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retroactive period. 757 N/A Processed by Medicaid Unit only Special Needs: BCCEDTP. Eligible for Medicaid. 757A N/A Processed by Medicaid Unit only Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a QI-1. 757Q N/A Processed by Medicaid Unit only Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a QMB and/or SLMB. Medicaid pays for the 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. 757S N/A Processed by Medicaid Unit only Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a SLIMB. 760 12 mos. Non-AFDC/TANF related child eligible because countable income is below 185% of the Federal Poverty Level Eligible for Title XIX (Medicaid) reimbursement. 762 12 mos. Processed by Medicaid Unit only Subsidized adopted child. Eligible for Title XIX (Medicaid) reimbursement. 763 12 mos. Repatriate child. Eligible for Title XIX (Medicaid) reimbursement.

766 12 mos. Unaccompanied minor under refugee status. Eligible for Title XIX (Medicaid) reimbursement. 774 12 mos. Childless Adult with countable income under 133% of Federal Poverty Scale. Eligible for Title XIX reimbursement. 775 12 mos. Childless Adult with countable income between 133% and 200% of Federal Poverty Level. Eligible for Title XIX reimbursement. 776 Adult under political asylum or refugee status. Eligible for Title XIX (Medicaid) reimbursement. 780 Varies Processed by Multi-National Unit only Non-qualified alien eligible for coverage for emergency medical services. Persons must otherwise be eligible for Medicaid. Persons may qualify for emergency coverage via the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement. 820 12 mos. Medical Expansion for children under 19 who