Insurance Help
Additional health coverage for Pennsylvania children
If your child has a disability, they may qualify for Pennsylvania Medical Assistance, also called Medicaid, even if your family earns too much for regular Medicaid or already has private insurance.
Pennsylvania calls this eligibility category PH95. It is simply the name of the eligibility pathway, not a separate insurance plan.
No. An autism diagnosis or another diagnosis alone does not guarantee approval. The state reviews medical and supporting records to determine whether your child meets the disability requirements.
How Does Secondary Insurance Work?
Your child can keep their private insurance. That insurance generally pays first, and Medicaid may help cover additional eligible services or equipment. Coverage depends on Medicaid’s rules and the providers involved.
What conditions may qualify?
PH95 is available for qualifying physical, developmental, intellectual, and mental health disabilities. Some conditions that may be less visible include:
- ADHD and other neurodevelopmental disorders
- Learning disorders and Tourette syndrome
- Anxiety disorders, obsessive-compulsive disorder (OCD), depression, bipolar disorder, and post-traumatic stress disorder (PTSD)
- Epilepsy and other seizure disorders
- Diabetes
- Hearing loss
These are examples, not a list of diagnoses that automatically qualify. The child must meet the applicable disability standards. The state considers the condition’s severity, its effect on daily functioning, and the medical evidence. This list is not exhaustive.
Does Our Family’s Income Matter?
Parents’ income does not count toward PH95 eligibility, but you still must report and verify it. The child’s own countable income is subject to a limit. Children must be under 18, live in Pennsylvania, and meet other program requirements. The state first checks whether the child qualifies under another Medicaid category.
How Do We Get Started?
- Apply for Medical Assistance. Use the COMPASS link on the official Pennsylvania PH95 page, call 1-866-550-4355, or contact your County Assistance Office.
- Identify your child’s disability. ASERT recommends adding “Child with Disability Category PH-95” in the application’s comments or notes.
- Provide supporting records. Ask your child’s clinician for records explaining the diagnosis, how it affects daily life, and needed treatment. Include an IEP or other supporting records and insurance information as requested.
Use ASERT’s Application Checklist →
For autism resource guidance, call ASERT at 877-231-4244.
Pennsylvania’s Department of Human Services determines eligibility. Families must complete required renewals, generally every 12 months. Learn about the childhood disability standards.