The following table explains the various Medicaid Program Codes used in ACEDS.
The 'First Digit' identifies the program and/or income level.
Digit
Program/Scale
Definition
000
QM
Eligible for Medicare Buy-in Only (applies to QMB's, SLMB's, QI's, and QDWI's).
100
SSI OR TANF
Eligible for Title XIX reimbursement. Individual receives SSI or TANF and, therefore, is categorically eligible for Medicaid.
300
Medically Needy
Eligible for Title XIX reimbursement. Group passed at the Medically Needy Income Level and medically needy resource test.
400
Special Programs
Not eligible for Title XIX reimbursement. Individual eligible for Immigrant Children’s Program or other locally-funded program.
500
Spenddown
Eligible due to meeting Spend-Down (used by Spend-Down Unit ONLY).
600
Not Eligible
Not eligible or conditionally eligible (eligible if the group meets the spend-down liability.)
700
Poverty
Eligible for Title XIX. Child/pregnant woman who passed under various poverty scales or an elderly/disabled person who has income below 100 percent of poverty line.
800
D.C. Healthy Families
Eligible for Title XIX reimbursement. Child or caretaker with income below 200 percent of the poverty level. Individual ineligible under other AR categories.
900
Categorically Needy
Eligible for Title XIX reimbursement. AR group eligible because income was below TANF payment level and resources were below $1,000 but group does not receive TANF. Passed at 'categorically needy' level
The 'Second Digit' identifies characteristics about the person.
Digit
Definition
010
Person is 65 years old or older
020
Child under 21
030
AR or AX adult
040
Blind person
050
Person is disabled and under 65
060
Child under 21 in foster care or ward of the city
070
Adult who is not 65, disabled, blind, or deceased and is not a caretaker of a child
090
Deceased Person
The 'Third Digit' identifies additional information about the person. When none of these apply, the individual is coded with a '0' in the 3rd digit
Digit
Definition
001
Child is a ward
002
Child in non-medical D.C. Gov't institution (i.e. Oak Hill)
003
Person is in LTC
006
Not eligible due to excess resources
007
Not eligible due to failure to provide information
008
Not eligible due to excess income
009
Not eligible due to non-residence
The following suffixes trail the standard Medicaid codes and provide additional information.
Letter
Definition
Example
----A
Qualified Individual-1 (QI-1)
010 A
----B
Qualified Individual-2 (QI-2) [Retired]
050 B
----C
D.C. Healthy Families/CHIP child
820 C
----G
Extended/Transitional Medicaid
938 G
----H
Hurrican/Disaster Evacuee
930H
----P
Eligible because of the Pickle decree, not a QMB
910 P
----Q
Qualified Medicare Beneficiary (QMB)
710 Q
----R
Eligible because of the Pickle decree and Qualified Medicare Beneficiary
