Department of Alcohol and Drug Programs Drug Medi-Cal Program Aid Codes Master Chart August 4, 2010

Transcription

1 Department of Alcohol Drug Programs Drug Medi-Cal Program Aid Codes Master Chart August 4, 2010 Overview The following chart organizes Medi-Cal aid codes in groups based on the percent of federal financial participation (FFP) for which the aid codes are eligible: Refugee (100 Percent FFP) Social Security Act Title XXI (Enhanced FFP) Breast Cervical Cancer Treatment Program (BCCTP) Aid Codes (Enhanced FFP) Regular FFP Aid Codes, Social Security Act Title XIX State Funds Only (Zero FFP) Within these groups, the program/description column identifies aid codes that have restrictions on the services for which FFP is available. These aid codes are also identified by color coding (see footnotes). The Early Periodic Screening, Diagnosis, Treatment (EPSDT) column identifies aid codes that may include beneficiaries under age 21 who are eligible for exped Medi-Cal benefits under the EPSDT program. When selecting from multiple aid codes in the Medi-Cal Eligibility Determination System (MEDS), the Short Doyle/Medi-Cal (SD/MC) claiming system pays a claim using the first aid code with FFP in the following order: Primary, Special 1, 2, 3. If the claim is billed payable with aid codes 7X, 8P, 8R, 8T, 8X, 0M, 0N or 0P, the claim will be paid at the Enhanced FFP rate. If a service is not covered under the aid code, the services will not be reimbursed by SD/MC.

2 Hisrical FFP Rates Federal Fiscal Year Federal Fiscal Year Period Regular FFP Enhanced FFP* FFY 2011 Ocber 1, 2010 December 31, % 65.00% FFY 2010 Ocber 1, 2009 September 30, % 65.00% FFY 2009 Ocber 1, 2008 September 30, % 65.00% FFY 2008 Ocber 1, 2007 September 30, % 65.00% FFY 2007 Ocber 1, 2006 September 30, % 65.00% FFY 2006 Ocber 1, 2005 September 30, % 65.00% FFY 2005 Ocber 1, 2004 September 30, % 65.00% FFY 2004 July 1, 2004 September 30, % 65.00% FFY 2004 Ocber 1, 2003 June 30, % 65.00% FFY 2003 April 1, 2003 September 30, % 65.00% FFY 2003 Ocber 1, 2002 March 31, % 65.00% FFY 2002 Ocber 1, 2001 September 30, % 65.98% FFY 2001 Ocber 1, 2000 September 30, % 65.88% FFY 2000 Ocber 1, 1999 September 30, % 66.17% Special Indicars The following indicars, which appear in the aid code portion of the county ID number, help Medi-Cal identify the following: IE Ineligible: A person who is ineligible for Medi-Cal benefits. An IE person may only use medical expenses meet the share of cost (SOC) for other family members associated within the same case. Upon certification of the SOC, the IE individual is not eligible for Medi-Cal benefits in this case. An IE person may be eligible for Medi-Cal benefits in another case where the person is not identified as IE. RR Responsible Relative: An RR is allowed use medical expenses meet the SOC for other family members for whom he/she is responsible. Upon certification of the SOC, an RR individual is not eligible for Medi-Cal benefits in this Medi-Cal Budget Unit (MBU). The individual may be eligible for Medi-Cal benefits in another MBU where the person is not identified as an RR. Aid Codes Change Log New Previous Added Codes Inactive in MEDS Changed Codes Revision Date Revision Date E1, 0W, 2H, 5E 4P,4R, C1,C2,C3,C4,C5,C6, C7,C8,C9,D1,D2,D3, D4,D5,D6,D7,D8,D9 0M,0N,0P changed Enhanced from Regular FFP Page 2 of 13

