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APPENDIX D2 - ACTIVE MEDICAID PROGRAM CODES

Program Code ACEDS Recertification Period Processing Notes Full Definition 010A 12 mos. Aged person non-eligible for Medicaid but meeting requirements of Qualified Individual (QI- 1) program. Medicaid pays the full Medicare Part B Premiums. 010Q 12 mos. Aged person non-eligible for Medicaid but meeting eligibility requirements of Qualified Medicare Beneficiary (QMB) program and/or Special Low-Income Medicare Beneficiary (SLMB) program. Medicaid pays the full Medicare Part B Premiums. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period. 010S 12 mos. Aged person non-eligible for Medicaid but meeting eligibility requirements of Special Low- Income Medicare Beneficiary (SLIMB) program. Medicaid pays the full Medicare Part B Premiums. 050A 12 mos. Disabled person non-eligible for Medicaid but meeting requirements of Qualified Individual (QI- 1) program. Medicaid pays the full Medicare Part B Premiums. 050Q 12 mos. Disabled person non-eligible for Medicaid but meeting eligibility requirements of Qualified Medicare Beneficiary (QMB) program and/or Special Low-Income Medicare Beneficiary (SLMB) program. Medicaid pays the full Medicare Part B Premiums. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period. 050S 12 mos. Disabled person non-eligible for Medicaid but meeting eligibility requirements of Special Low- Income Medicare Beneficiary (SLIMB) program. Medicaid pays the full Medicare Part B Premiums.

110 N/A (categorically eligible) Aged person and receiving SSI and/or State Supplement. Eligible for Title XIX (Medicaid) reimbursement. 110Q N/A (categorically eligible) Aged person and receiving SSI and/or State Supplement and is also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare)