Supplemental Nutrition Assistance Program (SNAP)

The Supplemental Nutrition Assistance Programis the new name for the Food Stamp program. These benefits are used to buy food and help eligible low-income households in Pennsylvania obtain more nutritious diets by increasing their food purchasing power at grocery stores and supermarkets. If you are eligible, you will receive a Pennsylvania Electronic Benefits Transfer (EBT) ACCESS Card which is used to make food purchases at grocery stores and supermarkets.

How to Apply:

There are a couple of different ways to apply for SNAP, please choose the option that suits you. If you do not know if you are eligible, you may still apply.

You can apply for or renew your SNAP benefits online by using COMPASS. COMPASS is the name of the website where you can apply for the SNAP program and many other services that can help you make ends meet.

Or, you can file an application at your local county assistance office

  • Download an Application for SNAP benefits from the Web and return it to your local county assistance office

Application for cash assistance, SNAP and Medical Assistance Benefits (English version)

Solicitud para recibir beneficios(Solicitud para recibir beneficios)

If you need help completing the application form or need more information about benefits, trained county assistance office staff can help you.

The following persons may apply:

  • The head of the household;
  • The spouse of the head of household;
  • Any other responsible household member; or
  • A designated authorized representative, who can be a friend, relative, neighbor, or anyone else the applicant trusts to go food shopping and use his/her SNAP benefits.

What are the minimum and maximum monthly benefit amounts?

Family Size12345678910Each Additional
Maximum$200$367$526$668$793$952$1052$12021352$1502+$150

Minimum benefits for eligible households range from $2 to $16.

More information about the eligibility requirements for SNAP can be found in the SNAP Handbook.

How do SNAP benefits Work?

SNAP benefits are placed in an “electronic” account that only the recipient can use. This system is called Electronic Benefits Transfer or EBT. The eligible household receives a plastic card, the Pennsylvania EBT ACCESS Card. This card allows withdrawals for food purchases at grocery stores and supermarkets. The store simply uses the EBT ACCESS card to “electronically” subtract purchases from the SNAP account. The eligible household can only spend the amount that is in the account. This is not a credit card.

What are the income eligibility requirements?

To get SNAP benefits, your income has to be under certain limits.

SNAP households may recieve deductions from their gross income for things like housing costs, child or dependent care payments, and medical expenses over $35 for elderly or disabled people.

Questions Regarding SNAP Benefits

If you have questions about SNAP you may call the Department of Public Welfare Helpline toll-free at 1-800-692-7462 (1-800-451-5886 TDD number for individuals with hearing impairments) or your local county assistance office.

In accordance with Federal law and U.S. Department of Agriculture (USDA) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, religion, political beliefs, or disability.

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326 Witten Building, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call (202) 720-5964.  Individuals who are deaf, hard of hearing , or have speech disabilities and wish to communicate with the Office of Civil Rights, may call the Federal Relay Service at (800) 877-8339 (English) or (800) 845-6136 (Spanish).  USDA is an equal opportunity provider and employer.

Substance Abuse Services

There are a wide variety of substance and alcohol abuse services available to children and adults in Pennsylvania. Community substance abuse programs are administered through county program offices called Single County Authorities (SCAs.)

The county SCA determines a person’s eligibility for service funding, assesses the need for treatment or other services, and makes referrals to appropriate programs to match treatment and/or service needs.

For county SCA locations and contact information visit: County Drug and Alcohol Agencies Near You

Pennsylvania Department of Health Drug and Alcohol Facility Locator Page

The Pennsylvania Network of Care is a web resource which provides information and tools, such as:

  • Information & service directories for every county in Pennsylvania
  • Research library
  • Free online trainings available in multiple languages, including American Sign Language
  • Local, state and national links to government resources and organizations that specialize in mental health
  • Bill tracking to follow current state and federal legislation
  • Social networking
  • Secure storage of personal folders including health information, reference materials, WRAP plans and Mental Health Advance Directives

Payment for Drug and Alcohol Services

The cost of these services will vary depending upon the type of service. Pennsylvania’s Medical Assistance Program, either through a managed care organization or the traditional fee-for-service system, pays for many of these services for eligible individuals. People who use services, but are not on Medical Assistance and are without access to other insurance, will be assessed for their ability to pay for services by the county SCA. If you need further assistance you may be referred to your local County Assistance Office (CAO), or the local Social Security Administration (SSA) Office.

