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1 © 2021 Gainwell Technologies. All rights reserved. Job Aid Member Coverage Descriptions This Job Aid provides the full description of a member’s coverage and coverage level.

Coverage Coverage Description Coverage Level 001 - Supplemental Security Income (SSI) Individual SSI Cash Assistance program for low-income aged/blind/disabled individuals. Includes those receiving cash payments & those "deemed" to be cash recipients. Aged, blind and disabled individuals. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 002 - SSI Retro Eligibility Retroactive Medicaid for SSI applicants for up to 3-months prior to the application for SSI. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 003 - IV-E Foster Care/ Adoption Assistance Related IV-E Foster Care/Adoption Assistance/Refugee - CPS certified for benefits because individuals either: Receive cash assistance under Title IV-E (federal funds for maintenance payments). IV-E eligibility has low - income criteria; but resource limit for child = $10,000. - Children to Age 18 Or children for whom an adoption assistance agreement under IV-E is in effect. Children to Age 18 or age 21 at CPS discretion. Or Adult refugees certified as eligible for refugee medical assistance under a grant held by Dept of Child Protective Services (CPS). Eligibility for medical assistance is time-limited under the grant. A refugee beneficiary has coverage for up to 8 months under the grant. CPS must reimburse DOM 100% of Medicaid expenditures from the grant. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits 005 - SSI Only - Institution Individuals in institutions receiving SSI. Aged, Blind, Disabled Individuals. Individuals in long term care must pay toward the cost of care. The amount of the recipient's liability is referred to as Medicaid Income, which is total income less allowable deductions. Individuals with income over the limit can qualify under the terms of an Income Trust which obligates all of their income toward the cost of care and/or to Medicaid. If income exceeds the private pay rate for the facility in which the individual resides, the individual cannot qualify for Medicaid. This beneficiary has Full Medicaid Benefits Coverage. Full Medicaid Benefits