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COMAR 10.09.24.03

301 State of Maryland Medical Assistance Manual Revised July 2012

300.1 Introduction-Coverage Groups A coverage group is a group of people who meet specific criteria to receive Medical Assistance (also known as Medicaid or MA) or other benefits through Maryland‟s Medical Care Programs. Sometimes the only difference between coverage groups is a single criterion.

For example, children under the age of one are in one group, while those between one and six years of age are in another. Families whose income is within the medically needy income limit are in one group and those with income exceeding the limit (spend-downs) are in another. Consequently, there are many different coverage group codes to describe how recipients qualify for benefits. How many coverage group codes? There are 68 coverage group codes in the Maintenance Management Information System (MMIS-II). Each coverage group is identified by a code; one letter designating the “track,” followed by two numbers (e.g., F01). Some coverage group codes are assigned to recipients by a database program; Client Automated Resource and Eligibility System (CARES), as part of an eligibility determination that is used by Department of Health and Mental Hygiene (DHMH) and Department of Human Resources (DHR). Other codes originate within DHMH in order to identify recipients enrolled in programs that are not included in CARES. Generally, Case Manager (CM) does not need to know all 68 coverage groups but should be familiar with the tracks 300.2 Medicaid Categorically Needy (CN) Coverage Definition: The federally matched Medicaid (Title XIX) and CHIP (Title XXI) programs provide the broadest scope of medical coverage. Persons may be eligible for Categorically Needy (CN) only or may also be eligible for cash benefits under the Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF) programs. CN includes full scope coverage for Pregnant Women (PW), children, the aged, blind, and persons with disabilities.

Coverage Group: The following persons are eligible without having to file a separate application and are