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PA Bulletin, Doc. No. 96-2194



Division of Special Health Care Needs; Eligibility Criteria

[26 Pa.B. 6222]

   The Department of Health hereby provides notice of intent to apply the following eligibility criteria to the Department's programs set forth below, effective January 1, 1997:

Disease or Condition

   Coverage is provided for the following conditions:

   For children up to 21 years of age:  chronic respiratory failure, cardiac, orthopedic, cleft palate/plastic surgery, hearing and speech;

   For both children and adults:  cystic fibrosis, hemophilia, spina bifida and end-stage renal disease.

   A written physician's verification of the diagnosis of disease or condition is required.


   Applicants must have an annual income of 0% to 300% of the Federal poverty guidelines as published by the Department of Health and Human Services in the Federal Register and any revisions thereto (to the extent services are not covered by Medical Assistance). A sliding fee scale will be applied to applicants with an annual income of 185% to 300% of the Federal poverty guidelines as published by the Department of Health and Human Services in the Federal Register and any revisions thereto and in compliance with the requirements of the Maternal and Child Health Services Block Grant of Title V of the Social Security Act, 42 U.S.C.A. § 701 et seq. Applicants must submit their most recent Federal 1040 tax return to verify annual income. If no Federal 1040 tax return was filed, other supporting documentation of annual income is required.


   Verification of other health care resources, including other third party benefits such as Medical Assistance and Insurance, is required.


   Children up to 21 years of age with chronic respiratory disease, cardiac, orthopedic, cleft palate/plastic surgery, hearing and speech conditions are eligible for services.

   Children and adults of all ages with cystic fibrosis, hemophilia, spina bifida and end-stage renal disease are eligible for services.


   Applicants must be United States citizens or legal aliens (admitted under the Immigration Return and Control Act of 1986 [IRCA] or who qualify for refugee/asylum status) and Pennsylvania residents for at least 90 consecutive days. Applicants who have not lived in Pennsylvania for 90 consecutive days will be considered residents for purposes of the Department if they can establish an intent to maintain a permanent home in Pennsylvania for the indefinite future. The following documentation must be submitted with the application and updated annually as necessary:  birth certificate; naturalization papers or INS documents; dated identification with Pennsylvania address and/or other verification, for example, public utility records and receipts, rent receipts, motor vehicle records, local tax records, or completed and signed Federal or State income tax return with preprinted name and address.

Length of Eligibility

   Eligibility is for a period of 1 year and will be re- evaluated annually.

   Questions regarding this notice should be directed to C. Gail Stock, Director, Division of Special Health Care Needs, Department of Health, Bureau of Maternal and Child Health, P. O. Box 90, Harrisburg, PA 17108, (717) 783-5436. Persons with a disability may submit questions to C. Gail Stock in alternative formats, such as audio tape, braille or using TDD:  (717) 783-6514. Persons with a disability who require an alternative format of this document (for example, large print, audio tape, braille), should contact C. Gail Stock so that she may make the necessary arrangements.

Acting Secretary

[Pa.B. Doc. No. 96-2194. Filed for public inspection December 27, 1996, 9:00 a.m.]

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