55 Pa. Code § 123.82

Current through Register Vol. 54, No.43, October 26, 2024

Section 123.82 - Definitions

The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:

Applicant-An adult or emancipated minor who indicates to the county office, either in person, or through someone acting in his behalf, that he wants his eligibility for MA determined. The adult with whom an unemancipated minor lives, or the guardian or trustee of that adult, will be the applicant in the behalf of the child. For a child in foster care, the child welfare agency supervising the care will be the applicant. For a child who is a resident in an institution, an official of the institution will be the applicant.

Applicant group-A person living alone or the following persons living together: spouses, parents and their unemancipated minor children and any other unemancipated minor children who are related by blood or marriage, or any other adults or emancipated minor children living in the household who consider themselves to be dependent upon the head of the household and who do not wish to apply on their own behalf. If a person who would have been included with other persons as a member of an applicant group dies within 90 days of the date of application, he will be considered to be a member of the applicant group insofar as being eligible for the services he received within the 90 days before the date of application.

Application-Application shall include the following:

(i) An action by which a person requests that the county office determine his eligibility for medical assistance.

(ii) A separate application for MA will not be required when a person has been found to be needy that is, a money payment or nonmoney payment recipient.

(iii) An application may be made for any kind of medical care provided by the program. It will not be necessary to apply for any one kind of care or for different kinds of care in a sequence.

(iv) The date of a request for MA, as distinguished from an inquiry, is the date the eligibility form, Form PA 743, is completed and signed. The applicant must be living at the time this request is made.

(v) A reapplication will be considered an application.

(vi) A request for MA by an adult or emancipated minor, or on behalf of an unemancipated minor, will be considered an application even though the person is added to an existing applicant group.

(vii) When a categorically needy recipient, whether money payment or nonmoney payment, is no longer eligible as a categorically needy person because he has sufficient resources to meet his basic needs, but he is eligible as a medically needy only person, it will not be necessary to complete a Form PA 743.

(viii) If a person who has been found ineligible for MA should request a County or State appeal hearing, the request will be considered an application.

(ix) An application will continue in effect until disposed of.

Inquiry-An inquiry differs from a request in that the person making the inquiry is seeking information only and not MA. When a person asks for information intended for the use of someone other than himself, the Department will consider the request as an inquiry unless or until it knows that the person is, in actuality, requesting MA on behalf of another person and is doing so with the knowledge and consent of the latter.

55 Pa. Code § 123.82

This section cited in 55 Pa. Code § 123.72 (relating to definitions); and 55 Pa. Code § 125.84 (relating to procedures).