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have health insurance. Eligible for Title XIX (Medicaid) reimbursement. 820C 12 mos. Medical Expansion for uninsured children under 19 (SCHIP). Eligible for Title XXI (Medicaid/SCHIP) reimbursement. 830 12 mos. Medical expansion for parents of eligible children. Eligible for Title XIX (Medicaid) reimbursement.

830A 12 mos. Medical expansion for parents of eligible children. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a QI-1. 830Q 12 mos. Medical expansion for parents of eligible children. Part B premium paid because customer is a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid.) Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.

830S 12 mos. Medical expansion for parents of eligible children. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a SLIMB. 850 N/A Processed by Medicaid Unit only Special Needs: H2O. Eligible for Medicaid. 850A N/A Processed by Medicaid Unit only Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1. 850Q N/A Processed by Medicaid Unit only Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QMB and/or SLMB. Note: effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period. 850S N/A Processed by Medicaid Unit only Special Needs: H2O. Dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB. 853 N/A Processed by Medicaid Unit only Special Needs: EPD. Eligible for Medicaid. 853A N/A Processed by Medicaid Unit only Special Needs: EPD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1. 853Q N/A Processed by Special Needs: EPD customer who is dually