NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Notice of Rule Change; Eligibility for Cash and Medical Assistance Benefits
[26 Pa.B. 2865] Act No. 1996-35 (Act 35), enacted on May 16, 1996, amends certain sections of the Public Welfare Code which govern eligibility for cash and Medical Assistance benefits. This notice concerns those provisions of Act 35 that are effective immediately. Separate Notices of Rule Change will be published at later dates concerning eligibility changes which are effective October 1, 1996, and changes which are effective upon receipt of necessary waivers of Federal law by the United States Department of Health and Human Services.
The amendments to the Public Welfare Code are explained within this notice. The explanation is organized by the eligibility groups that are affected and how they are affected. Each change in policy described within this notice identifies the section of Title 55 of the Pennsylvania Code that is being changed.
The changes in eligibility mandated by Act 35 will be applied to applicants for cash and Medical Assistance as of June 17, 1996. Each current recipient of cash or Medical Assistance who may be affected by these changes will undergo an individual redetermination of eligibility before these changes may be applied to them.
The following requirements apply to Aid to Families with Dependent Children (AFDC) and General Assistance (GA), Cash and related Non-Money Payment (NMP) programs:
--55 Pa. Code §§ 125.21(b)(1), 125.24(c)(1), 125.74, 181.11(a); 45 CFR § 206.10(a)(3)(i) and 62 P. S. § 432.19:
Initial authorization of assistance will occur when all factors of eligibility are verified unless verification is pending from a third party and the client has cooperated in the verification attempt or unless certification of cooperation is pending with the domestic relations section of the Court of Common Pleas. Initial authorization of cash assistance will not be delayed more than 30 days after application. If the applicant establishes eligibility, assistance will be authorized effective with the date that all conditions of eligibility are verified.
--55 Pa. Code §§ 141.42, 168.2, 171.22, 175.22, 177.2 and 183.2; 62 P. S. § 402:
The term ''assistance group'' is defined as one or more related or unrelated individuals who occupy a common residence or would occupy a common residence if they were not homeless and whose needs and eligibility are considered together in determining eligibility for cash or medical assistance. ''Assistance group'' has the same meaning as the terms ''assistance unit,'' ''filing unit,'' ''grant group'' and ''budget group'' which are used throughout 55 Pa. Code. Definitions of the aforementioned terms are revised to include a reference to assistance group.
The following requirements apply to the AFDC and GA cash assistance programs:
--55 Pa. Code § 141.21; 62 P. S. § 481(f):
An applicant or recipient of AFDC or GA who has been convicted of violating section 481(a) of the Public Welfare Code, that is, has been convicted of securing or attempting to secure, or aiding or abetting or attempting to aid or abet any person in securing assistance or Federal food stamps by means of a willfully false statement or misrepresentation, or by impersonation or by willfully failing to disclose a material fact regarding eligibility either prior to, or at the time of, or subsequent to the application for assistance, a crime commonly referred to as welfare fraud, is ineligible for cash assistance for a period of 6 months from the date of a first conviction, for a period of 12 months from the date of a second conviction, and permanently from the date of a third conviction.
The following requirements apply to the GA cash assistance program:
--55 Pa. Code § 141.21; 62 P. S. § 432(9):
The definition of ''satisfied the penalty'' imposed by law is amended to include compliance with an approved plan for paying fines, costs and restitution as an alternative to completion of payment.
--55 Pa. Code § 147.23(a); 62 P. S. § 432.4:
In order to receive GA cash assistance, an applicant must establish that he has been a resident of the Commonwealth for at least 12 months immediately preceding his application.
--55 Pa. Code § 175.24(f); 62 P. S. § 434:
Cash assistance granted shall be reduced by amounts obtained by cashing an assistance check at a gambling casino, racetrack, bingo hall or other establishment that derives more than 50% of its gross revenues from gambling.
