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Appendix J (09/23) 2 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 Waivers TEFRA ● ● ● ● ● ● * Appropriateness of Care; Cost Effectiveness Autism ● ● ● ● ● ● * Appropriateness of Care; Cost Effectiveness Workers with Disabilities ● ● ● ● Must Be Working; Unearned income under SSI/SPA Miscellaneous Aged Individual-EC & SD ● ● ● ● ● AFDC-EC & SD ● ● ● ● ● ● Blind Individual-EC & SD ● ● ● ● Disabled Individual-EC & SD ● ● ● ● ● ● Under 18 Years of Age-SD ● ● ● ● ● * Pregnant Woman-EC ● ● ● * Must Be Pregnant Pregnant Woman-SD ● ● ● * AFDC-UP-EC & SD ● ● ● ● ● ● Refugee Resettlement-EC & SD ● ● ● * Foster Care-EC & SD ● ● ● ● * Foster Care (Non-IVE or IVE) ● ● ● ● * SSI Medicaid Must have been a SSI Recipient Pickle (COLA) ● ● ● * Disabled Adult Child (DAC) ● ● ● ● ● * Widows, Widowers with a Disability & Divorced Surviving Spouse with a Disability (OBRA 90) ● ● ● ● ● * Not Medicare Eligible A green dot signifies that there is an eligibility criterion 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.