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MA Co-payment Notice to Families
September 14, 2012

The Pennsylvania Health Law Project (HLP) has informed PCPA and families that the Department of Public Welfare (DPW) will send letters September 17 to families whose children will be subject to the proposed PH 95 (“MA Loophole”) co-pays.  These letters will be individualized, setting out the family’s annual gross income according to DPW records, and information about the co-pays.  Because the imposition of co-pays and the cap on aggregate monthly co-pays are based on family income, it is important that families review the income information on the letter carefully to determine if it is accurate.

If the information on the letter regarding family income is not accurate, families should call the child’s caseworker at the County Assistance Office and mail a copy of paystubs or other verification of income. If families cannot reach the caseworker or cannot get income information corrected through the caseworker, an appeal can be filed.

  • Families whose children are on the state Health Insurance Premium Payment program known (HIPP) and those who use a yellow Access card to obtain services (fee-for-service) will be subject to co-pays beginning November 1 for physical health and behavioral health care unless delayed by DPW. 
  • Families whose children are enrolled in the Medical Assistance HealthChoices physical and behavioral health managed care programs will not be subject to the co-pays unless and until their physical and behavioral health managed care organizations make the decision to impose the co-pays and provide them and providers with prior notice about the change.
Many details impacting providers, families, and managed care organizations related to the co-pays have yet to be determined. PCPA is continuing its efforts with DPW, legislators, and other stakeholders to promote a reasonable, efficient, and minimally disruptive implementation of the state’s fair share Medicaid co-payment initiative.

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