ADDENDUM 2 APA Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes

ADLTC - Alaska Aged, Disabled and Long Term Care Medicaid Manual

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ADDENDUM - 2

APAAdult Public Assistance Related Medicaid Subtypes, Eligibility Codes, and Waiver Codes

Medicaid Subtype	Description
AS	Waivered Assisted Living
BB	Individual lost SSISupplemental Security Income /APAAdult Public Assistance eligibility from 1977 SSASocial Security Administration COLACost of Living Allowance "Pickle Person"
BC	Breast and Cervical Cancer (Ladies First)
BE	Disability exams (blindness), with or without need for HCBHome and Community-Based Waiver Determination. Non-standard coupon.
DC	Under 18, Receiving SSISupplemental Security Income
DE	Applicant who requires an ADAid to the Disabled-2, and, if needed, an HCBHome and Community-Based Waiver Determination.
DK	Disabled Kid (TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248)
DW	Working Disabled Medicaid Buy-In
GF	Individuals eligible for State APAAdult Public Assistance 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 HCBHome and Community-Based Waiver)
NHNursing Home	Nursing Home (eligible for SSISupplemental Security Income or APAAdult Public Assistance if not institutionalized)
NS	Ineligible for SSISupplemental Security Income /APAAdult Public Assistance because of requirements which do not apply to Medicaid (use for SSISupplemental Security Income eligible individuals who have not applied for SSISupplemental Security Income )
PM	Section 1619(b) eligible individuals. See Manual Section 530-E ;or
	Disabled Adult Children; or
	Disabled Widowers who have lost SSISupplemental Security Income or APAAdult Public Assistance due solely to receipt of title II benefits
QD	Qualified Disabled and Working Individuals (QDWIQualified Disabled and Working Individuals)
QM	Qualified Medicare Beneficiaries (QMBQualified Medicare Beneficiaries)
RC	Eligible for but refusing APAAdult Public Assistance 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	Ineligible for SSISupplemental Security Income /APAAdult Public Assistance because of alien sponsor deeming
SI	Receiving SSISupplemental Security Income
SL	Specified Low Income Medicare Beneficiary. (SLMBSpecified Low Income Medicare Beneficiaries)
SS	Individuals eligible for SSISupplemental Security Income or state supplemental payments except for the 20% Social Security Benefit increase (OASDIOld Age, Survivors, and Disability Insurance (Social Security)I ) in 1972.
ST	Not receiving SSISupplemental Security Income
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 – Dual Medicaid/QMB
40	Alaskans Living Independently Waiver – Special LTC
41	Alaskans Living Independently Waiver *
44	Alaskans Living Independently Waiver – Dual Medicaid/QMB
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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