Section 442.1. The Medically Needy; Determination of Eligibility.--(a) A person shall be considered medically needy if that person meets the requirements of clauses (1), (2) and (3):
(1) Resides in Pennsylvania continuously for ninety days immediately preceding the effective date of eligibility, except for persons eligible for federally funded categories of medical assistance.
(2) Meets the standards of financial and nonfinancial eligibility established by the department with the approval of the Governor. In establishing these standards the department shall take into account:
(i) the funds certified by the Budget Secretary as available for medical assistance for the medically needy;
(ii) pertinent Federal legislation and regulations; and
(iii) the cost of living.
(3) Complies with subclause (ii): (Intro. par. amended June 28, 2019, P.L.43, No.12)
(i) ((i) deleted by amendment June 28, 2019, P.L.43, No.12).
(ii) Is not eligible for cash assistance but is:
(A) a child under twenty-one years of age;
(B) a custodial parent of a dependent child under twenty-one years of age;
(C) a person fifty-nine years of age or older;
(D) a refugee for whom Federal financial participation is available;
(E) a pregnant woman;
(F) 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
(G) a person who verifies employment of at least one hundred hours per month earning at least the minimum wage.
((3) amended June 30, 2012, P.L.668, No.80; amendment declared unconstitutional 2018)
(c) Medical assistance benefits can be authorized retroactively for an eligible person who requests coverage for an unpaid medical expense which was incurred during a period up to three months prior to the month of application. In determining eligibility, all income received or expected to be received in a six-month period shall be counted even if the person requests medical assistance coverage for less than six months. If retroactive medical assistance coverage is requested, the six-month period can combine both retroactive and prospective periods. Medical assistance coverage can continue as long as the need exists, but no longer than the six-month period from which income is counted.
(442.1 amended May 16, 1996 P.L.175, No.35)
2018 Unconstitutionality: The amendment of section 442.1(a)(3) by Act 80 of 2012 was declared unconstitutional on July 18, 2018, by the Supreme Court of Pennsylvania in Washington v. Commonwealth, Department of Public Welfare, 188 A.3d 1135 (Pa. 2018). The Legislative Reference Bureau effectuated the 2018 unconstitutionality.
Compiler's Note: The Department of Public Welfare, referred to in this section, was redesignated as the Department of Human Services by Act 132 of 2014.
Compiler's Note: Section 20 of Act 49 of 1994, which amended section 442.1, provided that regulations promulgated by the Department of Public Welfare prior to December 31, 1995, for the purpose of implementing section 442.1 shall not be subject to the act of June 25, 1982 (P.L.633, No.181), known as the Regulatory Review Act. Such regulations shall be subject, however, to review for form and legality by the Attorney General and the General Counsel under sections 204(b) and 301(10) of the act of October 15, 1980 (P.L.950, No.164), known as the Commonwealth Attorneys Act.