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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 52 Pa.B. 6342 (October 1, 2022).

55 Pa. Code § 140.221. Conditions of eligibility.


§ 140.221. Conditions of eligibility.

 Eligibility for MA under the Healthy Horizons Program is based on the following:

   (1)  An individual shall meet the following eligibility requirements:

     (i)   Chapters 125 and 127 (relating to application process; and reserved).

     (ii)   Chapter 148 (relating to residence).

     (iii)   Chapter 149 (relating to citizenship and alienage).

     (iv)   Chapter 155 (relating to enumeration).

     (v)   Chapter 178 (relating to resource provisions for categorically NMP-MA and MNO-MA).

     (vi)   Chapter 255 (relating to restitution).

     (vii)   Chapter 257 (relating to reimbursement).

   (2)  Under the Healthy Horizons Categorically Needy Program, an individual shall also meet one of the following criteria:

     (i)   Be 65 years of age or older.

     (ii)   Be a disabled person who is receiving Social Security Disability benefits or disability benefits based on SSI disability criteria at §  141.71 (relating to policy).

     (iii)   Be a disabled person who meets the disability requirements of §  141.71.

   (3)  Under the Healthy Horizons Medicare Cost-Sharing Program, an individual shall also be a qualified Medicare beneficiary.


   The provisions of this §  140.221 amended May 24, 1996, effective May 25, 1996, and apply retroactively to January 1, 1993, for the SLMB Medicare Cost-Sharing Program for persons whose income does not exceed 110% of the FPIGs, and retroactively to January 1, 1995, for persons whose income does not exceed 120% of the FPIGs, 26 Pa.B. 2412. Immediately preceding text appears at serial page (211594).

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