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APPENDIX D1 - MEDICAID PROGRAM CODES

The following table explains the various Medicaid Program Codes used in ACEDS. The 'First Digit' identifies the program and/or income level. Digit Program/Scale Definition 000 QM Eligible for Medicare Buy-in Only (applies to QMB's, SLMB's, QI's, and QDWI's). 100 SSI OR TANF Eligible for Title XIX reimbursement. Individual receives SSI or TANF and, therefore, is categorically eligible for Medicaid. 300 Medically Needy Eligible for Title XIX reimbursement. Group passed at the Medically Needy Income Level and medically needy resource test. 400 Special Programs Not eligible for Title XIX reimbursement. Individual eligible for Immigrant Children’s Program or other locally-funded program. 500 Spend-down Eligible due to meeting Spend-Down (used by Spend-Down Unit ONLY). 600 Not Eligible Not eligible or conditionally eligible (eligible if the group meets the spend-down liability.) 700 Poverty Eligible for Title XIX. Child/pregnant woman who passed under various poverty scales or an elderly/disabled person who has income below 100 percent of poverty line. 800 D.C. Healthy Families Eligible for Title XIX reimbursement. Child or caretaker with income below 200 percent of the poverty level. Individual ineligible under other AR categories. 900 Categorically Needy Eligible for Title XIX reimbursement. AR group eligible because income was below TANF payment level and resources were below $1,000 but group does not receive TANF. Passed at 'categorically needy' level

The 'Second Digit' identifies characteristics about the person.

Digit Definition 010 Person is 65 years old or older 020 Child under 21 030 AR or AX adult 040 Blind person 050 Person is disabled and under 65 060 Child under 21 in foster care or ward of the city 070 Adult who is not 65, disabled, blind, or deceased and is not a caretaker of a child 090 Deceased Person