Medical Assistance Copays Still Planned for Families of Children with Disabilities

A notice sent out recently from the Department of Public Welfare regarding changes to copayments under Medical Assistance effective May 15th has caused some confusion among families who have children with disabilities on Medical Assistance. While this notice does not apply to children under 18, it does not mean that DPW has dropped plans to impose significant copays under Medical Assistance on families with children under 18 with disabilities.

DPW still plans to impose significant copays on families with incomes at or above two times the federal poverty level for services provided under Medical Assistance to children with disabilities under 18. Those copays may begin in September although operational issues may push the implementation date back. Nonetheless, we fully expect DPW to impose copays on many families of children with disabilities sometime this year or next. A separate notice will be sent by DPW before they implement those copays.

While DPW is still going forward with copays on services to children with disabilities, there are still important issues regarding how much families will have to pay. The copays will not apply to families with countable income below two times the poverty level. We have urged DPW to deduct out-of-pocket costs and insurance premiums for the child from parental income in determining whether the family is above or below two times the poverty level. Furthermore, for those families who would still be at or above two times the poverty level, deducting out-of-pocket costs and insurance premiums would still help as the total amount a family pays in copays cannot exceed 5% of their “countable” income. We also support premiums on a sliding scale based on income. To that end, we continue to urge families to write to the Director of Policy for Medical Assistance in support of these recommendations at the address below:

Leesa Allen, Director
Bureau of Policy, Analysis and Planning
Office of Medical Assistance Programs
Department of Public Welfare
P.O. Box 2675
Harrisburg, PA 17105

Please explain how these recommendations would assist your family in coping with copays.  Send a copy to your State Senator and State Representative.



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