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83 BCCT – PE 6 77 XXI Adults 0-125% Poverty, NCPR (INACTIVE)

84 BCCT 6 78 Adults – Parents Fair Share, (INACTIVE)

85 TWHA – Premium 10 79 Adults – 0-300% Poverty, Custodial Parent (INACTIVE)

86 TWHA – Non-Premium 10 80 EWHS 1 8 State Only 88 Voluntary Placement Agreements 10 82 MO Rx 1 9 State Only E2 Adult Expansion Group (AEG) 13 87 PE for Children 6 Title XIX

89 UWHS 1 8 State Only

90 NOT CURRENTLY USED

91 GTBH – Tier 1 20 Title XIX

93 GTBH – Tier 3 20 Title XIX

95 SMHB – Income between 201-305% FPL 5 Title XXI

96 SMHB – Ineligible non-citizen with income 0-305% FPL 5 Title XXI

97 SMHB Newborn 12 Title XXI

98 SMHB Preg 60 5 Title XXI

99 NOT CURRENTLY USED

0F Foster Care Title IV-E 3 State Only

4M CHIP 4M-Non-Premium Ages 1 through 5 148%-150% FPL Ages 6 through 18 110%-150% FPL 7 Title XXI

5A Adoption/Guardianship Subsidy Title IV-E 3 State Only

6S SMHB Newborn of Ineligible Immigrant With Income at/below 196% FPL 8 Title XXI

9S SMHB Newborn of Ineligible Immigrant With Income 196%-300% FPL 12 Title XXI MAGI – Appendix H (3/2023)