Page 14

the Medically Needy income and resource scales. ESA first determines eligibility under the AR/AX or SR programs and, if necessary, considers such persons under the Refugee- Related Medicaid program. Also, all persons receiving Refugee cash assistance are eligible for Refugee-Related Medicaid if they are not eligible for the AR/AX or SR programs. o Non-Qualified Immigrants: Immigrants ineligible for Medicaid due only to their immigration status are eligible for emergency Medicaid services. These services are described in Section 2.2.4: Benefit Provision in this Chapter.

Individuals who meet all non-financial Medicaid requirements and asset limits, if applicable, but whose income exceeds the Medicaid income eligibility limit may qualify for partial coverage of medical bills if they have unpaid medical bills. Such individuals are eligible through the 'spend down' Medicaid provisions (see Chapter 7: Spend-Down in Part VI).

ACEDS MA Program Types 2.2.2

Within the Automated Client Eligibility Determination System (ACEDS), there are six MA program types. These program types can be thought of as groupings of the eligibility criteria described in Section 2.2.1: MA Program Types in this Chapter. The following table shows how the eligibility criteria correspond to the MA program types.

MA Program Types Eligibility Criteria AR (This code was not changed when Aid to Families with Dependent Children (AFDC) was replaced by TANF.) • TANF Standard • Foster Care/Department Ward/Adoption Assistance Recipient • Medically Needy Families and Children • Poverty Level Families and Children • Transitional Medicaid AX • Children with Other Health Insurance • D.C. Healthy Families Expansion Group for Children (CHIP) • D.C. Healthy Families Expansion Group for Parents/Caretaker Relatives MA eligibility for non-elderly parents, caretakers, and children must be tested under AR criteria before being tested under AX criteria. If a child, parent, or caretaker relative is ineligible for MA under any AR criteria except Transitional Medicaid, the Department must then determine if they meet AX eligibility. SR • SSI Recipients • Aged/Disabled QM • QMB (Most QMBs are also eligible for Medicaid based on the Aged/Disabled category. Individuals eligible for Medicaid under the Aged/Disabled category and Medicare Buy-In are processed under the SR program type.) • SLIMB (Note that effective July 1, 2005, SLIMB eligibility applies only to the month of application and the three months prior to the month of application, since the QMB income limit has been increased to include these customers for the period beginning with the month following the month of application.)