RCPA - Rehabilitation and Community Providers Association


MA Co-pay Request to Families from PHLP
February 3, 2012

The Department of Public Welfare (DPW) has announced its plan to impose co-pays on Medical Assistance (MA) behavioral and physical health services provided to children who have MA due to a medical condition or disability and whose family income is at or above twice the federal poverty level. The Pennsylvania Health Law Project (PHLP) has received several inquiries as to what families can do. PHLP recommends that families who may be impacted by MA co-payment for their child’s health care services write to DPW urging them to allow deductions from family income for out-of-pocket medical costs and health insurance premiums.

Out-of-pocket health care costs should be counted in determining family income for co-pay purposes. Many families have high out-of-pocket expenses for children with disabilities. These may be for therapists or other providers that don’t accept insurance, home modifications, equipment, or premiums to cover the child under the parent’s health insurance. For families with incomes at or above twice the poverty level, federal law limits the total amount of MA co-pays for any family in a month or quarter to no more than five percent of their countable income. DPW gets to decide how family income is counted. 

PHLP is asking DPW to deduct out-of-pocket costs related to the child’s disability or medical condition and the premium paid for covering the child under the parent’s insurance policy from family income. For some families, deducting these expenses will bring their income under the limit for co-pays. Families are encouraged to ask DPW to support these recommendations by writing to:

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

Explain how these recommendations would assist your family in coping with co-pays.  Send a copy to your state senator and state representative. Families can find information about legislators at http://www.legis.state.pa.us/cfdocs/legis/home/findyourlegislator/#address.

PHLP also asks that families send a copy of letters to David Gates, Pennsylvania Health Law Project, 1414 N Cameron St, Ste B, Harrisburg, PA, 17103. PCPA invites members to share copies of this information with families.

< Back