Directions for Applying for Medical Assistance and CHIP. As of May 2014



Similar documents
APPLICATION FOR HEALTH CARE COVERAGE FOR UNINSURED CHILDREN AND ADULTS

Health Care Coverage APPLICATION FOR. Health Care in Pennsylvania. Easy, affordable protection for your family

FINANCIAL ASSISTANCE APPLICATION: COVER LETTER

APPLICATION FOR HEALTH CARE COVERAGE FOR UNINSURED CHILDREN AND ADULTS

CHIP Health Insurance Renewal Form

P E N N S Y L V A N I A

Application Information for Children s Health Insurance Program (CHIP), Children s Medicaid, and CHIP perinatal coverage

Understanding MAWD: The Medical Assistance for Workers With Disabilities Program A Guide for Advocates

Instructions to fill out this Application

Renewal Form.

Why Medical Assistance? Will my child qualify?

The Joint Commission Page 1 of 6

Understanding The Benefits

COMPASS Quick Reference Guide

You will need to mail or fax us copies of items that apply to your case. See the next page for a list of these items.

It's Your Fund - Your Money - Your Choice You can earn up to $2,400 per year

Questions and Answers for Customers Applying for Medicaid in Illinois February, 2014

Making it happen SUPPLEMENTAL SECURITY INCOME (SSI) BENEFITS FOR ADULTS

Consumer Health Coalition

Immigration Fee Waivers

Experience Health Care that Cares About You

Health Charity Care Application - Requirements

MAWD or Marketplace?

Consumer Guide for Annual Household Income Data Matching Issues

WE CAN HELP YOU! DTE ENERGY OFFERS A LOW INCOME SELF- SUFFICIENCY PLAN (LSP)

What to Expect: Your Guide to Affordable Housing

Medicaid Presumptive Eligibility Instructions for Providers September 2015

can provide you with medical insurance for your entire family

Sara Simon Tompkins Staff Attorney National Law Center on Homelessness & Poverty

Application for Health Coverage & Help Paying Costs

Sliding Fee Discount Application

THE HOLY CROSS HEALTH FINANCIAL ASSISTANCE PROGRAM

Health Benefits for Workers with Disabilities Application

Georgia Lions Lighthouse Foundation Better vision. Better hearing. Better Georgia.

Health Coverage & Help Paying Costs Application for One Person

Apply faster online at Compass.ga.gov.

Department of Elder Affairs Emergency Home Energy Assistance for the Elderly Program (EHEAP) Application Instructions Revised April 2014

Board of County Commissioners, Broward County, Florida HUMAN SERVICES DEPARTMENT FAMILY SUCCESS ADMINISTRATION DIVISION

HEARING AID BANK APPLICATION

How to Apply To complete your application, here s what you need to do:

Application for Legal Assistance

Application for Health Coverage & Help Paying Costs

How to Apply for Employment and Income Assistance in Manitoba

Application for Health Coverage and Help Paying Costs

MEDICAL ASSISTANCE (MEDICAID) FINANCIAL ELIGIBILITY APPLICATION

Supplemental Security Income (SSI)

Supplemental Security Income (SSI)

Affordable Care Act Frequently Asked Questions (ACA FAQ)

Kentucky Children s Health Insurance Program FREE OR LOW COST HEALTH INSURANCE FOR CHILDREN

housing answers for residents of public housing falling behind in the rent Benefits Plus Learning Center Fighting Poverty Strengthening New York

Application for Health Coverage & Help Paying Costs

HENRY COUNTY GENERAL ASSISTANCE APPLICATION 106 N. Jackson, Mt. Pleasant, IA Fax:

Are you a Social Security beneficiary who is considering returning to work? Many people

3. You can complete this form to apply for our help. To submit this paper application you can:

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

Division of Health Care Finance and Administration (HCFA), Bureau of TennCare

Children s Medical Programs

MA Free and Reduced Price School Meal Application

P E N N S Y L V A N I A

There are other Medicaid programs that require a different application from this one.

How To Get A Health Care Plan In Pennsylvania

A Comparison of Financial Screening Forms

201% through 225% of FPG. 226% through 250% of FPG. 75% Adjustment. 50% Adjustment

University of Pennsylvania Health System Health Services Policy and Procedure. Effective: 3/1/15 Page: 1 of 11

Cedar Springs Apartments

TEMPORARY ASSISTANCE for NEEDY FAMILIES a guide to Virginia s cash assistance program

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

How To Win Your Fair Hearing

Supplement Healthcare Coverage Application

Set out guidelines to assist in determining when a rentgeared-to-income (RGI) tenant or co-op member should be required to pursue income.

