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Medicaid Unit only 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. 853S 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 SLIMB. 870 N/A Processed by Medicaid Unit only Special Needs: TWWIIA. Eligible for Medicaid.

870A N/A Processed by Medicaid Unit only Special Needs: TWWIIA customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1. 870Q N/A Processed by Medicaid Unit only Special Needs: TWWIIA customer who is 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. 870S N/A Processed by Medicaid Unit only Special Needs: TWWIIA customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB. 873 N/A Processed by Medicaid Unit only Special Needs: MRDD. Eligible for Medicaid. 873A N/A Processed by Medicaid Unit only Special Needs: MRDD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a QI-1. 873Q N/A Processed by Medicaid Unit only Special Needs: MRDD customer who is 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. 873S N/A Processed by Medicaid Unit only Special Needs: MRDD customer who is dually eligible for Title XVIII (Medicare) and Medicaid; Part B premium paid because customer is a SLIMB. 880 N/A Processed by Medicaid Unit only Special Needs: 1115. Eligible for Medicaid.