3 Department of Alcohol Drug Programs Aid Codes Master Chart Refugee Aid Codes (100 Percent FFP) 0A Full Refugee Cash Assistance (FFP). Includes unaccompanied children. Covers all eligible refugees during their first eight months in the United States. Unaccompanied children are not subject the eighth-month limitation provision. This population is the same as aid code 01, except that they are exempt from grant reductions on behalf of the Assistance Payments Demonstration Project/California Work Pays Demonstration Project. 01 Full Refugee Cash Assistance (FFP). Includes unaccompanied children. Covers all eligible refugees during their first eight months in the United States. Unaccompanied children are not subject the eighth-month limitation provision. 02 Full Y/N Refugee Medical Assistance/Entrant Medical Assistance (FFP). Covers refugees entrants who need Medi-Cal who do not qualify for or want cash assistance. 08 Full Entrant Cash Assistance (ECA) (FFP). Provides ECA benefits Cuban/Haitian entrants, including unaccompanied children who are eligible, during their first eight months in the United States. (For entrants, the month begins with their date of parole.) Unaccompanied children are not subject the eighth-month limitation provision. Title XXI of the Social Security Act Aid Codes (Enhanced FFP) E1 Unverified citizens. Covers eligible unverified citizen children. One Month Medi-Cal Healthy Families Bridge. Only. Covers services only eligible children ages 0-19, who are unverified citizens 7X Full One-Month Healthy Families (HF) Bridge (FFP). Provides one additional calendar month of health care benefits with no Share of Cost, through the same health care delivery system, Medi-Cal-eligible children meeting the criteria of the HF Bridging Program. 8P Full 133 Percent Program. Child United States Citizen (with excess property), Permanent Resident Alien/ Permanent Residence Under Color of Law (PRUCOL) Alien (FFP). Provides full-scope Medi-Cal benefits children ages 1 up 6, beyond 6 years when inpatient status, which began before 6 th birthday, continues, family income is at or below 133 percent of the federal poverty level. 8R Full 100 Percent Program. Child (FFP) United States Citizen (with excess property), Lawful Permanent Resident/Persons residing in the United States under color of Law (PRUCOL)/Immigration Reform Control Act of 1986 (IRCA) Amnesty Alien [Aged, Blind or Disabled (ABD) or Under 18]. Provides full-scope benefits otherwise eligible children, ages 6 19, beyond 19 when inpatient status begins before the 19 th birthday, family income is at or below 100 percent of the federal poverty level. 8T 100 Percent Program. Child-Undocumented/nimmigrant Status/(IRCA Amnesty Alien [with excess property]). Covers emergency pregnancy-related services only otherwise eligible children ages 6 19, beyond 19 when inpatient status begins before the 19 th birthday, family income is at or below 100 percent of the federal poverty level. Aid Code Typeface Legend: Page 3 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

4 Department of Alcohol Drug Programs Aid Codes Master Chart Title XXI of the Social Security Act Aid Codes (Enhanced FFP) 8X Full Medically Indigent (MI) - Accelerated Enrollment (AE) - Child Health Development Protection (CHDP) Gateway for Healthy Families. Provides for the preenrollment of CHILDREN in the Medi-Cal program who are Screened as Probable Healthy Families Eligibles. Provides Temporary, full scope Medi-Cal benefits with no SOC. Breast Cervical Cancer Treatment Program (BCCTP) Aid Codes (Enhanced FFP) Title XIX of the Social Security Act 0M Full BCCTP-Accelerated Enrollment (AE). Provides AE for temporary full-scope, no SOC Medi-Cal for females under 65 years of age who are diagnosed with breast /or cervical cancer. Eligibility limited 2 months. 0N Full BCCTP-AE, Provides AE for temporary full-scope, no SOC Medi-Cal for females under 65 years of age who have been diagnosed with breast /or cervical cancer are without creditable insurance coverage. time limit. 0P Full BCCTP-Federal Provides full-scope, no SOC Medi-Cal for females under 65 years of age who have been diagnosed with breast /or cervical cancer are without creditable insurance coverage. Regular FFP Aid Codes 0W Full BCCTP Transitional Coverage. Covers recipients formerly in aid code 0P who no longer meet federal BCCTP requirements due reaching age 65, are no longer in need of treatment for breast /or cervical cancer, or have obtained creditable health coverage. Recipients in aid code 0W will continue receive transitional fullscope Medi-Cal services until the county completes an eligibility determination for other Medi-Cal programs. 03 Full Adoption Assistance Program (AAP) (FFP). A cash grant program facilitate the adoption of hard--place children who would require permanent foster care placement without such assistance. 04 Full Adoption Assistance Program/Aid for Adoption of Children (AAP/AAC). Covers cash grant children receiving Medi-Cal by virtue of eligibility AAP/AAC benefits. 1E Full Continued eligibility for the Aged (FFP). Covers former Supplemental Security Income (SSI) beneficiaries who are Aged (with exception of persons who are deceased or incarcerated in a correctional facility) until the county re-determines their eligibility. 1H Full Federal poverty level Aged (FPL-Aged) Provides full scope (no share of cost) Medi- Cal qualified aged individuals/couples. 1U Federal poverty level Aged ( FPL Aged) Provides emergency pregnancy-related benefits (no Share of Cost) qualified aged individuals/couples who do not have satisfacry immigration status 1X Full Multipurpose Senior Program Medi-Cal Qualified. Eligible due application of spousal impoverishment rules. Covers persons 65 years older who meet the Medi-Cal criteria for inpatient care in a nursing facility. 1Y Full Multipurpose Senior Program Medi-Cal Qualified. Eligible due application of spousal impoverishment rules. Covers persons 65 years older who meet the Medi-Cal criteria for inpatient care in a nursing facility. Aid Code Typeface Legend: Page 4 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

