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PA Bulletin, Doc. No. 05-1534



1115 Demonstration Waiver for Medicaid for Children with Special Needs

[35 Pa.B. 4676]

   The Department of Public Welfare (Department) announces its intent to establish a demonstration waiver under section 1115 of the Social Security Act (42 U.S.C.A. § 1315), for children with disabilities. The waiver will apply only to children under the age of 18 who meet the Social Security Administration's (SSA) definition of disability. The determination of disability must be established either by an SSA assessment or an assessment completed by the Department's medical review team.

   The waiver will not apply to children who receive Supplemental Security Income. Under the waiver, custodial parents with a child who has an SSA level of disability will be assessed a premium receive Medicaid for the child with a disability. The premium will be based on the family's income, that is the income of the custodial parents and the child's own income. Premiums will not be charged to a family with income below 200% of the Federal Poverty Income Guidelines.

   The Department will establish premiums based on a sliding scale which will consider household income and household size. Families with higher income will pay a higher premium. The family will be assessed only one premium per household even if there is more than one child in the family who is receiving Medicaid as a child with a disability.

   The premium will not exceed the average monthly expenditure that the Department pays for children in this category of assistance. Families will be informed of the premium amount at least 30 days prior to the due date of the first premium payment. The premiums will be payable monthly. Premiums will be adjusted annually based on changes in the household's circumstances and changes in the Department's Medical Assistance costs. Premiums will be adjusted prior to the annual update if there is a decrease in the household's income or an increase in household size.

   This notice takes effect upon publication in the Pennsylvania Bulletin.

Fiscal Impact

   The Department estimates net savings of $23.642 million ($10.590 million in State funds) in Fiscal Year (FY) 2005-2006. The Department estimates an annual net savings of $31.768 million ($14.379 million in State funds) in FY 2006-2007.

Public Comment

   Interested person are invited to submit written comments regarding this notice to the Department at the following address: Department of Public Welfare, Office of Income Maintenance, Edward J. Zogby, Director, Bureau of Policy, Room 431 Health and Welfare Building, Harrisburg, PA 17120, (717) 787-4081. Comments received within 30 calendar days will be reviewed and considered for any subsequent revision of the notice.

   Persons with a disability who require auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users)


   Fiscal Note:  14-NOT-438. (1) General Fund; (2) Implementing Year 2005-06 is $367,000; (3) 1st Succeeding Year 2006-07 is $367,000; 2nd Succeeding Year 2007-08 is $367,000; 3rd Succeeding Year 2008-09 is $367,000; 4th Succeeding Year 2009-10 is $367,000; 5th Succeeding Year 2010-11 is $367,000; (4) 2004-05 Program--$34,257,000; 2003-04 Program--$41,030,000; 2002-03 Program--$56,835,000; (7) County Administration--Statewide; (8) recommends adoption. The cost that this action will generate to the Count Administration--Statewide line item is included in the 2005-2006 budget. The net affect of this action will be a General Fund savings of $10 million due to savings generated in the Medical Assistance--Outpatient line item.

[Pa.B. Doc. No. 05-1534. Filed for public inspection August 12, 2005, 9:00 a.m.]

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