Rape Crisis and Prevention

If you are a victim/survivor or the significant other of a victim/survivor, contact your local sexual violence center for free and confidential crisis counseling and intervention. Available 24 hours a day. In addition to crisis counseling, your local sexual violence center provides: individual and support counseling; hospital, court and police accompaniment; prevention education within schools and the community; and information and referral services.

Where to Find Help:

Pennsylvania Coalition Against Rape (PCAR) 
(888) 772-PCAR (Toll free call)

PCAR is a non-profit organization working at the state and national levels to prevent sexual violence. Founded in 1975, PCAR continues to use its voice to challenge public attitudes, raise public awareness, and effect critical changes in public policy, protocols, and responses to sexual violence. To provide quality services to victims/survivors of sexual violence and their significant others, PCAR works in concert with its statewide network of 52 sexual violence centers serving all 67 counties. The centers also work to create public awareness and prevention education within their communities.

General Information:

What is sexual violence?

Sexual violence violates a person’s trust and feeling of safety. It occurs any time a person is forced, coerced, and/or manipulated into unwanted sexual activity. The continuum of sexual violence includes rape, incest, child sexual assault, ritual abuse, date and acquaintance rape, statutory rape, marital or partner rape, sexual exploitation, sexual contact, sexual harassment, exposure, and voyeurism. It is estimated that one out of every four girls and one out of every six boys will be sexually assaulted before their 18th birthday.

How can I reduce my risk?

Although sexual violence can never be prevented and is never the victim’s fault, here are some ways to reduce your risk of being assaulted:

  • Trust your gut. If you do not feel comfortable in a situation, leave.
  • Be in charge of your own life. Do not put yourself in a situation where you have to rely on other people to take care of you. Also, when on a date, do not feel you “owe” that person anything.
  • Be cautious inviting someone into your home or going to someone else’s home. Three out of five sexual assaults occur in the victim’s home or the home of an acquaintance.
  • Do not mix sexual decisions with drugs and alcohol. Your ability to make smart decision is hampered when you are high or drunk.
  • When going out with someone new, do not feel you have to go alone. Go on a group date or meet in a public place.
  • Be aware of date rape drugs. Do not accept beverages from open containers and do not leave your drink unattended.
  • Walk near the curb. Avoid passing close to shrubbery, dark doorways, or other places of concealment.
  • Avoid falling for lines such as “If you loved me….” If your partner loved you, he/she would respect your feelings and wait until you are ready.
  • Communicate. Think about what you really want before you get into a sexual situation, and communicate clearly with your partner. If you think you are getting mixed messages, ask your date what he/she wants.
  • Be assertive. Respect yourself enough not to do anything you don’t want to do. Your opinions matter, and when you say “no,” your date should stop.
  • Use only well-lit entrances. If you notice an entrance without appropriate lighting, notify your landlord or a maintenance person.
  • Avoid individuals who:
    • Do not listen to you or ignore personal space boundaries
    • Make you feel guilty or accuse you of being “uptight” for resisting sexual advances
    • Express sexist attitudes and jokes or act jealous or possessive

How can I help end sexual violence?

  • Always believe victims of sexual violence.
  • Volunteer your time at your local sexual violence center.
  • Send hand-written letters to your local, state and federal legislators. Ask them to support legislation that extends the statute of limitations on sexual assault cases, provides funding to test all rape evidence kits, and allocates money to sexual violence services.
  • Confront people who tell sexist jokes and make sexist comments, and tell them that those attitudes lead to sexual violence. (Yes, men can do this, too!)
  • Teach the children in your life to have respect for others and for their choices. Explain to them what sexual violence is and the various ways it occurs. Call 1-888-772-PCAR for a free CD and magazine to help facilitate the discussion.
  • Encourage your school district’s teachers, principals, and school board members to include sexual violence prevention education in school. (Your local sexual violence center can provide this education for free)

Pharmacy Frequently Asked Questions

Q: What is a PDL?
A: PDL stands for Preferred Drug List. The Preferred Drug List is a list of medicines that are considered “first choice” medicines by the Department of Public Welfare. These medicines are chosen by the Department’s Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is a group of doctors, pharmacists and Medical Assistance consumers or advocates. The P&T Committee considers each medicine for its safety and effectiveness. The medicines that are the most safe and the most effective are put on the Preferred Drug List as preferred or “first choice” drugs. If some medicines used for the same problem are considered to be equally safe and effective, then cost will be considered in the decision of which drug will be called Preferred on the Preferred Drug List. The Preferred Drug List also lists the medicines that are Non-Preferred. The non-preferred drugs are still covered by the Department after preferred drugs are tried and the non-preferred drug is medically necessary. Your doctor can call the Department’s Pharmacy Prior Authorization Call Center (1-800-558-4477 ) to request prior authorization for Non-Preferred drugs.

