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Medicaid Coverage Groups Chart. Institutional and Non institutional programs.

Revised July 2, 2009

Purpose: This chart is used as a cheat sheet for medical coverage groups used in the ACES system.

NOTE: Scope Terms: CN-Categorically Needy MN-Medically Needy MSP-Medicare Savings Program AEM-Alien Emergent Medical MCS-Medical Care Services-STATE FUNDED, non federally matched.

SSI and SSI related. Aged/Blind/Disabled (ABD) Category Category ACES Description  Scope Aged/Blind/Disabled (ABD) (ABD) SSI & State Supplement  S01  SSI recipients and 1619B eligibles  CN (ABD) SSI related-CN  S02  ABD Categorically Needy  CN (ABD) Medicare Programs  S03  QMB  Medicare Savings Program (MSP)  Medicare premium and medicare co payments  MSP (ABD) Medicare Programs  S04  QDWI Medicare Savings Program   MSP (ABD) Medicare Programs  S05  SLMB Medicare Savings Program. Medicare Premium only  MSP (ABD) Medicare Programs  S06  QI-1 (ESLMB) Medicare Savings Program  MSP (ABD) AEM-Emergency Medical  S07  Undocumented Alien, Emergency related services only  AEM (ABD) SSI related MN  S95  Medically Needy no Spenddown  MN (ABD) SSI related MN Spenddown  S99  Medically Needy with Spenddown  MN ABD-Living in an alternate living facility (ALF) 388-513-1305  G03  Non institutional in an ALF CN-P income under the SIL  and under state rate x 31 days + $38.84  CN ABD-Living in an alternate living facility (ALF) 388-513-1305  G95  Medically needy non institutional in ALF-no spenddown  MN ABD-Living in an alternate living facility (ALF) 388-513-1305  G99  Medically needy non institutional in ALF-with spenddown  MN ABD Healthcare for Workers with Disabilities (HWD )  S08  CN-P premium based program.  Substantial Gainful Activity (SGA) not a factor in disability determination  CN  ABD-Institutional & Waivers  ACES  SSI related Institutional Programs   ABD-HCBS Waivers (HCS and DDD) and Hospice  C01  Categorically Needy DDD/HCS Waivers or Hospice.  Income under the SIL  CN ABD-Hospice in a nursing home or hospice care center-MN  C95  Medically Needy Hospice in a medical institution no spenddown  MN ABD-Hospice in a nursing home or hospice care center-MN    C99  Medically Needy Hospice in a medical institutional- with spenddown  MN ABD-Non Citizen Hospice  C04  Must be pre-approved by HRSA medical consultant. Emergency related services only  AEM ABD-Residing in a medical institution 30 days or more  L01  SSI recipient.  Categorically Needy  CN ABD-Residing in a medical institution 30 days or more  L02  SSI related. Categorically Needy.  Income at or below the SIL  CN ABD-Residing in a medical institution 30 days or more -  L04 Undocumented alien/non citizen LTC must be pre-approved by HRSA medical consultant.  Emergency related services only  AEM  ABD-Residing in a medical institution 30 days or more-MN  L95  Medically Needy-No Spenddown.  Income over the SIL, Income under the state rate  MN  ABD-Residing in a medical institution 30 days or more-MN  spenddown  L99  Medically Needy-With Spenddown. Income over the SIL.  Income over the state rate but under the private rate.  Locks into state NF rate  MN

NOTE: ABD-Institutional is also called the "300% Group".  The difference between CN and MN is the Medicaid Special Income Level (SIL) which is 300% of the federal benefit rate (FBR ).  The FBR is also known as the SSI standard.  Institutional programs are unique in that there is initial eligibility and post eligibility.  Post eligibility is the calculation that determines what the client must pay toward their cost of care.  This is also called participation. Institutional programs are used for those residing or projected to reside in a medical institution 30 days or more and for Home & Community Based Waiver programs authorized by DDD and HCS. Institutional medical programs are under the L, C and K track.  L and C track are ABD related and K track is institutional children and families based on TANF related income and resource eligibility. For more information on institutional medical programs see Overview of LTC. Long Term Care table of contents.

NOTE: Section below is under construction.

General Assistance and ADATSA  Category  ACES  Description  Scope  General Assistance-Unemployable (GA-U) State funded medical  G01  GA-U  MCS  General Assistance-presumptive disabled, disabled, aged(GA-X, GA-D, GA-A) GA state cash with federally matched CN-P Medicaid  G02  GA-X, GA-D, GA-A  CN  ADATSA State Program Drug & Alcohol TX program-State Funded  W01    MCS  ADATSA Medical Care-State Funded  W02    MCS  ADATSA DETOX Medical-State Funded  W03    MCS

Family/Children Related Institutional  Category  ACES  Description  Scope  TANF related income/resource rules  KO1  CN Family/child in medical institution  CN    K03 Undocumented alien family in medical institution. Emergency related services only.   AEM    K95  Family LTC MN no spenddown in medical institution  MN    K99  Family LTC MN with spenddown in medical institution  MN

Family/Children Related non institutional  Category  ACES  Description  Scope  Family and children related Medical programs F01  TANF cash and Medical  CN   F02  Transitional Medical  CN   F03  Post TANF Child/Spousal Support  CN   F04  TANF related  CN   F05  Newborn  CN   F06  Categorically Needy Medical Children-Apple Kids  CN   F07  Children's Health Insurance Program (CHIP).  Note this is not Medicaid funded.   CN   F09  Undocumented alien-Emergency related Service Only  AEM   F10  Interim Categorically Needy  CN   F95  Medically Needy no spenddown  MN   F99  Medically Needy with spenddown  MN

DCFS/JRA Medical-Foster Care  Category  ACES  Description  Scope  Foster Care  D01  SSI recipient FC/AS/JRA  CN  Foster Care  D02  FC/AS/JRA  CN Foster Care Medical is handled by a special unit at HRSA/Childrens Medical CSO 076

Refugee  Category  ACES  Description  Scope  Refugee cash and medical  R01  Cash & Medical  CN  Transitional 4 month extension  R02  4 month Medical extension  CN  Refugee Medical only  R03  Medical only  CN

Mental Health-Institutional, Breast & Cervical Cancer Program, Take Charge, Psychiatric inpatient  Category  ACES  Description  Scope  Mental Health Institutional  I01  Inpatient Psychiatric (Mental Health)  CN  Breast & Cervical Cancer Program  S30  Breast & Cervical Cancer-Health Department approval.  CN  Take Charge  P06  Family Planning  Family Planning Only  Psychiatric Inpatient-State Funded  M99  Psychiatric Indigent Inpatient spenddown Mental Health Approval only  MCS

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Modification Date: July 2, 2009

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