Families of children and youth with special health care needs (CYSHCN) will have adequate private and/or public insurance to pay for the services the need.

These resources provide guidance and information to address outcomes to improve health care insurance and funding for CYSHCN.

On this page:

Medical Assistance (MA)

Many CYSHCN in PA are eligible for Medical Assistance (Medicaid) coverage.

Apply for Medical Assistance on the Basis of a Child’s Disability or Special Health Care Need:

Getting Medical Assistance for a Child (under 18) with a Severe Disability, Behavioral or Autism Spectrum Disorder under the PH-95 Category (“loophole”)PA Health Law Project 

COMPASS, an online application for Pennsylvanians to apply for many health and human service programs

  • — Learn about benefits
  • — Apply for benefits
  • — Check your status
  • — Find providers

Managed Care

Managed Care programs provide Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCO). Most CYSHCN in PA are provided coverage through HealthChoices, PA’s managed care program.

HealthChoices is divided into two parts: Physical Health and Behavioral Health

Physical Health MCO – List of providers in PA
  • — Special Needs Unit (SNU) – Each Physical Health MCO has a SNU to that can be reached by calling the customer service number on the patient card and asking to be connected to the SNU
Behavioral Health MCO – List of providers in PA

Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program

The child health portion of Medicaid, EPSDT Program, aims to improve the health of low-income children in every state. The elements of the program include:

  • Early | Identify problems early, starting at birth
  • Periodic | Check children’s health at periodic, age-appropriate intervals
  • Screening | Provide physical, mental, developmental, hearing, vision, and other screening tests to detect potential problems
  • Diagnosis | Perform diagnostic tests to follow up when a risk is identified
  • Treatment | Treat any problems that are found

 

Learn more about EPSDT here.

Waivers

PA offers several waivers for individuals with disabilities. Waiver programs provide certain medical and non-medical services to individuals in their home or a community-based setting in order to help them remain living independently.

Eligibility

To be eligible for a waiver program, individuals must meet functional criteria and financial criteria. Each waiver program has its own criteria so it’s important to read through each program’s specific requirements.

Waiver InformationPA Department of Human Services

Adult Autism Waiver (AAW)PA Department of Human Resources

Attendant Care/Act 150PA Department of Human Services

PA’s Children’s Health Insurance Program (CHIP)

Families whose income is too high to qualify for Medicaid can receive health coverage for their children through CHIP.

Learn more about CHIP in PA here.

PA Autism Insurance Act (ACT 62)

In PA, your child’s autism-related services may be covered by private health insurance, the MA program, or CHIP under the PA Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).

PA Autism Insurance Act (ACT 62)PA Department of Human Services

Achieving a Better Life Experience (ABLE Act) , PA ABLE Savings Account

A PA ABLE Savings Account is a savings program that gives individuals with qualified disabilities, and their families and friends, a tax-free way to save for disability-related expenses without jeopardizing government benefits

Resources for a PA ABLE Savings Account here.