Q: How does the PDL work?
A: If you have a prescription for a drug that is listed as preferred on the PDL, you may take it to the pharmacy and get it filled as you always have in the past. But please note that some preferred drugs require prior authorization when the quantity is higher than recommended or the drug should only be used to treat specific medical problems.

If you have a prescription for a drug that is listed as Non-Preferred on the PDL, your doctor will need to call the Department’s Pharmacy Prior Authorization Call Center. Your doctor will request prior authorization of the drug. A prior authorization is granted when the non-preferred drug is medically necessary because you cannot take the preferred medicine for a medical reason. If a prior authorization is approved you will be able to get the non-preferred medication.

If you have a prescription for a drug that is not listed on the PDL at all you may take it to the pharmacy and have it filled as you always have in the past.

Q: What is the Pharmacy and Therapeutics Committee (P&T)?
A: The P&T Committee is a group of doctors, pharmacists and MA consumers or advocates. The Committee meets once every quarter to review new drugs that are available as well as review drugs reviewed at an earlier meeting to make sure that the Preferred Drug List contains preferred drugs that are best at treating the medical conditions of the Medical Assistance Consumers. The meetings are open to the public and announcements of when and where the meetings are available on this Web site.

Q: What happens when a drug is denied?
A: A letter is sent to both the consumer and the doctor explaining why the medicine was denied and how to file an appeal on the decision.

If you cannot find the question or answer you need, please Contact DPW.

Mental Health Services

Mental Health services are administered through county Mental Health/Mental Retardation (MH/MR) program offices. The county MH/MR offices serve as a referral source. Most actual mental health services are delivered by local provider agencies under contract with the county MH/MR office. The county MH/MR office determines a person’s eligibility for service funding, assesses the need for treatment or other services, and makes referrals to appropriate programs to fit treatment and/or other service needs.

For a list of county MH/MR office locations and contact information visit: MH/MR Program Administrators Association of Pennsylvania

The Pennsylvania Network of Care is a web resource which provides information and tools, such as:

  • Information & service directories for every county in Pennsylvania
  • Research library
  • Free online trainings available in multiple languages, including American Sign Language
  • Local, state and national links to government resources and organizations that specialize in mental health
  • Bill tracking to follow current state and federal legislation
  • Social networking
  • Secure storage of personal folders including health information, reference materials, WRAP plans and Mental Health Advance Directives

You can also find services in your county by using the Human Services Provider Online Directory

Pennsylvania’s Approach to Mental Health

A Call For Change 

  • A Call for Change Towards a Recovery-Oriented Mental Service System for Adults: establishes a firm foundation for the Pennsylvania transformation to a recovery-oriented mental health system. It offers an understanding of how we have arrived at this time of recovery transformation, provides a concise definition of recovery, and further consideration of what a recovery-oriented system is and is not. Indicators are provided to serve as critical reference points for services, agencies and county mental health programs looking for more specific strategies for transforming to more recovery-oriented services. A Call for Change highlights the challenges we have yet to address and the need for us to engage in open, honest discussion and debate about these issues.

Community Support Program (CSP) 

  • The Community Support Program helps to provide consumers, family members, and professionals a forum to help shape the continued transformation of the mental health services in Pennsylvania into a recovery-oriented system.  The CSP in Pennsylvania has developed into four regional committees which support the development of local committees and coalitions, all committees are comprised of mental health consumers, family members and professionals. Both the regional and local CSP committees provide a community-based avenue for CSP principles, education, information-sharing, and for the collective input on major successes and concerns regarding community mental health services. Concerns and recommendations are then shared with the OMHSAS Adult Advisory Committee.  To learn more about CSP and to find local contacts, visit the Pennsylvania Mental Health Consumers Association web site:  www.pmhca.org

 Positive Practice Resource Team (PPRT)

  • The Positive Practices Resource Team is a joint initiative between the Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) to serve those individuals with a developmental disability who are demonstrating at-risk behavioral challenges and who the support team determines may be needing enhanced levels of support not readily known or available to them.

