|
Program Code |
ACEDS Recert Period |
Processing Notes |
Full Definition |
|
460
|
12 mos.
|
|
Child under the age of 21 who is eligible for the DC Healthcare Alliance. |
|
470
|
12 mos.
|
|
Adult who is eligible for the DC Healthcare Alliance.
|
518
|
6 mos. |
Processed by Spend-Down unit only |
Aged person who acquires eligibility by the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement.
|
518A
|
6 mos. |
Processed by Spend-Down unit only |
Aged person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a QI-1.
|
|
518Q
|
6 mos. for SR/ 12 mos. for QM
|
Processed by Spend-Down unit only |
Aged person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) and meets requirements of a QMB and/or SLMB. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 518S |
6 mos. |
Processed by Spend-Down unit only
|
Aged person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX as a SLIMB. |
528
|
6 mos. |
Processed by Spend-Down unit only |
Child under 21 meeting AFDC/TANF definition who acquires eligibility by the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement.
|
538
|
6 mos. |
Processed by Spend-Down unit only |
Adult meeting AFDC/TANF definition who acquires eligibility by the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement.
|
| 548 |
6 mos.
|
Processed by Spend-Down unit only |
Blind person who acquires eligibility by the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement. |
|
548Q
|
6 mos. for SR/ 12 mos. for QM
|
Processed by Spend-Down unit only
|
Blind person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) and meets requirements of a QMB and/or SLMB. Medicaid pays the full Medicare Part B premiums. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
558
|
6 mos. |
Processed by Spend-Down unit only |
Disabled person who acquires eligibility by the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement. |
558A
|
6 mos. |
Processed by Spend-Down unit only |
Disabled person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid); Part B premium paid because customer is a QI-1.
|
|
558Q
|
6 mos. for SR/ 12 mos. for QM
|
Processed by Spend-Down unit only
|
Disabled person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) and meets requirements of a QMB and/or SLMB. Medicaid pays the full Medicare Part B premiums. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
| 558S |
6 mos.
|
Processed by Spend-Down unit only |
Disabled person who acquires eligibility by the Spend-Down process. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) and meets requirements of a SLIMB.
|
| 606 |
|
|
Person whose resources exceed Medicaid resource limit (generally for SR, LT, and AZ Medicaid only.)
|
| 607 |
|
|
Insufficient information to determine eligibility or continued eligibility.
|
609
|
|
|
Not domiciled in the District of Columbia. |
618
|
|
|
Aged person. Must spend-down. |
| 628 |
|
|
AFDC/TANF related child whose countable income is above the Medicaid eligibility requirements. Must spend-down.
|
| 638 |
|
|
AFDC/TANF related adult whose countable income is above the Medicaid eligibility requirements. Must spend-down.
|
648
|
|
|
Blind person whose countable income is above the Medicaid eligibility requirements. Must spend-down. |
658
|
|
|
Disabled person whose countable income is above the Medicaid eligibility requirements. Must spend-down.
|
668
|
|
|
Non-AFDC/TANF related child whose countable income is above the Medicaid eligibility requirements. Must spend-down.
|
690
|
|
|
Deceased person who was eligible as categorically related or noncategorically related prior to the date of death.
|
710
|
12 mos. |
|
Aged person and eligible because countable income is below the Federal Poverty Level. Eligible for Title XIX (Medicaid) reimbursement.
|
710Q
|
12 mos. |
|
Aged person and eligible because countable income is below the Federal Poverty Level and is also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
720
|
12 mos. |
|
AFDC/TANF related child under 21 eligible because countable income is below: 1) 185% of the Federal Poverty Level for children under 1; 2) 133% of the FPL for children aged 1-5; 3) 100% of the FPL for children aged 6-18; or 4) 200% of the FPL for children aged 19 or 20. Eligible for Title XIX (Medicaid) reimbursement.
|
726
|
12 mos. |
|
Child under political asylum or refugee status. Eligible for Title XIX (Medicaid) reimbursement.
|
730
|
12 mos. |
|
AFDC/TANF related pregnant woman or mother eligible because countable income is below 185% of the Federal Poverty Level. Eligible for Title XIX (Medicaid) reimbursement.
|
730W
|
approx. 2 mos. (See Policy Manual) |
|
AFDC/TANF related pregnant woman presumed eligible for a limited period because countable income is below 185% of the Federal Poverty Level. Eligible for Title XIX (Medicaid) reimbursement.
|
| 740 |
12 mos.
|
|
Blind person eligible because countable income is below the Federal Poverty Level. Eligible for Title XIX (Medicaid) reimbursement.
|
740Q
|
12 mos. |
|
Blind person eligible because countable income is below the Federal Poverty Level and also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
750
|
12 mos. |
|
Disabled person eligible because countable income is below the Federal Poverty Level. Eligible for Title XIX (Medicaid) reimbursement.
|
| 750Q |
12 mos.
|
|
Disabled person eligible because countable income is below the Federal Poverty Level and also eligible as a QMB and/or SLMB. Dually eligible for Title XVIII (Medicare) and XIX (Medicaid) reimbursement. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
757
|
N/A |
Processed by Medicaid Unit only |
Special Needs: BCCEDTP. Eligible for Medicaid. |
| 757A |
N/A |
Processed by Medicaid Unit only |
Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a QI-1. |
757Q
|
N/A |
Processed by Medicaid Unit only |
Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a QMB and/or SLMB. Medicaid pays for the Medicare Part B premiums. Note: Effective July 1, 2005, SLMB eligibility is only for the month of application and any eligibility during the 90-day retroactive period.
|
757S
|
N/A |
Processed by Medicaid Unit only |
Special Needs: BCCEDTP customer who is dually eligible for Title XVIII (Medicare) and Medicaid and meets requirements of a SLIMB.
|
| 760 |
12 mos. |
|
Non-AFDC/TANF related child eligible because countable income is below 185% of the Federal Poverty Level Eligible for Title XIX (Medicaid) reimbursement.
|
| 762 |
12 mos.
|
Processed by Medicaid Unit only |
Subsidized adopted child. Eligible for Title XIX (Medicaid) reimbursement. |
763
|
12 mos. |
|
Repatriate child. Eligible for Title XIX (Medicaid) reimbursement. |
766
|
12 mos. |
|
Unaccompanied minor under refugee status. Eligible for Title XIX (Medicaid) reimbursement.
|
| 774 |
12 mos |
|
Childless Adult with countable income under 133% of Federal Poverty Scale. Eligible for Title XIX reimbursement.
|
| 775 |
12 mos. |
|
Childless Adult with countable income between 133% and 200% of Federal Poverty Level. Eligible for Title XIX reimbursement.
|
776
|
|
|
Adult under political asylum or refugee status. Eligible for Title XIX (Medicaid) reimbursement.
|
780
|
Varies |
Processed by Multi-National Unit only |
Non-qualified alien eligible for coverage for emergency medical services. Persons must otherwise be eligible for Medicaid. Persons may qualify for emergency coverage via the Spend-Down process. Eligible for Title XIX (Medicaid) reimbursement.
|
| 820 |
12 mos.
|
|
Medical Expansion for children under 19 who have health insurance. Eligible for Title XIX (Medicaid) reimbursement.
|
820C
|
12 mos. |
|
Medical Expansion for uninsured children under 19 (SCHIP). Eligible for Title XXI (Medicaid/SCHIP) reimbursement. |
830
|
12 mos. |
|
Medical expansion for parents of eligible children. Eligible for Title XIX (Medicaid) reimbursement.
|
