|
Program Code |
ACEDS Recert Period |
Processing Notes |
Full Definition |
830A
|
12 mos. |
|
Medical expansion for parents of eligible children. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a QI-1.
|
830Q
|
12 mos. |
|
Medical expansion for parents of eligible children. Part B premium paid because customer is a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid.) Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 830S |
12 mos. |
|
Medical expansion for parents of eligible children. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a SLIMB. |
850
|
N/A |
Processed by Medicaid Unit only
|
Special Needs: H2O. Eligible for Medicaid. |
| 850A |
N/A |
Processed by Medicaid Unit only
|
Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1. |
| 850Q |
N/A |
Processed by Medicaid Unit only |
Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
|
850S
|
N/A |
Processed by Medicaid Unit only |
Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB. |
853
|
N/A |
Processed by Medicaid Unit only |
Special Needs: EPD. Eligible for Medicaid. |
| 853A |
N/A
|
Processed by Medicaid Unit only |
Special Needs: EPD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1.
|
853Q
|
N/A |
Processed by Medicaid Unit only |
Special Needs: EPD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
853S
|
N/A |
Processed by Medicaid Unit only Special Needs: |
EPD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB. |
870
|
N/A |
Processed by Medicaid Unit only |
Special Needs: TWWIIA. Eligible for Medicaid. |
870A
|
N/A |
Processed by Medicaid Unit only |
Special Needs: TWWIIA customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1.
|
870Q
|
N/A |
Processed by Medicaid Unit only |
Special Needs: TWWIIA customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 870S |
N/A |
Processed by Medicaid Unit only |
Special Needs: TWWIIA customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB.
|
873
|
N/A
|
Processed by Medicaid Unit only |
Special Needs: MRDD. Eligible for Medicaid. |
| 873A |
N/A
|
Processed by Medicaid Unit only |
Special Needs: MRDD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1.
|
| 873Q |
N/A
|
Processed by Medicaid Unit only Special Needs: |
MRDD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
873S
|
N/A |
Processed by Medicaid Unit only |
Special Needs: MRDD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB.
|
| 880 |
N/A |
Processed by Medicaid Unit only
|
Special Needs: 1115. Eligible for Medicaid. |
| 910 |
12 mos. |
|
Aged person meeting medically needy eligibility requirements with income less than the SSI payment standard but not receiving SSI. Eligible for Title XIX (Medicaid) reimbursement.
|
|
910H
|
initially,
4 mos.
|
|
Aged person eligible for Medicaid who is a hurricane/natural disaster evacuee now living in DC. Eligible for Title XIX (Medicaid) reimbursement.
|
910Q
|
12 mos. |
|
Aged person meeting medically needy eligibility requirements with income less than the SSI payment standard but not receiving SSI; also meets requirements of a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 913 |
12 mos.
|
Processed by LTC unit only |
Aged person receiving income less than SSI payment standard but not receiving SSI, and who is subject to long term care financial provisions. Eligible for Title XIX (Medicaid) reimbursement.
|
913Q
|
12 mos. |
Processed by LTC unit only |
Aged person receiving income less than SSI payment standard but not receiving SSI, and who is subject to long term care financial provisions; also meets requirements of a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
920
|
12 mos. |
|
AFDC/TANF related child meeting medically needy eligibility requirements with income less than the AFDC/TANF financial assistance payment standard. Eligible for Title XIX (Medicaid) reimbursement.
|
|
920H
|
initially,
4 mos.
|
|
Child eligible for Medicaid who is a hurricane/natural disaster evacuee now living in DC. Eligible for Title XIX (Medicaid) reimbursement.
|
928
|
4 mos. |
|
AFDC/TANF child eligible for extended coverage for four months because of increased child support. Eligible for Title XIX (Medicaid) reimbursement.
|
928G
|
6 mos. |
|
AFDC/TANF related child eligible for six additional months due to termination of Medicaid benefits because of increased earnings. Eligible for Title XIX (Medicaid) reimbursement.
|
| 930 |
12 mos.
|
|
AFDC/TANF related adult meeting medically needy eligibility requirements with income less than the AFDC/TANF financial assistance standard. Eligible for Title XIX (Medicaid) reimbursement.
|
|
930H
|
initially,
4 mos.
|
|
Parent, adult caretaker or pregnant individual who is eligible for Medicaid and who is a hurricane/natural disaster evacuee now living in DC.
|
| 930Q |
12 mos. |
|
AFDC/TANF related adult meeting medically needy eligibility requirements with income less than the AFDC/TANF financial assistance standard. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement as a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
938
|
4 mos. |
|
AFDC/TANF child eligible for extended coverage for four months because of increased child support. Eligible for Title XIX (Medicaid) reimbursement.
|
938G
|
3 mos. |
|
AFDC/TANF related adult eligible for six additional months due to termination of coverage because of increased earnings or hours of employment of a member of the AFDC/TANF family unit. Eligible for Title XIX (Medicaid) reimbursement.
|
940
|
12 mos.
|
|
Blind person meeting medically needy eligibility requirements with income less than the SSI payment standard but not receiving SSI. Eligible for Title XIX (Medicaid) reimbursement.
|
| 940Q |
12 mos.
|
|
Blind person receiving income less than SSI payment standard but not receiving SSI, and who is subject to long term care financial provisions; also meets requirements of a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 943 |
12 mos.
|
Processed by LTC unit only |
Blind person with income less than the SSI payment standard but not receiving SSI, and who is subject to long term care eligibility financial provisions. Eligible for Title XIX (Medicaid) reimbursement.
|
943Q
|
12 mos. |
Processed by LTC unit only |
Blind person with income less than the SSI payment standard but not receiving SSI, and who is subject to long term care eligibility financial provisions and is also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursent. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 950 |
12 mos.
|
|
Disabled person meeting medically needy eligibility requirements with income less than the SSI payment standard but not receiving SSI. Eligible for Title XIX (Medicaid) reimbursement.
|
|
950H
|
initially,
4 mos.
|
|
Disabled person eligible for Medicaid who is a hurricane/natural disaster evacuee now living in DC. Eligible for Title XIX (Medicaid) reimbursement.
|
| 950Q |
12 mos.
|
|
Disabled person receiving income less than SSI payment standard but not receiving SSI, and who is subject to long term care financial provisions; also meets requirements of a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
953
|
12 mos. |
Processed by LTC unit only |
Disabled person receiving income less than SSI payment standard but not receiving SSI, and who is subject to long term care financial provisions. Eligible for Title XIX (Medicaid) reimbursement. |
953Q
|
12 mos. |
Processed by LTC unit only |
Disabled person with income less than the SSI payment standard and subject to long term care eligibility financial provisions and is also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period. |
| 960 |
12 mos. |
|
Person under the age of 21 and receiving General Assistance for Children. Eligible for Title XIX (Medicaid) reimbursement. |