Answering Questions about Your Family s Income When Applying for Health Insurance

1. APPLICANT INFORMATION. Applicant's Name Age & Birth date Applicant's Name Age & Birth date

Free or Low-Cost Health Insurance For Families with Children and Pregnant Women

How To Get Help For Your Child In Delaware County

SECTION 3 - ENROLLMENT & ELIGIBILITY

Application for Health Coverage & Help Paying Costs

How Assisters Can Help Consumers Apply for Coverage through the Marketplace Call Center. July 17, 2015

DIMENSIONS HEALTHCARE SYSTEM AUGUST 7, 2013 DHS POLICY No Page 1 of 8 FINANCIAL ASSISTANCE PROGRAM

MEDICAID BUY-IN for Workers with Disabilities

Patient Care Financial Assistance

SECTION I. Answer the questions in Section I to determine if application needs to be completed for person needing help with medical bills.

Guide to Health and Social Services

Pennsylvania s Medicaid program (Medical Assistance) has dozens of eligibility groups and programs, each with its own qualifying criteria.

A QUICK AND EASY GUIDE TO SSI AND SSDI

The Health Insurance Premium Tax Credit. Topics. What is the Premium Tax Credit? 10/1/2014

PUBLIC ASSISTANCE PROGRAMS. Joseph N. DiVincenzo, Jr. County Executive COUNTY OF ESSEX DEPARTMENT OF CITIZEN SERVICES DIVISION OF WELFARE

Instructions for Completing a Medicare Savings Program (MSP) Application

MassHealth Commonwealth of Massachusetts EOHHS MassHealth Buy-In for people who are eligible for Medicare

Medical Assistance Eligibility Manual

Medical Assistance Eligibility Manual

Working While Disabled How We Can Help

CONTINUING YOUR BENEFITS

PATIENT DEMOGRAPHIC INFORMATION FORM

COUNTY OF POLK Community, Family & Youth Services. Application Guidelines

CHARITY CARE APPLICATION REQUIRED DOCUMENTATION CHECK LIST

Instructions for AHCCCS Health Insurance Application and Forms. Verification and Documentation Choosing a Health Plan

Application for Health Coverage & Help Paying Costs (Short Form)

Nutrition Assistance Programs

UPMC Financial Assistance Application Information

Application & Renewal Form

Transcription:

1 Directions for Applying for Medical Assistance and CHIP As of May 2014 Parents/guardians can apply for child health insurance a number of ways: calling PCCY s Child Healthwatch Helpline; using the online state COMPASS application; using the federal health insurance marketplace, or visiting a local County Assistance Office (to apply for Medical Assistance only). How or Where Can I Apply? PCCY Child Healthwatch Helpine Call the Child Healthwatch Helpline at 215-563-5848 X 17 from 9 a.m. to 5 p.m. If you get our voicemail, please leave a message with your name, a brief description of your request and a good time to call you back. We will call you back as soon as we can. This may take a few days, depending on our volume of calls, so please be patient. Rest assured, we will call you back. If you need to talk with someone outside these hours, leave us a message and we will try to set up an appointment to talk with you at a mutually convenient time. Helpline staff will work with you on the phone. First we will do an initial screening to see what kind of insurance your children are eligible for. If you have the needed information for the screening, this will only take about 5 minutes. Then we will do an intake interview to get the answer to the questions on the application form. This will take 15-20 minutes. We will go over the documents needed, if any, to complete your application. Once you supply us with all the information and all the documents needed for your application, we will submit your application for you. We will also follow-up on your application, if it is not approved in a timely manner. State Online Application COMPASS You can also go to the PA online website, COMPASS, to apply for Medical Assistance, CHIP and other state benefits. The link is www.compass.state.pa.us/compass.

2 If you apply through COMPASS, there are a few important things to remember. 1. Write down your login, password and E Form number of your application. Use these to go back to COMPASS and check the status of your application. 2. Make sure your go all the way through the application and press the SUBMIT button. You have not sent in an application until you do that. 3. Print a copy of your application for your records. 4. Make sure you are clear about which documents you need to send in, where and how you can deliver them (in person, mail, email or fax) and the date by which they must be received in order for your application to be approved. Make sure you send the documents before the cut-off date. Federal Health Insurance Marketplace The federal government expanded health insurance coverage with the Affordable Care Act and the creation of the Federal Health Insurance Marketplace in the fall of 2014. For people applying for Medicaid and CHIP, the Marketplace is open year round, every day. To apply through the Marketplace, go to www.healthcare.gov or call 1-800-318-2596. Local County Assistance Office (for Medical Assistance Coverage Only) Parents can apply in person with a representative at their local County Assistance Office. To find a Philadelphia office, call the Philadelphia Change Center at 215-560-7226 or go online at https://www.humanservices.state.pa.us/philacaodistricts/phillycaodistricts.htm l. To find an office any Pennsylvania county call the state wide call center at 877-395-8930 or go online at

3 http://www.dpw.state.pa.us/findfacilsandlocs/countyassistanceofficecontactinfor mation/. What information do I need to complete an MA or CHIP application? Some of the key information needed includes: Name and date of birth of everyone in your household. The social security numbers for everyone you are applying for. Your household tax status meaning who, if anyone in your household, will be filing taxes next year, and who will claim the members of your household as dependents on their tax returns. Amount of taxable income you expect to have in the coming year. Any significant expenses you are planning to claim on your next tax return such as medical costs, costs of business, etc. Amount of monthly expenses, if you have them, for childcare, traveling to and from work and a car payment. Auto insurance information (name of the company and policy holder, policy number and expiration date). Information about any health insurance plans that currently cover your children that covered your children in the last 90 days and why that coverage was lost. Whether anyone seeking coverage has a behavioral health disability. Information about unpaid medical bills within the last three months for the children you re applying for. Documents needed to apply include: Proof of taxable monthly gross household income from all sources, such as: paystubs, a letter from your employer if paid in cash, letter from Unemployment that states your benefit amount, letter from the Social Security Administration that states the amount of your Disability, Retirement or Survivor benefits, letter that shows the amount of pension or Worker s Compensation you receive Child support amount from a letter from the court or a computer print-out.

4 If self-employed, a recent tax return including all tax schedules filed. Written document that shows your income from any other source Note: Supplemental Security Income (SSI) and child support received are not taxable income and should not be required to be documented when applying for MA or CHIP. If you have no current income and your household is being supported or helped out by another individual, you will need a letter from that individual stating how s/he is helping you out, and for how long (i.e. providing free room and board for the last two months or paying your rent and utility bills). If you are living off your savings, you can say so and provide a copy of your bank statement. If you are applying for a child who is not a US citizen, you will need proof of immigration status, such as a copy of a permanent residency ( green ) card, proof of asylee or refugee status or other immigration documents that prove the child has a qualified status. If you are applying for a child based on her/his disability, you will need proof of the disability such as from an evaluation written recently by a practitioner with an MD or PHD degree that states your child s diagnosis, how the diagnosis is disabling to your child and states treatment options, A PA 586 form or an audiogram and accompanying written reports. *Note: An IEP or an ISP is not accepted in most counties in the Delaware Valley area for this purpose unless an MD or PHD practitioner helped write the report. How Do I Submit a Paper Application? For Medical Assistance, mail an application to your local County Assistance Office. To find the address, contact the Department of Public Welfare Call Center.

5 In Philadelphia call 215-560-7226 or check out the Philadelphia County Assistance office finder online at https://www.humanservices.state.pa.us/philacaodistricts/phillycaodistricts.html. In suburban Delaware Valley call 1-877-395-8930 or go online at http://www.dpw.state.pa.us/findfacilsandlocs/countyassistanceofficecontactinfor mation/. PCCY suggests you mail the application by registered mail, so you will have proof that your application wasreceived and on what date. You can go in person and drop it off, always get a receipt. If you fax your application to the local county assistance office, even if you have a fax OK sheet, PCCY suggests you seek verbal or written/email confirmation that it was received by the appropriate person. For CHIP, mail or fax your paper application directly to the health plan to which you are applying. The health plan s address is on the application. How are Applications Processed? If you applied through COMPASS for Medical Assistance or CHIP, you can go back to COMPASS and check the status of your application. For Medical Assistance, the County Assistance Office has 30 days to process your application. You should receive a letter in the mail stating whether your child has been approved or denied coverage. If you don t hear from them after a month, its time to follow up. Contact the Call Center at 877-395-8930 statewide or 215-560-7226 in Philadelphia and ask about the status of your application. Alternatively, you can try calling your CAO office directly. If you don t reach anyone after several tries, please call PCCY s Helpline and we will assist you at 215-563-5848 x17.

6 If your child is denied coverage, the letter should explain why. If you don t understand why you were denied or if you don t agree with their reasoning, you can appeal the decision. To appeal, the letter will have the number to call to make your appeal. Don t wait! You can always end your appeal, but if you don t register your appeal within 10 days, it will be too late. You can have a phone appeal or a face-to-face appeal. It s your choice. It may take the CAO up to 2-3 weeks to get back to you with an appeal date. If you don t hear back in 3 weeks, call PCCY s Helpline, and we will try to get more information for you. For CHIP, CHIP typically processes applications in 15 days. Shortly thereafter, you should receive a letter in the mail whether your child has been approved or denied coverage. If you don t hear from the CHIP health plan, contact the plan to inquire about the status of your application. If your CHIP application is denied, contact the CHIP health plan directly. Aetna 800-822-8447 Keystone Health Plan East 800-464-5437 Kidzpartners 888-888-1211 United HealthCare 800-414-9025