Pennsylvania Medical Assistance for a Grandchild in Relative Care

When a grandchild moves into your home, health coverage is one of the first things to sort out. Under MAGI (Modified Adjusted Gross Income) rules, a relative caregiver's income is generally excluded when the child is evaluated under non-filer rules. Household composition matters: a parent or minor sibling living with the child can change household size, and a caregiver who claims the child as a tax dependent may have their income counted.

How the "Family of One" Rule Works

When a child is not claimed as a tax dependent by another taxpayer, MAGI non-filer rules generally exclude a non-parent caregiver's income. The child's household can still include a parent or minor siblings who live with them; the child is a family of one only if no such family member is included. If you claim the child as a tax dependent, tax-filer household rules can count your income.

If the child's MAGI household has countable income within the applicable limit for the child's age group, the child meets the income test for Medical Assistance, which covers:

• Doctor visits, specialist referrals, and hospital care
• Dental, vision, and hearing
• Behavioral and mental health services
• Prescriptions
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) — a comprehensive preventive care standard for children
• Non-Emergency Medical Transportation (NEMT) through county MATP administrators

Medical Assistance vs. CHIP

If the child's countable MAGI household income falls below Medical Assistance thresholds (133% to 215% of the Federal Poverty Income Guidelines, depending on age), they meet the income test for direct Medical Assistance — full Medicaid coverage at no cost.

If countable MAGI household income exceeds those thresholds — unusual for children in kinship care, but possible if a child receives substantial survivor benefits — coverage may move to CHIP (Children's Health Insurance Program). Pennsylvania CHIP covers children under 19 who are not eligible for Medical Assistance, with costs ranging from no-cost to full-cost based on family income; there is no income ceiling. Even the subsidized tiers can cost less than private insurance.

In practice, most kinship children qualify for Medical Assistance outright.

How Care Arrangement Affects the Pathway

The way the child entered your home determines which eligibility track the CAO uses:

Informal kinship care or Caregiver Authorization Affidavit: MAGI household rules apply. Under non-filer rules, the caregiver's income is generally excluded, but a parent or minor sibling in the home can change the household size. Tax-dependent status can also change whose income counts. This is the most common path for grandparents who stepped in without child welfare involvement.

SPLC (Subsidized Permanent Legal Custodianship) — Title IV-E: The child receives categorical, automatic Medical Assistance. No income test at all.

SPLC — state-funded: The child is evaluated under MAGI household rules, with non-filer and tax-dependent rules determining whose income counts.

Formal child welfare placement (foster care): The child receives categorical Medical Assistance automatically through the placement.

The bottom line: regardless of which arrangement you're in, the child can almost certainly get health coverage.

You Don't Need Custody to Apply

A relative caregiver does not need a court custody order or legal guardianship to submit a Medical Assistance application for a child in their care. Under federal Medicaid enrollment rules and DHS policy, any adult who exercises care, control, and supervision over the child can sign the application as a representative.

If you've been told you need custody papers before the child can get Medical Assistance, that's incorrect. File the application.

Continuous Eligibility and Renewals

Once enrolled, children receive 12 months of continuous eligibility — the coverage stays active for a full year regardless of income changes during that period. At the annual renewal, the CAO first tries an automated review using data matching. If everything checks out, coverage renews without you doing anything.

If the CAO can't verify automatically, they'll send a renewal packet. You have 30 days to respond with updated documentation. Missing the deadline can cause coverage to lapse, so watch the mail.

How to Apply

Medical Assistance is part of the same PA 600 application used for Child-Only TANF and SNAP. File through COMPASS or at your County Assistance Office. Check the Medical Assistance box alongside TANF and SNAP — there's no reason not to file for all three at once.

For a complete map of every PA kinship benefit, how they interact, and what documents to bring, the Pennsylvania Kinship Financial Help Guide covers the full picture.

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