ADDENDUM - 2
APA Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes
Medicaid Subtype |
Description |
AS |
Waivered Assisted Living |
BB |
Individual lost SSI /APA eligibility from 1977 SSA COLA "Pickle Person" |
BC |
Breast and Cervical Cancer (Ladies First) |
BE |
Disability exams (blindness), with or without need for HCB Waiver Determination. Non-standard coupon. |
DC |
Under 18, Receiving SSI |
DE |
Applicant who requires an AD -2, and, if needed, an HCB Waiver Determination. |
DK |
Disabled Kid (TEFRA ) |
DW |
Working Disabled Medicaid Buy-In |
GF |
Individuals eligible for State APA cash program(s) in December 1973 |
IL |
Emergency Alien (AD, AB, and OA) – legal alien or ineligible non-immigrant |
IN |
Long Term Care (Nursing Home or HCB Waiver) |
IP |
Residential Psychiatric Treatment Center Waiver |
Nursing Home (eligible for SSI or APA if not institutionalized) |
|
NS |
Ineligible for SSI /APA because of requirements which do not apply to Medicaid (use for SSI eligible individuals who have not applied for SSI ) |
PM |
Section 1619(b) eligible individuals. See Manual Section 530-E ;or |
Disabled Adult Children; or |
|
Disabled Widowers who have lost SSI or APA due solely to receipt of title II benefits |
|
QD |
Qualified Disabled and Working Individuals (QDWI ) |
QM |
Qualified Medicare Beneficiaries (QMB ) |
RC |
Eligible for but refusing APA cash payments or has countable income above the APA need/payment standard but below the Expanded Refused Cash Income Limits outlined in ADLTC MS 530(C) |
SA |
|
SI |
Receiving SSI |
SL |
Specified Low Income Medicare Beneficiary. (SLMB ) |
SS |
Individuals eligible for SSI or state supplemental payments except for the 20% Social Security Benefit increase (OASDII ) in 1972. |
ST |
Not receiving SSI |
UL |
Emergency Alien (AD, AB, or OA) – undocumented illegal alien only |
WD |
Waiver applicant who does not require a disability determination, but does need a waiver determination. Eligibility is for the cost of a Waiver Agency's assessment for Waiver eligibility. Non-standard coupon. |
Incarceration Medicaid Subtype |
Description |
AI |
APA Related (AD, AB & OA) |
BI |
Breast and Cervical Cancer |
II |
Emergency Alien (AD, AB & OA) – legal alien or ineligible non-immigrant |
IU |
Emergency Alien (AD, AB, or OA) – undocumented illegal alien only |
KI |
Pregnant Woman |
The following Medicaid eligibility codes are specific to ADLTC Medicaid unless here is a "*" in the description.
Medicaid Eligibility Code |
Description |
11 |
Pregnant Woman * |
19 |
Waiver Determination Only |
20 |
No other eligibility codes apply * |
24 |
LTC (300%) Institutionalized |
25 |
Disability/Blind/Waiver Determination |
30 |
Adults with Physical and Developmental Disabilities Waiver – Special LTC |
31 |
Adults with Physical and Developmental Disabilities Waiver * |
34 |
Adults with Physical and Developmental Disabilities – APA/QMB eligible |
40 |
Alaskans Living Independently Waiver – Special LTC |
41 |
Alaskans Living Independently Waiver * |
44 |
Alaskans Living Independently Waiver – APA/QMB eligible |
53 |
Ineligible Alien Emergency coverage (used for everyone except pregnant women) * |
54 |
SSI disabled child |
66 |
Medicare Savings Program – QDWI only |
67 |
Medicare Savings Program – QMB only |
68 |
Medicare Savings Program – SLMB only |
69 |
Medicare Savings Program – Dual Medicaid/QMB |
70 |
Intellectual and Developmental Disabilities Waiver – Special LTC |
71 |
Intellectual and Developmental Disability Waiver * |
74 |
Intellectual and Developmental Disabilities Waiver – Dual Medicaid/QMB |
78 |
Medicare Savings Program – SLMB Plus only |
80 |
Complex Medical Condition Waiver – Special LTC |
81 |
Complex Medical Condition Waiver * |
91 |
Individualized Supports Waiver – Special LTC |
92 |
Individualized Supports Waiver * |
93 |
Individualized Supports Waiver – Pregnant* |
94 |
Individualized Supports Waiver – Dual Medicaid/QMB |
Waiver Codes |
Description |
MC |
Complex Medical Condition |
MD |
Intellectual and Developmental Disabilities |
DA |
Adults with Physical and Developmental Disabilities |
AG |
Alaskans Living Independently |
IS |
Individualized Supports |
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