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BEM 101 4 of 15 MA DESK AIDS BPB 2017-008 4-1-2017

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

EXHIBIT IV - CODES

Name

BEM Program Group Type BEM Program Code Scope Coverage Code Eligibility Status Code BEM 150 Recipients A/B/E Recipients A/B/E Transferred to M/O/P MA While Appealing SSI Termination LOCAL OFFICE M, O AND P OPEN- INGS” 150 SSI TSO TSI TSI A,B,E M,O,P M,O,P M,O,P 1F 1F 1F 1F 4 4 4 4 503 Individuals 155 503 M, O, P See EXHIBIT II, SSI- Related MA coding Early Widow(er)s 157 EW O,P See EXHIBIT II, SSI- Related MA coding Disabled Adult Child 158 DAC O,P See EXHIBIT II, SSI- Related MA coding AD-Care 163 AD M, P See EXHIBIT II, SSI- Related MA coding Extended Care 164 EC M,O,P See EXHIBIT II, SSI- Related MA coding Medicare Savings Programs (MSP) 165 QMB SLMB ALMB1 See EXHIBIT II, SSI-Related MA coding Group 2 Aged, Blind and Disabled 166 G2S M,O,P See EXHIBIT II, SSI- Related MA coding Qualified Disabled Working Individual (QDWI) 169 QDWI P 1Q 4 Home Care Child 170 HCC P 1F, 1E1 4 Children’s Waiver 171 CHW P 1F, 1E1 4 SED Waiver 172

P 1F, 1E 4 Breast and Cervical Cancer Prevention and Treatment Program 173 BCCP O 1F, 1E1 4 Refugee Assistance Program - Medical (Refugee Assistance, not Medicaid) 630 RAPM I 202, 1F, 2F 4, 3, 73