What is Medical Assistance (MA)?
Medical Assistance is the Pennsylvania Medicaid Program. It provides basic health coverage to eligible adults and children. It is operated by the PA Department of Welfare through County Assistance Offices, which, in Montgomery County, are located at 1931 New Hope St., Norristown (610-270-3500) and 19 N. Charlotte St., Pottstown (610-327-4280).
Which mental health services does MA cover?
MA covers inpatient psychiatric care, crisis residential services (e.g., the Ranch House at MCES), partial hospitalization services, outpatient treatment, and prescription medications. MA coverage enables an individual in need of mental health services to receive ongoing treatment.
Does MA cover a current hospitalization?
If the patient applies and meets the MA eligibility criteria (see below), MA may cover all or part of the inpatient care if the hospital is a participating provider in the MA Program and accepts MA reimbursement. Patients are responsible for their inpatient charges, and for co-pays and deductibles, where applicable.
Who may be eligible for MA?
Adults and those under age 18 with limited assets and no health insurance may be eligible. Those receiving Supplemental Security Income (SSI) may be eligible. Also those receiving Social Security Disability (SSD) may be eligible depending on the amount of the payment. Some applicants may be eligible for partial coverage.
How is eligibility determined?
It is based on documentation of personal identification, proof of address, Social Security number, and financial resources. Financial eligibility is based on wages, savings, checking account balance, and life insurance. MCES works with patients and families to gather the information needed to apply for MA coverage.
Where can MA applications be made?
An MA application may be made by an inpatient at a participating hospital (e.g., at MCES). This type of application covers the hospital stay only. Application must then be made at a County Assistance Office for ongoing coverage outside of the hospital. In-home applications may be taken only if the applicant is bedridden or homebound by serious illness or disability.
Why may an MA application be denied?
An MA application may be turned down because the individual's financial resources exceed the amount allowed by the PA Department of Public Welfare. Coverage will also be denied if the necessary information is incorrect or incomplete in any way. This includes use of invalid Social Security numbers, false financial data, or unverifiable mailing addresses.
How is MA coverage maintained?
MA coverage received for a specific hospital stay terminates upon discharge. In order to continue coverage an MA application must be completed at the County Assistance Office. Once accepted, maintaining coverage means keeping the County Assistance Office informed about changes in address, income, employment, and other factors that may affect eligibility.
Does an MA application include food stamps and cash assistance?
An MA application only determines eligibility for health coverage through the MA Program. An individual who is eligible for MA may be eligible for other benefits. Food stamps and cash assistance are separate programs with separate eligibility requirements and separate applications. Contact the County Assistance Office for information about food stamps and cash assistance.
Who can help with an MA application?
The MCES Patient Resources Department will assist patients with MA applications during their stay. MCES can not help with food stamp or cash assistance applications. Each Base Service Unit (BSU), the community mental health center, has staff that can help with MA applications.
What about managed care and MA?
Each county Mental Health/Mental Retardation-Drug and Alcohol Program (MH/MR) contracts with a managed care company to manage behavioral health services for those covered by MA. Magellan Behavioral Health (MBH) serves Montgomery County, and provides case management and other services.
Posted 10.24.01