Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Pennsylvania program

Medicaid without counting parents' income (PH95, "the loophole")

Free Medical Assistance for a child under 18 who meets disability rules. PH95 checks parents' income, then leaves it out.

What it is

Free Medical Assistance for a child under 18 who meets disability rules. PH95 checks parents' income, then leaves it out.

PH95 is Pennsylvania's route for children with special needs whose parents' income blocks ordinary MA. The county checks the child's own income, and a state medical team reviews disability. A high family income does not by itself close this route.

Eligibility rules
  • Your child must live in Pennsylvania, be under 18 and meet Social Security's disability standard as reviewed by the DHS Medical Review Team.
  • The child's own counted income must be at or below 100% of poverty: $1,330 monthly in 2026. Court-ordered child support and the child's RSDI benefits are excluded.
  • There is no resource test for children under 21. PH95 is a last-resort MA category after other MA categories are considered.
  • Social Security's rules treat acute leukemia as a disability for at least two years from diagnosis or relapse, and for at least a year after a transplant. After that the Medical Review Team looks at your child's actual limits; coverage once granted runs to 18 unless a review finds no disability.
  • PH95 does not require your child to meet an institutional level of care. It is Pennsylvania’s child disability MA route, not a separate Katie Beckett or Family Opportunity Act buy-in. Home nursing still needs its own review.
What you get
  • No premium for full Medical Assistance.
  • Coverage can sit behind your work plan.
  • Access to rides and home nursing after their separate reviews.
  • No savings test for this child coverage.
What the help includes
  • Full MA includes hospital and cancer care, medicines and other covered services. Work insurance can remain primary.
  • Nursing hours depend on your child's care needs, and rides need county arrangements. PH95 approval alone does not schedule either service.
If you decide to apply
  1. Ask the oncology social worker to help you request PH95 by name through COMPASS or the County Assistance Office.
  2. Bring parents' pay stubs and records of income in your child's name.
  3. Ask the oncologist for a summary of the diagnosis, treatment, expected duration and day-to-day limits.

1-866-550-4355 · Official page ↗

After you ask
  • A medical-record request normally allows 30 days from mailing to respond. Your caseworker can discuss an extension if the clinic needs more time.
  • The county can open MA on adequate medical evidence while the Medical Review Team decides PH95. DHS says coverage stays open during that review when the family cooperates with medical-record requests. The caseworker confirms the review’s progress; the 30-day records deadline is not a promised final decision date.
  • Financial renewal occurs at least every 12 months. Medical certification can continue until age 18 unless a relevant medical change affects the disability criteria. At 18, the county can review ordinary child MA through age 18, adult SSI or disability routes, and medically needy coverage as appropriate.
Good to know

Parents' pay still needs proof even though it is excluded. PH95 ends at 18, so an approaching birthday changes the coverage conversation.

Other details
  • The care summary should describe what treatment prevents your child from doing, as well as the diagnosis.
  • Ordinary MA remains the first category if your child qualifies. A cancer diagnosis does not make PH95 the required choice for every family.

Federal background: A Medicaid option you may hear called Katie Beckett.

Official sources
Ask your social worker

“Could PH95 help us even if our income is too high for ordinary MA? What would the disability review and a second insurance plan involve, and could you help with the paperwork?”

Why I’m asking: I want to understand whether our child's medical needs open free coverage regardless of our earnings.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on COMPASS naming PH95. Hand over the parents' pay stubs (checked, then left out) and any income in the child's name, and answer the county's letter within 30 days.

Your social worker

The oncology social worker helps discuss PH95, gathers the medical summary and asks whether presumptive medical evidence supports MA while the Medical Review Team reviews it.

The care team

The oncologist writes a current, comprehensive summary: diagnosis, treatment plan, duration, and what the child cannot do day to day.

Who decides
The County Assistance Office checks the child's own income and verifies the parents'. The state Medical Review Team decides disability.
Ask your social worker
“Could you help us decide whether PH95 fits and gather the medical summary? Could the county open MA using presumptive medical evidence while it reviews the case?”

How to apply

First step: Ask the oncology social worker about PH95 and the medical summary needed. If you decide to proceed, COMPASS or 1-866-550-4355 is an application route.