5 Department of Alcohol Drug Programs Aid Codes Master Chart 10 Full SSI/State Supplementary Payment (SSP) Aid the Aged (FFP). A cash assistance program administered by the Social Security Administration (SSA) which pays a cash grant needy persons 65 years of age or older. 13 Full Y/N Aid the Aged Long Term Care (LTC) (FFP). Covers persons 65 years of age or older who are medically needy in LTC status. 14 Full Aid the Aged Medically Needy (FFP). Covers persons 65 years of age or older who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. 16 Full Aid the Aged Pickle Eligibles (FFP). Covers persons 65 years of age or older who were eligible for receiving SSI/SSP Title II benefits concurrently in any month since April 1977 were subsequently discontinued from SSI/SSP but would be eligible receive SSI/SSP if their Title II cost-of-living increases were disregarded. These persons are eligible for Medi-Cal benefits as public assistance recipients in accordance with the provisions in the Lynch v. Rank lawsuit. 17 Full Aid the Aged Medically Needy, SOC (FFP). Covers persons 65 years of age or older who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. 18 Full Aid the Aged In Home Supportive (IHSS) (FFP). Covers aged IHSS cash recipients, 65 years of age or older, who are not eligible for SSI/SSP cash benefits. 2E Full Continued eligibility for the Blind (FFP). Covers former SSI beneficiaries who are Blind (with exception of persons who are deceased or incarcerated in a correctional facility) until the county re-determines their eligibility. 2H Full Blind Federal Poverty Level covers blind individuals in the FPL for the Blind Program. 20 Full SSI/SSP Aid the Blind (FFP). A cash assistance program administered by the SSA, which pays a cash grant needy blind persons of any age. 23 Full Y/N Aid the Blind LTC Status (FFP). Covers persons who meet the federal criteria for blindness, are medically needy, are in LTC status. 24 Full Aid the Blind Medically Needy (FFP). Covers persons who meet the federal criteria for blindness who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. 26 Full Aid the Blind Pickle Eligibles (FFP). Covers persons who meet the federal criteria for blindness are covered by the provisions of the Lynch v. Rank lawsuit (See aid code 16 for definition of Pickle eligibles). 27 Full Aid the Blind Medically Needy, SOC (FFP). Covers persons who meet the federal criteria for blindness who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. 28 Full Aid Blind IHSS (FFP). Covers persons who meet the federal definition of blindness are eligible for IHSS (See aid code 18 for definition of eligibility for IHSS). 3A Full SAFETY NET All other Families, CalWORKs Timed-Out, Child-Only Case. (FFP) Provides for continued cash Medi-Cal coverage of children whose parents have been discontinued from cash aid removed from assistance unit (AU) due reaching the CalWORKs 60 month time limit without meeting a time extender exception. 3C Full SAFETY NET Two Parent, CalWORKs Timed-Out, Child-Only Case. (FFP) Provides for continued cash Medi-Cal coverage of children whose parents have been discontinued from cash aid removed from AU due reaching the CalWORKs 60 month time limit without meeting a time extender exception. 3D Full t on cash aid, but cash-linked Medi-Cal eligible because the individual has been determined be eligible for CalWORKs. 3E Full CalWORKS Legal Immigrant Family Group (FFP). Provides aid families in which a child is deprived because of the absence, incapacity or death of either parent. Aid Code Typeface Legend: Page 5 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