Other Resources:

For specific information on OMHSAS initiatives regarding Recovery and Resiliency visit: PaRecovery.org

For information and resources related to co-occurring mental health and substance use disorders visit: Pa-Co-Occurring.org

Intellectual Disabilities Services

The intellectual and developmental disability service system is evolving from one focused on providing service in large institutions – often far from a person’s home and community — to one based on a flexible and dynamic system of supports and services close to home and community. The new system is tailored to the needs of persons living in their home community which include community residential and day support services.

Community residential options include group homes, single apartments with a roommate, or a family living setting. People are provided supports in their family home or their own home. Day services, such as supported employment, training and recreation are provided to people who live in residential settings and at home. A wide array of services and supports are also available to families caring for a child or adult sibling with an intellectual disability. Services include case management, mobility training, employment training and opportunities and adult day care.

Who Can I Contact for Help?

Intellectual and developmental disability services are administered through county Mental Health/Mental Retardation (MH/MR) program offices. The county MH/MR offices serve as a referral source and most services are delivered by local agencies under contract with the county office. The county MH/MR office determines a person’s eligibility for service funding and if found eligible a person will receive a supports coordinator. The supports coordinator will:

  • Talk with you about what kinds of supports and services would be helpful to you.
  • Offer you an opportunity to complete an application for the Medicaid Home and Community Based Waiver Program.
  • Enroll you in services which require completing applications.
  • Help you develop your individual plan.
  • Help you talk with individuals or agencies in the community that could support you.
  • Coordinate and monitor supports and services.

The Department of Public Welfare, the Office of Development Programs toll-free Intellectual Disabilities Customer Service Line: 1-888-565-9435. Toll Free TTY Number (Telephone for Hearing Impaired Only) 1-866-388-1114. Local telephone: 717-265-7427. A Customer Service member will answer calls during normal business hours, which are 8:30 a.m. to 4:00 p.m. (Eastern time), Monday through Friday.

Publications

The fundamental concept of Everyday Lives is that with the support of family and friends, individuals with intellectual and developmental disabilities decide; how to live their lives; what supports they need; and how they want to spend the money in their individual budgets. It also means that they are responsible for their decisions and actions.

The intellectual and developmental disabilities system in Pennsylvania was established to provide services for individuals and their families. It is a system that may, at times, seem complicated and difficult to navigate. People using the system have continually pressed for the need for current and accurate information. The Office of Developmental Programs is pleased to endorse The Gold Book 2010 – Understanding the Office of Developmental Programs in Pennsylvania: Mental Retardation and Autism Services.

Homeless Assistance Programs

Are you or someone you know in danger of being evicted from your apartment or home? Or perhaps, you have already been evicted and are currently homeless and do not know where to go for help. The Homeless Assistance Program (HAP) helps to assure that homelessness can be avoided, people who are homeless can find refuge and care and homeless and near homeless clients are assisted in moving toward self-sufficiency.

Where You Can Get Help:

The Homeless Assistance Program County Contact List will provide you with the name and phone number of the organization in your county that you need to contact to request help with your housing situation.

Homeless Assistance Program Services Available:

Case Management: This service is designed to assist you in identifying your needs and the reasons why you became homeless or near homeless. The focus of Case Management is to provide you with the tools and skills that you need to prevent you from ever being in a homeless situation again. The many services include budgeting, life skills, job preparation, home management and referral to drug and alcohol services, if necessary.

Rental Assistance: If you are in danger of being evicted from your apartment or home, your county may be able to assist you with payments for rent, mortgage, security deposits and utilities. Your county HAP provider will work hard with your landlord to maximize your chances for staying in your apartment or home, or work with you to find a more affordable apartment. HAP can also be used to move you out of shelter into an affordable apartment.

Bridge Housing: This is “The Bridge” that will move you from being homeless into permanent housing. This is usually the next step up from an emergency shelter. This service will allow you to stay in a shared facility or apartment for up to 18 months for a small co-pay depending on your income and you will continue to receive case management services to assist you with your goal in living in your own home or apartment.

Emergency Shelter: If you are currently homeless and have no permanent residence or are a victim of domestic violence, the Emergency Shelter component provides you with shelter, for a short period of time. During that time, you will be provided with case management services to assist you with securing more permanent housing.

Innovative Supportive Housing Service: This component enables the service provider to design a supportive housing service for homeless and near homeless persons that is outside the scope of existing HAP components and addresses unique county needs.

Income Guidelines:

The maximum level for income eligibility must be between 100 percent and 200 percent of the United States Department of Health and Humans Services Poverty Guidelines. Counties and providers must establish poverty guidelines for determining eligibility within this limit.

