ADDENDUM 2 APA Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes

ADDENDUM - 2

APA Adult Public Assistance Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes

Medicaid Subtype Description AS Waivered Assisted Living BB Individual lost SSI Supplemental Security Income / APA Adult Public Assistance eligibility from 1977 SSA Social Security Administration COLA Cost of Living Allowance "Pickle Person" BC Breast and Cervical Cancer (Ladies First) BE Disability exams (blindness), with or without need for HCB Home and Community-Based Waiver Determination. Non-standard coupon. DC Under 18, Receiving SSI Supplemental Security Income DE Applicant who requires an AD Aid to the Disabled -2, and, if needed, an HCB Home and Community-Based Waiver Determination. DK Disabled Kid ( TEFRA Tax Equity and Fiscal Responsibility Act, P.L. 97-248 ) DW Working Disabled Medicaid Buy-In GF Individuals eligible for State APA Adult Public Assistance cash program(s) in December 1973 IL Emergency Alien (AD, AB, and OA) – legal alien or ineligible non-immigrant IN Long Term Care (Nursing Home or HCB Home and Community-Based Waiver) NH Nursing Home Nursing Home (eligible for SSI Supplemental Security Income or APA Adult Public Assistance if not institutionalized) NS Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of requirements which do not apply to Medicaid (use for SSI Supplemental Security Income eligible individuals who have not applied for SSI Supplemental Security Income ) PM Section 1619(b) eligible individuals. See Manual Section 530-E ;or Disabled Adult Children; or Disabled Widowers who have lost SSI Supplemental Security Income or APA Adult Public Assistance due solely to receipt of title II benefits QD Qualified Disabled and Working Individuals ( QDWI Qualified Disabled and Working Individuals ) QM Qualified Medicare Beneficiaries ( QMB Qualified Medicare Beneficiaries ) RC Eligible for but refusing APA Adult Public Assistance cash payments or has countable income above the APA need/payment standard but below the Expanded Refused Cash Income Limits outlined in ADLTC MS 530(C) SA Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of alien sponsor deeming SI Receiving SSI Supplemental Security Income SL Specified Low Income Medicare Beneficiary. ( SLMB Specified Low Income Medicare Beneficiaries ) SS Individuals eligible for SSI Supplemental Security Income or state supplemental payments except for the 20% Social Security Benefit increase ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) I ) in 1972. ST Not receiving SSI Supplemental Security Income UL Emergency Alien (AD, AB, or OA) – undocumented illegal alien only WD Waiver applicant who does not require a disability determination, but does need a waiver determination. Eligibility is for the cost of a Waiver Agency's assessment for Waiver eligibility. Non-standard coupon.

Incarceration Medicaid Subtype Description AI APA Related (AD, AB & OA) BI Breast and Cervical Cancer II Emergency Alien (AD, AB & OA) – legal alien or ineligible non-immigrant IU Emergency Alien (AD, AB, or OA) – undocumented illegal alien only KI Pregnant Woman

The following Medicaid eligibility codes are specific to ADLTC Medicaid unless here is a "*" in the description.

Medicaid Eligibility Code Description 11 Pregnant Woman * 19 Waiver Determination Only 20 No other eligibility codes apply * 24 LTC (300%) Institutionalized 25 Disability/Blind/Waiver Determination 30 Adults with Physical and Developmental Disabilities Waiver – Special LTC 31 Adults with Physical and Developmental Disabilities Waiver * 34 Adults with Physical and Developmental Disabilities – Dual Medicaid/QMB 40 Alaskans Living Independently Waiver – Special LTC 41 Alaskans Living Independently Waiver * 44 Alaskans Living Independently Waiver – Dual Medicaid/QMB 53 Ineligible Alien Emergency coverage (used for everyone except pregnant women) * 54 SSI disabled child 66 Medicare Savings Program – QDWI only 67 Medicare Savings Program – QMB only 68 Medicare Savings Program – SLMB only 69 Medicare Savings Program – Dual Medicaid/QMB 70 Intellectual and Developmental Disabilities Waiver – Special LTC 71 Intellectual and Developmental Disability Waiver * 74 Intellectual and Developmental Disabilities Waiver – Dual Medicaid/QMB 78 Medicare Savings Program – SLMB Plus only 80 Complex Medical Condition Waiver – Special LTC 81 Complex Medical Condition Waiver * 91 Individualized Supports Waiver – Special LTC 92 Individualized Supports Waiver * 93 Individualized Supports Waiver – Pregnant* 94 Individualized Supports Waiver – Dual Medicaid/QMB

Waiver Codes Description MC Complex Medical Condition MD Intellectual and Developmental Disabilities DA Adults with Physical and Developmental Disabilities AG Alaskans Living Independently IS Individualized Supports

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