6 Department of Alcohol Drug Programs Aid Codes Master Chart 3G Full Aid Families with Dependent Children (AFDC) - Family Group (FG) (State only non-ffp cash grant) (FFP for Medi-Cal eligibles). Provides aid families in which a child is deprived because of the absence, incapacity or death of either parent, who does not meet all federal requirements, but State rules require the individual(s) be aided. This population is the same as aid code 32, except that they are exempt from the AFDC grant reductions on behalf of the Assistance Payments Demonstration Project/California Work Pays Demonstration Project. 3H Full AFDC-FU (State only non-ffp cash grant) (FFP for Medi-Cal eligibles). Provides aid pregnant women (before their last trimester) who meet the federal definition of an unemployed parent but are not eligible because there are no other children in the home. This population is the same as aid code 33, except that they are exempt from the AFDC grant reductions on behalf of the Assistance Payments Demonstration Project/California Work Pays Demonstration Project 3L Full CalWORKS Legal Immigrant Family Group (FFP). Provides aid families in which a child is deprived because of the absence, incapacity or death of either parent. 3M Full CalWORKS Legal Immigrant Unemployed (FFP). Provides aid families in which a child is deprived because of the unemployment of a parent living in the home. 3N Full AFDC Mary Coverage Group Section 1931(b) (FFP). Section 1931 requires Medi-Cal be provided low-income families who meet the requirements of the AFDC State Plan in effect July 16, P Full AFDC-Unemployed Parent (FFP cash). Aid families in which a child is deprived because of the unemployment of a parent living in the home the unemployed parent meets all federal AFDC eligibility requirements. This population is the same as aid code 35, except that they are exempt from the AFDC grant reductions on behalf of the Assistance Payments Demonstration Project/California Work Pays Demonstration Project. 3R Full AFDC-FG (FFP) in which the child(ren) is deprived because of the absence, incapacity or death of either parent. This population is the same as aid code 30, except that they are exempt from the AFDC grant reductions on behalf of the Assistance Payments Demonstration Project/California Work Pays Demonstration Project. 3T Initial Transitional Medi-Cal (TMC) (FFP). Provides six months of emergency pregnancy-related initial TMC benefits (no SOC) for aliens who do not have satisfacry immigration status (SIS) have been discontinued from Section 1931(b) due increased earnings from employment. 3U Full CalWORKS Legal Immigrant Unemployed (FFP). Provides aid families in which a child is deprived because of the unemployment of a parent living in the home. 3V Section 1931(b) (FFP). Provides emergency pregnancy-related benefits (no SOC) for aliens without SIS who meet the income, resources deprivation requirements of the AFDC State Plan in effect July 16, Full AFDC-FG (FFP). Provides aid families with dependent children in a family group in which the child(ren) is deprived because of the absence, incapacity or death of either parent. 32 Full AFDC-FG (State only non-ffp cash grant) (FFP for Medi-Cal eligibles). Provides aid families in which a child is deprived because of the absence, incapacity, or death of either parent, who does not meet all federal requirements, but State rules require the individual(s) be aided. 33 Full AFDC-Unemployed Parent (State-only program non-ffp cash grant) (FFP for Medi- Cal eligibles). Provides aid pregnant women (before their last trimester) who meet the federal definition of an unemployed parent but are not eligible because there are no other children in the home. Aid Code Typeface Legend: Page 6 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

7 Department of Alcohol Drug Programs Aid Codes Master Chart 34 Full AFDC-Medically Needy (FFP). Covers families with deprivation of parental care or support who do not wish or are not eligible for a cash grant but are eligible for Medi- Cal only. 35 Full AFDC-U (FFP cash). Provides aid families in which a child is deprived because of unemployment of a parent living in the home the unemployed parent meets all federal AFDC eligibility requirements. 36 Full Aid Disabled Widow/ers (FFP). Covers persons who began receiving Title II SSA before age 60 who were eligible for receiving SSI/SSP Title II benefits concurrently were subsequently discontinued from SSI/SSP but would be eligible receive SSI/SSP if their Title II disabled widow/ers reduction facr subsequent Cost-Of-Living Adjustments (COLAs) were disregarded. 37 Full AFDC-Medically Needy (FFP). Covers families with deprivation of parental care or support who do not wish or are not eligible for a cash grant, but are eligible for Medi- Cal only. 38 Full Continuing Medi-Cal Eligibility (FFP). Edwards v. Kizer court order provides for uninterrupted, no SOC Medi-Cal benefits for families discontinued from AFDC until the family s eligibility or ineligibility for Medi-Cal only has been determined an appropriate tice of Action sent. 39 Full Initial Transitional Medi-Cal (TMC) Six Months Continuing Eligibility (FFP). Provides coverage certain clients subsequent AFDC cash grant discontinuance due increased earnings, increased hours of employment or loss of the $30 1/3 disregard. 4A Full Adoption Assistance Program (AAP). Program for AAP children for whom there is a state-only AAP agreement between any state other than California adoptive parent(s). 4F Full Kinship Guardianship Assistance Payment (Kin-GAP). Federal program for children in relative placement receiving cash assistance. 4G Full Kin-GAP. State-only program for children in relative placement receiving cash assistance. 4K Full Assistance (EA) Program (FFP). Covers juvenile probation cases placed in foster care. 4M Full FORMER FOSTER CARE CHILDREN. This program covers former foster care youth who were in foster care on their eighteenth birthday. Coverage extends until the 21st birthday provides full-scope, no-cost benefits. 40 Full AFDC-FC/n-Fed (State FC). Provides financial assistance for those children who are in need of substitute parenting who have been placed in foster care. 42 Full AFDC-FC/Fed (FFP). Provides financial assistance for those children who are in need of substitute parenting who have been placed in foster care Related Income Disregard Program-Pregnant (FFP), United States Citizen/Permanent Resident Alien/PRUCOL Alien. Provides family planning, pregnancy-related postpartum services for any age female if family income is at or below 200 percent of the federal poverty level. 45 Full Children Supported by Public Funds (FFP). Children whose needs are met in whole or in part by public funds other than AFDC-FC. 47 Full Income Disregard Program-Infant (FFP), United States Citizen, Permanent Resident Alien/PRUCOL Alien. Provides full Medi-Cal benefits infants up one year old continues beyond one year when inpatient status, which began before first birthday, continues family income is at or below 200 percent of the federal poverty level Related Income Disregard Program-Pregnant, Undocumented/nimmigrant Alien (but otherwise eligible). Provides family planning, pregnancy-related postpartum services for any age female if family income is at or below 200 percent of the federal poverty level. Routine prenatal care is non-ffp. Labor, delivery emergency prenatal care are FFP. Aid Code Typeface Legend: Page 7 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

