timely manner, the 4 months begin with the date on which
assistance was erroneously paid.
(4) Persons who are ineligible for TANF, GA
or SSI only because of the 20% OASDI increase they received for September of
1972. Reference should be made to Chapter 183 (relating to income) for
procedures on disregard of the 20% increase.
(5) Aged, blind or disabled individuals who
were receiving SSI but become ineligible for SSI payments because of OASDI
cost-of-living increases paid after April 1977. In June of each year, the
County Assistance Office (CAO) will be provided with identifying case data for
those SSI recipients who are entitled to retain categorically needy MA
eligibility. The CAO will promptly change the category designation from A, M,
or J to PA, PM or PJ and will send a written notice to the client. The notice
will advise the client that although he is no longer eligible for SSI he will
continue to be eligible for MA as long as his circumstances remain unchanged.
It shall be his responsibility to report to the CAO any changes that may occur.
(6) Applicants or recipients who
would be eligible for cash assistance but for the elimination of the $30 plus
1/3 remainder of the earned income incentive deduction for 4 consecutive months
or the $90 work expense deduction, or both, in accordance with §
181.311(2)(ii)
(relating to deductions from earned income for the
TANF categories of
NMP-MA).
(7) The individuals
described in paragraphs (1)-(6) will be designated as categorically
needy-nonmoney payment recipients (NMP, Category Symbol P).
(c)
Money payment
recipients. The following persons will be eligible for MA services
provided the recipient does not have resources such as medical insurance or
governmental benefits that cover the costs of the services at MA standards:
(1) Persons eligible for SSI.
(2) Persons who meet the definitive
conditions of
TANF, GA or
SBP. GA persons, who are not eligible for
Federally-funded MA and who are eligible to receive a cash payment are entitled
to MNO level of benefits if otherwise eligible. In addition, these persons
receive coverage for prescribed medications. GA-related MA recipients eligible
for Federally-funded MA receive additional benefits under the MA Program.
Children under 21 years of age, pregnant women, migrants, refugees eligible for
MA up to 8 months from date of entry into the United States, as specified in
45 CFR
400.90 (relating to basis and scope),
repatriated nationals and persons who have applied for or been referred to the
SSA for Social Security or SSI disability benefits qualify for Federally-funded
MA.
(3) Newborn babies who would be
included in a family that meets the definitive conditions of AFDC.
(4) Children adopted under the Adoption
Opportunities Act of 1974 (62 P. S. §§
771-774), if financially eligible and either
the adoptive parents are receiving a maintenance subsidy from Child Welfare or
a physician certified prior to the adoption that the child has a physical or
mental handicap. The adoptive parents are in no way financially responsible for
providing help in paying for these medical services.
(5) A recipient of
SBP may not be eligible
for payment for inpatient hospital care, physician's service while in a
hospital, laboratory and x-ray services in independent facilities, three pints
of whole blood, hospital-home care, intermediate care or public nursing home
care unless he qualifies as medically needy as set forth in §
141.81 (relating to eligibility
policy for Medically Needy Only).
(6) A person under 65 may not be eligible if
he is a patient in an institution for tuberculosis.
(7) GA recipients may not be eligible for
intermediate care.
(8) A person
between 21 and 65 may not be eligible if he is a patient in an institution for
mental diseases.
(d)
Modifications to requirements. Modifications to requirements
will be allowed under the following circumstances:
(1) Except for the modifications listed in
this section, the
applicant shall meet the requirements and procedures peculiar
to
TANF or GA. However, if the person is eligible because he is a specified
relative as provided in §
151.43 (relating to requirements)
or under 21 or over 65 years of age, it may not be necessary to determine
whether he meets the conditions of disability or blindness.
(2) A decision that the applicant does or
does not meet the definitive conditions for TANF shall be supported in the case
record.
(3) To identify the type of
assistance the applicant would be eligible for, the appropriate symbol will be
added to the category symbol P. For example PC means that the person is a
categorically needy-nonmoney payment recipient who meets the definitive
conditions for TANF.
(e)
PC (Categorically Needy NMP-AFDC) requirements. All
regulations and procedures as set forth in §
141.41 (relating to policy) apply
except the following:
(1) The child need not
be living with a specified relative, including children in foster homes. To be
considered a specified relative, the relative shall meet the conditions as set
forth in §
151.42 (relating to
definitions).
(2) The child between
18 and 21 need not be attending school.
(3) The child support referral, cooperation
and assignment requirements of §
141.21 (relating to policy) is not
applicable.
(f)
Period when eligibility begins and ends. Eligibility periods
will begin and end in accordance with the following:
(1) For the money payment recipient,
eligibility for MA will begin 90 days preceding the date the authorization is
certified. For the NMP person, eligibility for MA will begin 90 days preceding
the effective date entered on the NMP Authorization Card.
(2) For the money payment recipient,
eligibility for MA will end on the last day covered by the last assistance
check he receives. For the NMP person, eligibility for MA will end on the date
he no longer meets eligibility conditions.
(3) If the money payment to a recipient who
is a patient receiving care in an institution is discontinued, his eligibility
for MA services as a categorically needy person will continue as long as he is
otherwise financially eligible.
(4)
A person no longer eligible for MA services as a categorically needy person may
be eligible for MA service as a medically needy person.
(g)
PD (Categorically Needy NMP-GA)
requirements. The policy and procedures in §
141.61 (relating to policy) apply.
A person who does not receive a cash payment and who is not eligible for
Federally-funded MA as described in subsection (c)(2) is entitled to the MNO
level of benefits if otherwise eligible. In addition, these persons receive
coverage for prescribed medications.
Notes
The
provisions of this § 141.71 adopted August 4, 1977,
effective 8/5/1977, 7 Pa.B. 2180;
amended March 7, 1980, effective 3/8/1980, 10 Pa.B. 983; amended March 28, 1980,
effective 2/1/1980, 10 Pa.B.
1390; implemented July 11, 1980, effective 5/15/1980 for new applicants and effective
6/1/1980 for currently active
applicants, 10 Pa.B. 2980 and 10 Pa.B. 3102; amended June 25, 1982, effective
6/26/1982, 12 Pa.B. 1940;
amended October 2, 1992, effective upon publication and apply retroactively to
August 1, 1989, 22 Pa.B. 4875; amended July 28, 2000, the provisions under Act
49 effective retroactive to September 1, 1994, the provisions under Act 20
effective retroactive to July 1, 1995, the provisions under Act 35 effective
retroactive to June 17, 1996, 30 Pa.B. 3779; amended September 13, 2002,
effective retroactively to March 3, 1997, 32 Pa.B.
4435.
The provisions of this § 141.71 amended under sections
201(2) and 403(b) of the Public Welfare Code (62 P. S. §§
201(2) and
403(b)); Titles I and III of
the Personal Responsibility and Work Opportunity Reconciliation Act of 1996
(Pub. L. No.
104-193) (PRWORA), creating the Temporary
Assistance for Needy Families (TANF) Program, and amending
42 U.S.C.A. §§
601-619,
651-669(b) and
1396u-1;
1902(a)(10)(A) of
the Social Security Act (42
U.S.C.A. §
1396a(a)(10)(A)); and the
Federal TANF regulations in 45 CFR 260.10-265.10.
This section cited in 55 Pa. Code §
140.221 (relating to conditions of
eligibility); and 55 Pa. Code §
175.74 (relating to
procedures).