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Medical Access

Medical Assistance Overview

Medical Assistance (“MA”) has the broadest coverage of medical and mental health services for individuals under 18 of any insurance plan. MA coverage includes behavioral health services, in-home nursing services, vision care, dental care, orthodontia, prescriptions and transportation to medical appointments, which private insurance often does not cover. Behavioral health services, often referred to as “wraparound” services, include a Therapeutic Support Staff (TSS), a Mobile Therapist (MT) and a Behavior Specialist Consultant (BSC) who all work together to provide behavior support to children at home and at school. MA also covers various types of therapy such as occupational, physical, and speech and language.

MA does not have a lifetime cap on benefits. MA can be a child’s only insurance, or it can be secondary insurance.

A child may qualify for Medical Assistance if he or she has a disability or special health care needs, regardless of the parental income. This eligibility is called Category PH 95 – Children with Special Needs, which is informally referred to as the “Loophole Category.” In order to qualify under the loophole, the student must have a physical or mental condition that very seriously limits his or her activities, and the condition must have lasted, or be expected to last, at least one year.

Many students who have an Individualized Education Plan (IEP) may be eligible for MA. In order to establish that your child meets the standards, you would need to provide documentation such as medical reports, therapy reports, guidance counseling reports and Evaluation Reports (ERs) prepared by your physician, school district, intermediate unit or early intervention program with the application.

You can apply online at In addition to the disability documentation, you would need to provide the child’s social security card, birth certificate, proof of address and documentation of income in the child’s name (interest or dividends and earnings of a child’s income are considered.)

The School Based Access Program (SBAP) is a partnership with families that allows school districts to receive some Medical Assistance (MA) reimbursement for certain IEP medically necessary health-related services provided at school to students who are enrolled in Medical Assistance.

Your option to provide a one-time consent to allow the school to bill Medical Access for School Based Access services would not affect or limit medically necessary health-related services your child receives outside of school in any way.

Please contact Joan Elvin, Pupil Services Secretary/Access Coordinator, with any questions or for further information at (610) 347-0970 x 3328 or