  1. Discuss PH95 and supporting medical records with the oncology social worker; COMPASS is an application route if you decide to proceed.
  2. Ask the oncology team for a current, comprehensive medical summary the week you file.
  3. Return anything the county asks for within 30 days and ask for presumptive MA meanwhile.

Official application / program page ↗

Where it starts: Apply on COMPASS, by phone at 1-866-550-4355, or at the County Assistance Office, and ask for Medicaid for Children with Special Needs (PH95) by name.

What to gather

  • Child's Social Security number and birth certificate
  • Parents' recent pay stubs (verified, then excluded)
  • Any income in the child's name (at most $1,330 a month; child support and Social Security dependent benefits do not count)
  • A current, comprehensive medical summary from the oncologist: diagnosis, treatment, duration, functional impact
  • The county's letter and its 30-day date

How long: The handbook gives the county 30 days from a COMPASS application. We found no published figure for how long the Medical Review Team takes; ask the county to open MA on the medical paperwork while it decides.

What a yes looks like

Full Medical Assistance with a confirmed start date and the applicable plan arrangements. Renewal is at least every 12 months; current medical evidence and income remain relevant.

What a no looks like, and the next move

Ask which test failed: the child's own income, the medical records (not current or complete enough), a missing document, or another MA category that fits first. Appeal by the date on the notice and send a fuller medical summary.

Watch out

  • Parents' income is excluded but must still be verified. Missing pay stubs stall the case.
  • The county's letter gives you 30 days to send medical records. Call the County Assistance Office before the deadline if the clinic is slow; cooperating keeps temporary MA open.
  • PH95 stops at 18. For a child of 17, plan the switch to spend-down or adult SSI rules a few months ahead.
  • A historical guide describes Medical Assistance opening on adequate presumptive evidence before the final disability review. Ask the caseworker to review that route; the current review turnaround is unknown.

Dates that change this

2026-07-01: The state still offers PH95 as of September 2026; no 2026-27 budget change to the category was found. (not yet confirmed against the final rule)

2027-01-01: Coverage reaches back up to three months before the application month now; two months for applications made on or after January 1, 2027.

2026-10-01: From October 1, 2026, federal immigration funding rules change. Pennsylvania preserves a lawfully residing child pathway; the county checks the child-specific category and coverage rules. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 10, 2026.

What it is worth

Full, free Medical Assistance behind your plan, whatever the parents earn. The child's own counted income must be at or below 100% of the poverty line ($1,330 a month for one person); no savings test.

  • $1,330/month (the child's income only; parents' income is excluded) — Child's own countable income ceiling (100% FPIG, one person, 2026)
  • $0/month — Premium

Covers: Full Medical Assistance benefits · EPSDT · Shift nursing, personal care and home health through the HealthChoices plan when approved · Rides to appointments (MATP)

Legal protection: The county reviews continuing disability and relevant medical changes. Certification is not an unconditional promise of coverage through age 18.

What it costs the family: None. "Full and free Medical Assistance coverage."

The eligibility facts, as published

Age max exclusive
18
Residency
Pennsylvania
Parental income
verified but excluded
Child income
at or below 100% FPIG; court-ordered child support and RSDI the child receives are excluded
Resources
exempt (children under 21)
Disability
SSA disability criteria reviewed by the DHS Medical Review Team; acute leukemia listing lasts at least 24 months after diagnosis or relapse, or 12 months after transplant, whichever is later. Continuing disability is reviewed thereafter; time alone does not end PH95.
Level of care
none in the published criteria
Category of last resort
the child must not qualify for any other MA category
Renewal
at least every 12 months
Tefra
not elected (State Plan Attachment 2.2-A, §1902(e)(3) box unchecked)

Decisions this site cannot make: County Assistance Office financial review (child's income; parents' income verified and excluded) · DHS Medical Review Team disability decision

Expect friction on: Records due 30 days from the letter (extension on request) · Practice wait for the Medical Review Team: not published and not found

The trap: Parents' income is left out but still checked: hand over the pay stubs or the application stalls. Medical records must be current and complete (signs, symptoms, findings, how long, and what the child cannot do), due within 30 days of the county's letter.

Where I read this

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