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Appendix D1 - Medicaid Program Codes

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

910 R

----S

Special Low Income Medicare Beneficiary (SLIMB)

050 S

----W

Presumptive Eligibility

730 W