Section 141.71. Policy

(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.

The provisions of this § 141.71 adopted August 4, 1977, effective August 5, 1977, 7 Pa.B. 2180; amended March 7, 1980, effective March 8, 1980, 10 Pa.B. 983; amended March 28, 1980, effective February 1, 1980, 10 Pa.B. 1390; implemented July 11, 1980, effective May 15, 1980 for new applicants and effective June 1, 1980 for currently active applicants, 10 Pa.B. 2980 and 10 Pa.B. 3102; amended June 25, 1982, effective June 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. Immediately preceding text appears at serial pages (268285) to (268288).

Notation

Authority

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; section 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.

Cross References

This section cited in 55 Pa. Code § 140.221 (relating to conditions of eligibility); and 55 Pa. Code § 175.74 (relating to procedures).