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Do I need a Medical Form to Get Medicaid?

Public Benefits

Do I need a Medical Form to Get Medicaid?

Date Posted: 
04/27/2016

Pennsylvania expanded Medicaid in 2015. Before Medicaid expansion, most lower-income adults who wanted Medicaid had to get forms from their doctors saying that they had health problems. Now, most lower-income adults can get Medicaid without medical forms.

Q:  Why does the welfare office ask for a medical form?             

A:  Before Pennsylvania expanded Medicaid in 2015, most people had to prove that they had health problems to get Medicaid.  Now, most lower-income adults can get Medicaid, even if they’re healthy. 

When you apply, the welfare office will check to see if you qualify for traditional Medicaid for people with health problems.  If you write on the application that you have health problems, the welfare office will send you a medical form for your doctor to sign, called an “Employability Assessment Form” or a “PA 1663”.  The welfare office will also ask for proof of your bank accounts and other resources.

If you don’t turn in a medical form, or proof of your resources, the welfare office will usually give you Medicaid anyway, through Medicaid expansion.

Q:  Will I get better health insurance if I get a medical form?

A:  No!  Traditional Medicaid and Medicaid expansion have the same benefits package.  If you don’t turn in a medical form, you will still have the same coverage for doctors’ and hospital visits and prescription drugs. 

Q:  Do I have to apply for Social Security benefits?         

A:  If you turn in a medical form that says that you have health problems, the welfare office will ask you to apply for Social Security.  You don’t have to apply if you don’t turn in a medical form.

If the welfare office asks you to apply for Social Security and you believe that you don’t qualify because you aren’t disabled, you should tell the welfare office.  The welfare office should agree that you don’t have to apply for Social Security.

Q: When do I have to return the medical form?

A:  Traditional Medicaid and Medicaid expansion have different income counting rules.  For people with health problems who are working, or who have spouses who are working, the income limits are higher.

If your income is over the limit for Medicaid expansion ($1,366 per month before taxes for a single person; $1,842 for a couple; $2,795 for a family of four) and you or your spouse work, you may still be able to qualify for traditional Medicaid based on the medical form.   Turn in the medical form if you have health problems that are expected to last twelve months or longer and your doctor checks Box 1 or Box 2 on the form.

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