The following requirements apply to both the GA cash and the GA-related NMP programs:
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(B):
Persons eligible for GA and GA-related NMP-MA include persons who are parents residing in a two-parent household with their child who is under 13 years of age or their child 13 years of age or older who has a verified disability.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(C):
A person who has been assessed by a physician or psychologist as having a verified physical or mental disability which causes a permanent or temporary disability that precludes gainful employment must provide verification of the disability in a form prescribed by the Department and completed by a physician or psychologist. The verification of the physical or mental disability must be based on acceptable clinical and laboratory diagnostic techniques rather than a statement of symptoms by the applicant or recipient. An applicant or recipient with a verified physical or mental disability which is temporary must seek appropriate treatment as a condition of eligibility for GA and GA-related NMP-MA.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(D):
Persons eligible for GA and GA-related NMP-MA include the nonparental caretaker of a child under 13 years of age. Assistance shall not be granted to a person under this criterion if there is another adult in the household who is capable of providing the care without GA being required.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(E):
A person undergoing active treatment for substance abuse in an approved drug or alcohol treatment program qualifies for GA or GA-related NMP-MA only if such treatment precludes the person from engaging in employment. The 9-month lifetime limitation remains unchanged.
--55 Pa. Code §§ 147.23, 150.1; 62 P. S. § 432.22:
A person who is not a United States citizen is not eligible to receive GA, GA-related NMP-MA, or GA-related MNO-MA unless specifically required by Federal law.
The following requirements apply to the MA program:
--55 Pa. Code § 141.81; 62 P. S. § 442.1(a)(3):
To receive MNO-MA, a person must either receive GA or belong to one of the following groups: a child under 21 years of age; a custodial parent of a dependent child under 21 years of age; a person 59 years of age or older; a refugee for whom Federal financial participation is available; a pregnant woman; a person with a disability who is receiving Social Security disability benefits, who has been referred to the Social Security Administration for a determination of eligibility for Supplemental Security Income or who is under review for a disability by the Department based upon Social Security disability criteria; or a person who verifies employment of at least 100 hours per month earning at least the minimum wage. For persons whose eligibility is based upon the work requirement, past, present and continuing employment will be evaluated to determine compliance with the 100-hours per month work requirement. If an episode of illness or injury is the reason for the interruption of work and it is verified that 100 hours per month employment will resume subsequent to recovery from that illness or injury, the person will be considered to have met the work requirement.
--55 Pa. Code § 125.74; 62 P. S. § 442.1(a)(2):
A person applying for MA in the GA-related category of MNO-MA must meet the standards of both financial and nonfinancial eligibility.
--55 Pa. Code § 148.1; 62 P. S. § 442.1(a)(1)
A person applying for MA in the GA-related categories of NMP or MNO-MA must have resided in Pennsylvania continuously for 90 days immediately preceding the effective date of MA eligibility, except for persons eligible for Federally-funded categories of Medical Assistance.
--55 Pa. Code §§ 181.1(b) and 181.12; 62 P. S. § 442.1(c):
In determining eligibility for retroactive MNO-MA, income received or expected to be received in a 6-month period is used, even if the person requests MA coverage for less than 6 months. The 6-month period can include both retroactive and prospective months. Medical coverage can continue as long as the need exists, but no longer than the consecutive 6-month period from which income is counted.
This rule change has been reviewed and approved by the Office of General Counsel and the Office of Attorney General.
This rule change is made under the Joint Committee on Documents Resolution 1996-1(2), 26 Pa.B. 2374 (May 18, 1996). This rule change will be in effect for 365 days pending adoption of final rulemaking by the Department.
Public comments to this rule change may be made by writing to Patricia H. O'Neal, Director, Bureau of Policy, Office of Income Maintenance, Room 431, Health and Welfare Building, Harrisburg, PA 17105. Persons with a disability may use the AT&T Relay Service by calling 1 (800) 654-5984 (TDD user) or 1 (800) 654-5988 (Voice user), or may use the Department of Public Welfare (TDD) by calling (717) 787-3616. Persons who require another alternative format should contact India Wood at (717) 783-2212.