Other Resources:

If you are a victim of Domestic Violence, contact the Pennsylvania Coalition Against Domestic Violence, (PCADV), a private non-profit organization. The Web site will provide you with the name and phone number of the domestic violence service provider, by county.

The National Alliance to End Homelessness is a nonprofit organization whose mission is to mobilize the nonprofit, public and private sectors of society in an alliance to end homelessness. This site has an extensive selection of referral links to help you if you are homeless and puts you in touch with providers who can assist you.

The National Coalition for the Homeless is one of America’s top 100 charities and has a section on their Web site that gives you step-by-step instructions on what to do if you are facing homelessness.

The U.S. Department of Housing and Urban Development (HUD) has many programs to assist the homeless and has specific information for obtaining help in your area if you are homeless.

Hearings and Appeals Process

Standing Practice Order – Formal Appeals – Provides information and instruction regarding the pre-hearing procedures for matters that have been docketed as Formal Appeals before the Bureau of Hearings and Appeals. This document also contains a list of Legal Services Corporations.

Standing Practice Order – Medical Assistance Provider Appeals – Establishes rules governing practice and procedure in Medical Assistance provider appeals.

Procedure for Telephonic Testimony in Formal Cases

Act 142

You can search Bureau of Hearings and Appeals decisions on Medical Assistance provider appeals. Most of the documents listed in this search are in Portable Document Format. If you have trouble accessing this information you may obtain an alternative format by contacting the Bureau of Hearings and Appeals (717-783-3950) and requesting a publication

Formal Appeals 

“Formal Appeals” refers to approximately 100 jurisdictional issues concerning the Department of Public Welfare (or the Department of Aging) but not relating to benefits for individual recipients or applicants, such as Cash Assistance or Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as Food Stamps.

The following is a summary listing of the general categories of appeals processed by the Formal Pre-Hearing Unit:

  • Act 142 Medical Assistance Provider appeals
  • Act 534 – Denial or termination
  • Adoption – Assistance waiver; denial of approval; denial of subsidy
  • Audit – Appeal from an audit determination
  • Child Abuse – Appeal from a report of child abuse; child abuse report expungement
  • Foster Care – Denial of approval as a foster care home; relocation of a child in foster care
  • Licensure – Child Day Care Facility Licensure denial or revocation; issuance of a provisional license to operate a child day care, personal care boarding home, or mental health/mental retardation facility
  • MA Preclusion – Preclusion by the Department of Public Welfare for health care providers to participate in the PA Medical Assistance Program
  • Aging – Report of elder abuse; pharmacy appeals relating to the PACE program

The Formal Pre-Hearing Unit is responsible for the pre-hearing processing of all formal type appeals received by BHA. Pre-hearing processes include: pre-screening for adherence to state and federal filing requirements, docketing, data entry, scheduling and conducting telephonic pre-hearing conferences and possibly a timeliness hearing. If a full hearing on the merits is needed, the date of such a hearing may be determined during the pre-hearing conference. Formal notices of a hearing are sent to the parties regarding the date, time, and location of the hearing. The file and all accompanying documentation are forwarded to the appropriate region prior to the hearing date.

The Administrative Regional Manager oversees this unit which consists of four Administrative Law Judges, three Legal Assistants 2 (Formal Docketing Coordinators), and two Legal Assistants who work together to ensure the timely and proper handling of formal appeals received by the BHA.

To determine if you have the right to appeal and/or if BHA has jurisdiction over the matter which you dispute, reference Pennsylvania regulations at www.pacode.com or www.pabulletin.com.

Jurisdiction 

The Bureau of Hearings and Appeals has the authority delegated by the Secretary of Public Welfare to hear and adjudicate over 280 jurisdictional issues for the Department of Public Welfare. The Bureau is also designated to hear and adjudicate issues for the Department of Aging under an interagency agreement. The issues under Bureau of Hearings and Appeals jurisdiction include, but are not limited to, the following:

  • Denial, reduction, suspension, or termination of Cash Assistance, Medical Assistance or Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as Food Stamps.
  • Denial, reduction, suspension, or termination of direct social services (e.g. day care, legal services, etc.).
  • Denial of PACE prescription benefits by the Department of Aging.
  • Denial, reduction, or termination of Department of Aging Adult Day Care services.
  • Appropriate level of care for nursing home residents.
  • Denial, suspension, or termination of providers from participation in the Medical Assistance Program.
  • Liability of payment for persons who are either receiving in-patient or out-patient care in mental health facilities.
  • Denial, suspension, or termination of licensure for personal care boarding home facilities or day care facilities.
  • Employee injury claims under Act 534.
  • Establishment of family service plans for persons receiving services through the local children and youth agency.
  • Adoption subsidy cases and foster care benefit cases.
  • Disputes regarding the maintenance of the permanent record of founded or indicated child abuse in the central state registry.
  • Nursing rate reimbursement (either the establishment of per diem rates or audit resolution issues).
  • In-patient utilization review.
  • Provisions of Low Income Home Energy Assistance cash payments.
  • Disputes regarding reports of elder abuse to the Department of Aging.

All hearings regarding recipient related appeals are conducted in accordance with the regulations found at Title 55 Pa. Code, Chapter 275 (and 6 Pa. Code, Chapter 3 for Department of Aging appeals). Recipient claims should be filed with the program office. Hearings for non-recipient related appeals are conducted in accordance with Title 1 Pa. Code Chapters 31, 33 and 35, and Medical Provider appeals are conducted under Title 55 Pa. Code Chapter 41.

Recipient Appeal Process 

When the Department of Public Welfare (DPW) or the Department of Aging notifies the applicant or recipient that benefits or payments have been denied or will be reduced, suspended or terminated, he or she has the right to request a fair hearing to dispute the adverse action. Appeals must be filed in written format, except in Supplemental Nutritional Assistance Program (SNAP), formerly Food Stamp, cases. An oral appeal can be filed to dispute an adverse action regarding SNAP benefits.

The Bureau of Hearings and Appeals conducts the fair hearings and decides the DPW applicant and recipient appeals and the appeals from Department of Aging adverse actions. The Bureau currently receives approximately 45,000 to 60,000 appeals per year. Appeals are filed with program offices, which process and track them, then forward them to BHA. Appeals must be forwarded to the Bureau within three workdays of receipt by the program offices.

When an appeal is received by the Bureau, it is docketed and scheduled for a hearing to be conducted by an Administrative Law Judge. When a hearing date has been assigned, a written notice is sent to both parties, i.e. the appellant and to the departmental program office. In appropriate cases, DPW’s Office of General Counsel (OGC) is also notified of the hearing.

Hearings may be conducted over-the-telephone or in person. Most recipient cases are handled via telephone. In Philadelphia, more of the hearings are held in person, i.e., the appellant and the DPW’s representative travel to the regional Bureau office and the hearing is conducted by the Administrative Law Judge with the parties present. Hearing method (telephone or in person) is the appellant’s preference. Whether in person or over-the-telephone, hearings are conducted in accordance with 55 Pa. Code, Chapter 275 (and also 6 Pa. Code, Chapter 6 in Aging appeals).

The responsibilities of the Administrative Law Judge include conducting the hearing in an orderly but informal manner and obtaining testimony and documentary evidence from the parties. The Administrative Law Judge may choose to make an oral decision on the appeal at the hearing. The oral decision at the hearing is called a bench decision. If the Administrative Law Judge decides the appeal with a bench decision, the Administrative Law Judge will issue a short written decision. If the Administrative Law Judge does not choose to issue a bench decision, the Administrative Law Judge prepares a written decision (adjudication) based upon the facts and evidence. The decision or recommendation contains a statement of the issues, findings of fact, a discussion and a ruling of the Administrative Law Judge. The adjudication of a DPW applicant or recipient appeal is then subject to review by the Director of the Bureau and can be affirmed, amended, reversed or remanded. In a Department of Aging appeal, the Administrative Law Judge writes an adjudication in the form of a proposed report to the Secretary of the Department of Aging (or Chief Counsel designee). The Secretary of Aging or Chief Counsel designee may accept the proposed report immediately or issue it to the parties to file exceptions to (i.e. arguments against) the proposed report. The parties have 30 days to submit any exceptions. At the end of the 30 days, the Secretary of Aging or Chief Counsel designee will issue a Final Order to accept the proposed report or reverse it.

