Need help? Call the COMPASS HELPLINE, Mon–Fri, 8:30 a.m.–4:30 p.m. They can explain rules, gather medical info, and ensure your child gets proper care.
Medicaid for Children with Special Needs (PH95)
Get secondary health coverage regardless of income to help cover costs.
Medicaid for Children with Special Needs (PH95)
Get secondary health coverage regardless of income to help cover costs.
Extra Medical Help for Your Child–At No Cost to You
Many families don’t realize that their child may qualify for extra health coverage. We’re here to help.
PH95 (Medicaid for Children with Special Needs) offers full secondary health coverage at no additional cost to you for children with disabilities or special care needs, regardless of your family's income.
This coverage works alongside your current commercial insurance to cover what your main plan leaves behind–like high deductibles, mounting copays, and strict limits on therapy visits.
What This Program Covers
Through your commercial coverage plus PH95, your child can get complete coverage for the vital care they need. Think of PH95 as the missing puzzle piece: your commercial plan pays first, and Medicaid steps in to cover the rest so you pay little to no out-of-pocket costs. This includes:
- Doctor Visits and Emergency Care: Regular check-ups, specialist visits, and urgent medical care.
Mental and Behavioral Health Support: Counseling, wraparound services, and emotional wellness care that commercial plans often limit. - Prescriptions and Medical Supplies: Daily medications, specialized formulas, and medical equipment.
- Therapy and Rehab: Medically necessary speech, physical, and occupational therapies to help your child thrive–even after your commercial plan’s yearly visit caps are reached.
- Medical Assistance Transportation Program (MATP): We work with MATP to provide free rides to doctor visits, therapy appointments, and pharmacies.
Highmark Tip: Extra benefits can vary based on specific qualifications and location.
Does My Child Qualify?
This program is a safety net specifically for children who need it most. To be eligible, your child must be:
- Under age 18 and a resident of Pennsylvania. A legal resident or citizen with a Social Security Number (or applying for one).
- Meeting the standard definition of a disability. This includes physical, learning, developmental, or mental health challenges. Your child’s doctor will be asked to verify the diagnosis.
Good to Know: Your parental income is looked at, but it will not be counted against your child for this specific program. This is designed to help families just like yours.
How to Get Started
Applying for government programs can feel stressful, but you don't have to do it by yourself. You can apply online, by phone, or by mail.
Apply Online: Use COMPASS
Apply by Phone: Call the Consumer Service Center at 1-866-550-4355.
Apply by Mail: Download and print a paper application, fill it out, and mail it to your local County Assistance Office (CAO).
Helpful Resources
To help you navigate PH95 and find local support, here’s a list of trusted guides, official state resources, and community programs.
Highmark Community Support: This localized search tool connects families with free or reduced-cost social service programs in their area to assist with immediate needs like food, housing, utility assistance, and job training.
PA Gov: This is the official state government landing page detailing the eligibility criteria, application process, and income guidelines for Pennsylvania’s PH95 Medicaid category for children with disabilities.
Pennsylvania Health Law Project: This comprehensive, advocate-written guide provides families with an in-depth breakdown of how the PH95 loop works, step-by-step application instructions, and strategies for navigating potential coverage denials.
Kidz Therapy Zone: Written from a provider's perspective, this article acts as a roadmap for parents looking to coordinate and maximize multiple state resources, including PH95, Act 62, and Supplemental Security Income (SSI).
Frequently Asked Questions
Nothing changes! Your commercial insurance remains your child’s primary coverage and will still be billed first. Think of Medicaid as a safety net–it acts as the “payer of last resort.” This means after your commercial insurance pays its share, Medicaid steps in to help cover the rest, including copays, deductibles, or services your main plan might miss.
Because your commercial plan stays primary, Medicaid quietly handles the leftover costs in the background.
Note: Always make sure to show both insurance cards at your child’s appointments so the provider knows exactly how to coordinate the billing.
You will make this choice right during your initial application after your child is determined eligible for PH95. When you apply on COMPASS, the system will ask you to select a Medicaid Managed Care Organization (MCO) to manage your child’s care.
A State medical team will do a final check to officially certify the medical paperwork. Watch your mail for an informational packet. You may be asked to provide for more detailed medical records.
Don't panic: You have 30 days to send these records back to your local County Assistance Office (CAO).
Ask for help: If you don't have the records on hand, just give the letter to your child's doctor or therapist, and their office can help you pull the paperwork.
Get ahead of the rush: If you want to jumpstart this step, you can download the official PA 1960: Physician Certification for Child with Special Needs form. Share a copy with your child’s doctor to fill out and submit along with your initial application.
Highmark Tip: As long as you are actively communicating with the CAO and working to get these papers submitted, your child's temporary care and medical coverage will stay active!
Once officially approved, the coverage stays in place until your child turns 18, or until their medical condition changes. The State will ask you to renew and verify your information once every 12 months.
Good to Know: Don't worry if you change jobs or you get a raise. Because this is the PH95 program, your parental income is still bypassed during your yearly renewal. Your child’s medical eligibility is the only thing being reviewed.
Take the Next Step
Take the Next Step
Need help? Call the COMPASS HELPLINE, Mon–Fri, 8:30 a.m.–4:30 p.m. They can explain rules, gather medical info, and ensure your child gets proper care.