FEATHER O. HOUSTOUN,
SecretaryPurpose
To provide revisions to the Aid to Families with Dependent Children (AFDC), General Assistance (GA), and Medical Assistance (MA) requirements contained in 55 Pa. Code Chapters 125, Application Process; 141, General Eligibility Provisions; 148, MA Residence Provisions for GA-related Categorically Needy NMP-MA and MNO-MA; 168, Transitional Child Care; 171, Budget Group Provisions for AFDC/GA; 175, Allowances and Benefits; 177, Resources; 181, Income Provisions for Categorically Needy NMP-MA and MNO-MA; and 183, Income.
Background
Act 35, enacted on May 16, 1996, amends certain sections of the Public Welfare Code which govern eligibility for cash and Medical Assistance benefits. This Bulletin concerns those provisions of Act 35 that are effective immediately. Separate Notices of Rule Change will be published at later dates concerning eligibility changes which are effective October 1, 1996, and changes which are effective upon receipt of necessary waivers of Federal law by the United States Department of Health and Human Services.
The amendments to the Public Welfare Code are explained within this notice. The explanation is organized by the eligibility groups that are affected and how they are affected. Each change in policy described within this notice identifies the section of Title 55 of the Pennsylvania Code that is being changed. It is followed by the Public Welfare Code citation (62 P. S. § __) as amended by Act 35.
The changes in eligibility mandated by Act 35 will be applied to applicants for cash and Medical Assistance as of June 17, 1996. Each current recipient of cash or Medical Assistance who may be affected by these changes will undergo an individual redetermination of eligibility before these changes may be applied to them.
Rule Change
The following requirements apply to Aid to Families with Dependent Children (AFDC) and General Assistance (GA), Cash and related Non-Money Payment (NMP) programs:
--55 Pa. Code §§ 125.21(b)(1), 125.24(c)(1), 125.74, 181.11(a); 45 CFR § 206.10(a)(3)(i) and 62 P. S. § 432.19:
Initial authorization of assistance will occur when all factors of eligibility are verified unless verification is pending from a third party and the client has cooperated in the verification attempt or unless certification of cooperation is pending with the domestic relations section of the Court of Common Pleas. Initial authorization of cash assistance will not be delayed more than 30 days after application. If the applicant establishes eligibility, assistance will be authorized effective with the date that all conditions of eligibility are verified.
--55 Pa. Code §§ 141.42, 168.2, 171.22, 175.22, 177.2 and 183.2; 62 P. S. § 402:
The term ''assistance group'' is defined as one or more related or unrelated individuals who occupy a common residence or would occupy a common residence if they were not homeless and whose needs and eligibility are considered together in determining eligibility for cash or Medical Assistance. ''Assistance group'' has the same meaning as the terms ''assistance unit,'' ''filing unit,'' ''grant group'' and ''budget group'' which are used throughout 55 Pa. Code. Definitions of the aforementioned terms are revised to include a reference to assistance group.
The following requirements apply to the AFDC and GA cash assistance programs:
--55 Pa. Code § 141.21; 62 P. S. § 481(f):
An applicant or recipient of AFDC or GA who has been convicted of violating section 481(a) of the Public Welfare Code, that is, has been convicted of securing or attempting to secure, or aiding or abetting or attempting to aid or abet any person in securing assistance or Federal food stamps by means of a willfully false statement or misrepresentation, or by impersonation or by willfully failing to disclose a material fact regarding eligibility either prior to, or at the time of, or subsequent to the application for assistance, a crime commonly referred to as welfare fraud, is ineligible for cash assistance for a period of 6 months from the date of a first conviction, for a period of 12 months from the date of a second conviction, and permanently from the date of a third conviction.
The following requirements apply to the GA cash assistance program:
--55 Pa. Code § 141.21; 62 P. S. § 432(9):
The definition of ''satisfied the penalty'' imposed by law is amended to include compliance with an approved plan for paying fines, costs and restitution as an alternative to completion of payment.
--55 Pa. Code § 147.23(a); 62 P. S. § 432.4:
In order to receive GA cash assistance, an applicant must establish that he has been a resident of the Commonwealth for at least 12 months immediately preceding his application.
--55 Pa. Code § 175.24(f); 62 P. S. § 434:
Cash assistance granted shall be reduced by amounts obtained by cashing an assistance check at a gambling casino, racetrack, bingo hall or other establishment that derives more than 50% of its gross revenues from gambling.