Either party to a DPW applicant or recipient appeal (unless the issue under appeal is food stamp related, then only the appellant may request reconsideration) may seek reconsideration by the Secretary of Public Welfare of the final order of the Director of the Bureau by requesting such within 15 calendar days from the date of the final order. Generally, only the appellant has the right to seek review by the Commonwealth Court of Pennsylvania of any decision by the Director of BHA. The appellant may seek reconsideration and petition Commonwealth Court simultaneously. If the Appellant elects to request reconsideration only, his or her right to petition Commonwealth Court is still preserved pending the Secretary’s decision on reconsideration. Should the Secretary find in favor of the appellant, the appropriate party(ies), where permitted, may take issue with the adjudication, and Order, and may petition the Commonwealth Court of Pennsylvania within 30 days from the date of the order. The petition must be filed with the Clerk of Commonwealth Court of Pennsylvania, 601 Commonwealth Avenue, Suite 2100, P.O. Box 69185, Harrisburg, PA 17106-9185. However, if the Secretary finds for DPW, the appellant may seek review before the Commonwealth Court of Pennsylvania. If Commonwealth Court review is sought, the DPW’s legal counsel represents the program office or agency involved in the dispute.

Health Care / Medical Assistance

Medical Assistance, also known as Medicaid, and sometimes referred to as MA, pays for health care services for eligible  individuals 
 

How to Apply for Medical Assistance

There are a couple of different ways to apply for Medical Assistance, please choose the option that suits you. If you do not know if you are eligible, you may still apply.

1. You can apply for or renew your Medical Assistance benefits online by using COMPASS.  COMPASS is the name of the website where you can apply for Medical Assistance and many other services that can help you make ends meet.

2.  You can also apply for Medical Assistance by contacting your local county assistance office.

3.  Or, you can download an application form to send to your county assistance office. If you need help completing the application form, a county assistance office staff member can help you.  Click on the link to download an application.  Application for cash assistance, SNAP and Medical Assistance Benefits (PDF download)

Solicitud para recibir beneficios (Solicitud para recibir beneficios; PDF transferencia directa)

 What if I am not eligible for Medical Assistance?

Contact your county assistance office  and a trained staff member will determine what programs may be available to you. 

Or you may explore these links to learn about additional health care programs available in Pennsylvania.

  • Dental Services
  • Breast and Cervical Cancer Screening and Treatment
  • Healthy Beginnings for Pregnant Women
  • Mental Health/Behavioral Health Services
  • Medicare Part D Drug Coverage Information
  • AIDS/HIV Information and Services
  • Special Pharmaceutical Benefits Program
  • Family Planning Services
  • SelectPlan for Women
  • Help with Medical Appointments if your English is Limited
  • Sign Language Interpreter Services for Medical Appointments
  • Substance Abuse Services
  • Office of Long-Term Living
  • Long Term Care Services
  • Long Term Living in PA
  • Get a Ride to the Doctor: Medical Assistance Transportation Program
  • Phillyhealthinfo.org
  • Special Kids Network
  • SelectPlan for Women Provider Search
  • Medical Assistance Eligibility Handbook
  • Long Term Care Handbook

What kind of care is available through Medical Assistance?

Physical Health Options

Mental Health/Substance Abuse Services Options

Estate Recovery Program

The estate recovery program enables the commonwealth to recover from the estate of individuals who were 55 years of age or older at the time nursing facility services or home and community-based services were received. Recovery applies to Medical Assistance payments provided on or after August 15, 1994, the effective date of the Act. The commonwealth shall recover the amount of Medical Assistance paid for all nursing facility services, home and community-based services, and related hospital and prescription services.

Q&A from the Medical Assistance Estate Recovery Seminars

1. What does the term “probate assets” mean?

Probate assets are the decedent assets that by law are subject to the claims of creditors.

2. When requesting a statement of claim, why does the Department need to know the gross value of the estate?

The Department needs to know the gross value of the estate in order to determine whether to open a case.

3. When requesting a statement of claim, can the request simply indicate the gross value as either over $2,400 or under $2,400?

Yes. If the initial request states the gross value of the estate is under $2,400 and at a later time other assets are discovered, which would make the gross value of the estate exceed $2,400, it is the responsibility of the executor or administrator to notify the Department.

4. When requesting a statement of claim, what type of documentation is needed to show the gross value of the estate as over or under $2, 400?

All assets of the estate should be itemized along with a reasonable estimate of the value of the assets.

5. Does the Estate Recovery Program allow a deduction of $2,400 when it processes a case?

No. However, the Department does not make a recovery against an estate with a gross value of $2,400 or less provided that there is an heir.

6. How does the Department determine the receipt date when there is a request for a statement of claim?

§258.4(c) of the Estate regulations states, “The certified mail receipt date, facsimile receipt date or the electronic mail receipt date verifies the receipt date of the notice from the personal representative”.

