Transcript Community Legal Services Welfare-to

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.