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Appendix J (09/23) 1 of 2 Medical Services - Appendix J, Eligibility Table Eligibility Group General Age Disability Income Resources Med Necessity Relationship OCSE Coop Other Policy Reference Section D MS F-110 MS F-120 MS E-100 MS E-500 MS F-151 MS F-110 MS F-130 Sections F and H Families & Individuals ARKids A ● ● ● ● * ARKids B ● ● ● ● * No Ins Coverage Newborns ● ● ● * Health Care Mom Parents & Caretakers ● ● ● ● Pregnant Woman (PW) ● ● ● * Must be Pregnant Unborn Child ● No Creditable Coverage Adult Expansion Group ● ● ● ● Not Medicare Eligible Former Foster Care ● ● ● Former Foster Care Status Aid to Aged, Blind or Disabled To qualify for one of these categories, the individual must be aged, blind, or have a disability. Long Term Services and Supports Nursing Facility ● ● ● ● ● ● * Transfer Penalty; Spousal Rules Assisted Living Facility ● ● ● ● ● ● * Cost Effective; Transfer Penalty; Spousal Rules ARChoices Waiver ● ● ● ● ● ● * Cost Effective; Transfer Penalty; Spousal Rules PACE ● ● ● ● ● ● * Cost Effective; Spousal Rules DDS Waiver ● ● ● ● ● * Cost Effective; Transfer Penalty; Spousal Rules Medicare Savings Program ARSeniors ● ● ● ● * QMB ● ● ● ● ● * SMB ● ● ● ● ● * QI-1 ● ● ● ● ● * QDWI ● ● ● ● ● * A green dot signifies that there is an eligibility criteria in that column that must be met for the indicated Health Care category to be approved. General heading includes: Citizenship, Residency, Social Security Enumeration and TPL Assignment. (Relationship = Living with a Specified Relative) (Health Care Mom = Mother eligible for Health Care coverage at child's birth) *An OCSE referral is not required for a child to receive coverage, but a parent or caretaker relative who receives Health Care and is not pregnant must comply with OCSE to maintain coverage.