Pennsylvania DHS Notice About Healthy Horizons — What It Means and What to Do
Why These Notices Are So Hard to Read
When the County Assistance Office makes a decision about your Medicare Savings Program (Healthy Horizons) application or renewal, it sends Form PA/FS 162. The notice uses internal category codes, program status codes, and legal references that make sense to caseworkers and mean nothing to the person holding the letter.
This is the document that tells you whether you've been approved, denied, or terminated — and your appeal clock starts from the date printed on it.
What to Look For on the Notice
The program tier. The notice lists your category of assistance code and program status code. Here's what they mean:
| Code | Program Status | What It Means |
|---|---|---|
| PH, PSC 00 | QMB (full MA) | Full Medical Assistance plus QMB protections — premiums, deductibles, copays covered |
| PG, PSC 00 | QMB (cost-sharing only) | Medicare cost-sharing coverage without full MA card |
| TA or TJ, PSC 65/67 | SLMB or QI | Part B premium assistance only |
The effective date. For QMB, coverage starts the first day of the month after the determination. For SLMB and QI, coverage can be retroactive up to three months before your application date.
The income and resource calculation. The notice shows the exact figures the CAO used. Compare them to your actual income and bank balances. If they counted income you don't have or missed the $20 unearned income disregard, that's an error you can challenge.
The appeal deadline. The standard deadline is 30 calendar days from the notice's mail date. The CAO or Bureau of Hearings and Appeals must receive the written appeal by that deadline; the postmark does not control.
Common Reasons You Got This Notice
Approval notice: You applied and were approved for a specific tier. Check the tier — if you applied for QMB but were approved for SLMB, the CAO calculated your income above the QMB ceiling but below the SLMB limit. You still get Part B premium help, but not deductible or copay coverage.
Denial notice: The CAO determined you don't qualify for any MSP tier. The most common reasons: income over the QI ceiling ($1,816 single), resources over $9,950/$14,910, or incomplete documentation.
Redetermination notice: Your annual renewal found a change in income or resources. If your Social Security increased or your bank balance grew past the limit, the CAO may shift you to a lower tier or terminate coverage.
Change notice: Something in your case changed — a new tier assignment, a correction, or an update to your effective date.
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What to Do Next
If approved: No immediate action needed, but note your tier and effective date. If you're on SLMB or QI, the Part B premium will keep coming out of your Social Security check for 60–90 days while the state syncs with SSA. A lump-sum refund arrives after the sync.
If denied or terminated: Read the income calculation. Check whether the CAO applied the $20 monthly unearned income disregard. Check whether spousal deeming was calculated correctly. If the numbers are wrong, file a written appeal so the CAO or Bureau of Hearings and Appeals receives it within 30 days of the notice's mail date. For a termination or reduction only, file within 10 calendar days of the mail date to maintain existing benefits while the appeal is pending.
If confused: Call PA MEDI at 1-800-783-7067 — a free counselor can translate the notice. For legal questions about an appeal, contact the Pennsylvania Health Law Project at 1-800-274-3258.
The Pennsylvania Medicare Savings Programs, Extra Help & PACE/PACENET Guide includes a notice-by-notice decoder and response templates, plus the full 30-day appeal timeline.
Get Your Free Pennsylvania — Medicare Savings Program Eligibility Checklist
Download the Pennsylvania — Medicare Savings Program Eligibility Checklist — a printable guide with checklists, scripts, and action plans you can start using today.