Medicaid for Children with Special Needs (PH95)

Medicaid for Children with Special Needs (PH95) provides full and free Medical Assistance (MA) coverage to children up to age 18 with disabilities whose parents make too much money to qualify for traditional Medicaid categories. The Children with Special Needs category is only authorized if a child is not eligible for any other MA category.

What benefits are available?

Benefits include but are not limited to:

  • Emergency and Physician Services 
  • Mental Health Treatment 
  • Prescriptions 
  • Medical Supplies and Equipment 
  • Rehabilitation Services

Who is eligible?

To be eligible for PH95, the child must be:

  • Under age 18 and a Pennsylvania resident; 
  • Lawfully present and provide or apply for a Social Security Number; and
  • Disabled according to Social Security Administration (SSA) standards. Disabilities include physical, developmental, mental health, or intellectual.

Financial Eligibility Factors:

  • The child’s countable income must be at or below 100% of the current year’s Federal Poverty Income Guidelines (FPIG)
  • Uses SSA rules for determining countable income. Less than half of the child’s earned income is countable. 
  • Court-ordered child support and any RSDI income the child receives is excluded. 
  • Parental income must be verified but will be excluded in this category. 
  • The child must not qualify for any other Medicaid category. It is the category of last resort.

More Information

Learn more about the Children with Special Needs (PH95) Medicaid Category.

Apply for Medicaid

You can apply online, in-person, on the phone, or through the mail.

Apply Online

Use our quick, easy, and secure COMPASS website.

Apply Online (opens in a new tab)

Apply by Telephone

Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355 

1-866-550-4355 (opens in a new tab)

Apply In-Person

Your local county assistance office (CAO) have professionals that will help you apply.

Find You County Assistance Office 

Apply by Mail

Download, fill out, and print a paper application then send it to your local County Assistance Office.

Download a form (PDF)

PH95 Frequently Asked Questions