7. What evidence will the Department retain or secure to demonstrate the date of the statement of claim was provided to the personal representative?

55 Pa. Code §258.4(d) of the Estate Recovery regulations state “The Department will date the statements of claim. The date on the statement of claim shall establish the Department’s issuance date of the statement of claim” these dates are put on automatically by the automated statement of claim system and cannot be changed.

8. What responsibility does the personal representative have when a nursing home resident dies?

55 Pa. Code §258.4(a) states that the personal representative has a duty to ascertain whether the decedent received Medical Assistance services during the 5 years preceding death and, if so, give notice to the Department by requesting a statement of claim.

9. 55 Pa. Code §258.4(a) states that if a person has received nursing home or home and community based services 5 years preceding death, the personal representative must notify the DPW. What responsibility does the personal representative have if more than 5 years has elapsed?

The 5-year time frame is for notification purposes only and does not limit the Department’s claim. The personal representative has no duty to notify the Department if the decedent had received nursing home or home and community based services more than 5 years preceding their death.

10. Can an undue hardship waiver be granted to anyone who cared for the decedent?

Yes, as long as the individual meets all the criteria as set forth in the regulations for an undue hardship waiver under 55 Pa. Code §258.10(b).

11. Does the caregiver have to be a beneficiary in the will in order to request an undue hardship waiver?

No, the caregiver does not have to be a beneficiary.

12. Does the caregiver have to be a relative? Does the caregiver have to be a full time caregiver?

The caregiver can be anyone. It does not have to be a relative. The caregiver must have continually resided in the primary residence of the decedent for at least 2 years immediately preceding the decedent’s receipt of nursing facility services, or for at least 2 years during the period of time that Medicaid-funded home and community based services were received. During the 2 year time period the caregiver resided with the decedent the caregiver must submit written documentation by a physician, including diagnosis, to show that the care provided prevented the decedent from entering the nursing home or receiving home and community based services for that 2-year period.

13. A resident is part owner of a property. The other owners are unwilling to sell their shares. How does estate recovery handle the issue of the property when the resident dies? The resident’s portion will be willed to an heir.

The administrator/executor can file a Petition to Partition. This will require the other owners of the property to either buy out the decedent’s portion or sell the property. If the property is income producing, a waiver request can be submitted under 55 Pa Code §258.10(c).

14. Can property be transferred to a child who has lived with a parent for two or more years, even if the child has another residence?

If the child’s property can be used as a home, then the answer is “no”. 55 Pa Code §258.10(b)(2) of the Estate Recovery regulations dealing with the undue hardship waivers clearly states, “The person has no other alternative residence”.

15. Is there a look back period for the transfer of assets?

All eligibility questions should be directed to your local County Assistance Office.

16. What is the liability of the personal representative and an individual who receives property subject to the Department’s claim?

Both the personal representative and the person receiving the property subject to the Department’s claim are liable if the personal representative did not receive fair market value for the property.

17. If a postponement is granted to the community spouse because the residence was titled in the name of the decedent and the community spouse subsequently sells the property, how does the Department know the house was sold?

When a postponement is granted, an agreement is signed between the personal representative and the Department. This document is recorded with the deed to the property. This document protects the Department’s claim at the time of sale.

18. If there is a request for a postponement, does the Department also make a determination whether a waiver should be granted?

No, the Estate Recovery Program only reviews what is requested.

19. If the decedent had a life insurance policy, can the named beneficiary collect the money from the policy without having to contact the Department?

Yes, the payment on a life insurance policy collected by a named beneficiary is not a probate asset.

20. Are assets titled as “tenants by the entireties” or “tenants with right of survivorship” excluded from recovery?

Yes, because they would not be a probate asset.

21. Are PDA waiver cases subject to estate recovery?

Yes.

22. If the nursing home resident has no one to care for their home and upon their death it is sold for back taxes, can the Department make a recovery?

If the residence only sells for back taxes, there is no recovery. If there are any funds remaining after the payment of the back taxes, the Department can make a recovery from those funds.

23. When there is money left in a decedent’s personal care account at a nursing home, what is the proper way to disburse it?

Patient’s care accounts up to $4,000.00 can be distributed pursuant to 20 Pa. C.S. § 3101(c). If there is an outstanding burial expense, the facility can transfer up to $3,500.00 of the $4,000.00 to a funeral director. The balance can be paid to a family member. If the gross value of the patient’s personal care account is in excess of $2400, any funds paid to a family member are subject to recovery by the Estate Recovery Program.