The following requirements apply to both the GA cash and the GA-related NMP programs:
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(B):
Persons eligible for GA and GA-related NMP-MA include persons who are parents residing in a two-parent household with their child who is under 13 years of age or their child 13 years of age or older who has a verified disability.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(C):
A person who has been assessed by a physician or psychologist as having a verified physical or mental disability which causes a permanent or temporary disability that precludes gainful employment must provide verification of the disability in a form prescribed by the Department and completed by a physician or psychologist. The verification of the physical or mental disability must be based on acceptable clinical and laboratory diagnostic techniques rather than a statement of symptoms by the applicant or recipient. An applicant or recipient with a verified physical or mental disability which is temporary must seek appropriate treatment as a condition of eligibility for GA and GA-related NMP-MA.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(D):
Persons eligible for GA and GA-related NMP-MA include the nonparental caretaker of a child under 13 years of age. Assistance will not be granted to a person under this criterion if there is another adult in the household who is capable of providing the care without GA being required.
--55 Pa. Code §§ 141.61(d)(1), 141.71; 62 P. S. § 432(3)(i)(E):
A person undergoing active treatment for substance abuse in an approved drug or alcohol treatment program qualifies for GA or GA-related NMP-MA only if such treatment precludes the person from engaging in employment. The 9-month lifetime limitation remains unchanged.
--55 Pa. Code §§ 147.23, 150.1; 62 P. S. § 432.22:
A person who is not a U. S. citizen is not eligible to receive GA, GA-related NMP-MA, or GA-related MNO-MA unless specifically required by Federal law.
The following requirements apply to the MA program:
--55 Pa. Code § 141.81; 62 P. S. § 442.1(a)(3):
To receive MNO-MA, a person must either receive GA or belong to one of the following groups: a child under 21 years of age; a custodial parent of a dependent child under 21 years of age; a person 59 years of age or older; a refugee for whom Federal financial participation is available; a pregnant woman; a person with a disability who is receiving Social Security disability benefits, who has been referred to the Social Security Administration for a determination of eligibility for Supplemental Security Income or who is under review for a disability by the Department based upon Social Security disability criteria; or a person who verifies employment of at least 100 hours per month earning at least the minimum wage. For persons whose eligibility is based upon the work requirement, past, present and continuing employment will be evaluated to determine compliance with the 100-hours per month work requirement. If an episode of illness or injury is the reason for the interruption of work and it is verified that 100 hours per month employment will resume subsequent to recovery from that illness or injury, she will be considered to have met the work requirement.
--55 Pa. Code § 125.74; 62 P. S. § 442.1(a)(2):
A person applying for MA in the GA-related category of MNO-MA must meet the standards of both financial and nonfinancial eligibility.
--55 Pa. Code § 148.1; 62 P. S. § 442.1(a)(1)
A person applying for MA in the GA-related categories of NMP or MNO-MA must have resided in Pennsylvania continuously for 90 days immediately preceding the effective date of MA eligibility, except for persons eligible for Federally-funded categories of Medical Assistance.
--55 Pa. Code §§ 181.1(b) and 181.12; 62 P. S. § 442.1(c):
In determining eligibility for retroactive MNO-MA, income received or expected to be received in a 6-month period is used, even if the person requests MA coverage for less than 6 months. The 6-month period can include both retroactive and prospective months. Medical coverage can continue as long as the need exists, but no longer than the consecutive 6-month period from which income is counted.
Fiscal Note: 14-NRC-064. No fiscal impact; (8) recommends adoption.
This Notice provides for the implementation of certain provisions of Act 35 that became effective with the enactment of the legislation. These provisions are anticipated to produce net savings, including minor costs to the County Administration and Bureau of Information Systems appropriations, as follows:
1996-97 $221,784,000 1999-00 $293,241,000 1997-98 $280,510,000 2000-01 $298,825,000 1998-99 $289,017,000 2001-02 $304,611,000
[Pa.B. Doc. No. 96-978. Filed for public inspection June 14, 1996, 9:00 a.m.]
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