8 Department of Alcohol Drug Programs Aid Codes Master Chart 5E Full Healthy Families the Medi-Cal Presumptive Eligibility (PE) program. Provides immediate, temporary, fee-for-service, full-scope Medi-Cal benefits certain children under the age of 19. 5F Y/N Omnibus Budget Reconciliation Act (OBRA) Aliens. Covers non-immigrant undocumented aliens who do not have proof of permanent resident alien, PRUCOL or amnesty alien status, but who are otherwise eligible for Medi-Cal. 5K Full Assistance (EA) Program (FFP). Covers child welfare cases placed in EA foster care. 5T Continuing TMC (FFP). Provides an additional six months of continuing emergency pregnancy-related TMC benefits (no SOC) qualifying aid code 3T recipients. 5W Four Month Continuing (FFP). Provides four months of emergency pregnancyrelated benefits (no SOC) for aliens without SIS who are no longer eligible for Section 1931(b) due the collection or increased collection of child/spousal support. 54 Full Four-Month Continuing Eligibility (FFP). Covers persons discontinued from AFDC due the increased collection of child/spousal support payments but eligible for Medi-Cal only Y/N This covers Undocumented Aliens in Long Term Care (LTC), but not PRUCOL aliens. LTC services are covered using state-only funds. pregnancy-related services are covered using state federal funds. Recipients remain in this aid code even if they leave LTC. OBRA Aliens. Covers nonimmigrant undocumented aliens who do not have proof of permanent resident alien, PRUCOL or amnesty alien status, but who are otherwise eligible for Medi-Cal. 59 Full Additional TMC Additional Six Months Continuing Eligibility (FFP). Covers persons discontinued from AFDC due the expiration of the $30 plus 1/3 disregard, increased earnings or hours of employment, but eligible for Medi-Cal only, may receive this extension of TMC. 6A Full Disabled Adult Child(ren) (DAC)/Blindness (FFP). 6C Full Disabled Adult Child(ren) (DAC)/Disabled (FFP). 6E Full Continued eligibility for the Disabled (FFP). Covers former SSI beneficiaries who are Disabled (with exception of persons who are deceased or incarcerated in a correctional facility) until the county re-determines their eligibility. 6G Full 250 Percent Program Working Disabled. Provides full-scope Medi-Cal benefits working disabled recipients who meet the requirements of the 250 Percent Program. 6H Full Federal Poverty Level Disabled (FPL Disabled). Provides full-scope Medi-Cal ( share of cost) qualified disabled individuals/couples Aid Code Typeface Legend: Page 8 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

9 Department of Alcohol Drug Programs Aid Codes Master Chart 6J Full SB 87 Pending Disability Program. Provides full scope (no share of cost) benefits recipients years of age, who have lost their non-disability linkage Medi-Cal are claiming disability. Medi-Cal coverage continues uninterrupted during the determination period. 6N Full Personal Responsibility Work Opportunity Reconciliation Act (PRWORA)/ Longer Disabled Recipients (FFP). Former SSI disabled recipients (adults children not in aid code 6P) who are appealing their cessation of SSI disability. 6P Full PRWORA/ Longer Disabled Children (FFP). Covers children under age 18 who lost SSI cash benefits on or after July 1, 1997, due PRWORA of 1996, which provides a stricter definition of disability for children. 6R Full SB 87 Pending Disability (SOC). Covers with an SOC those aged who have lost their non-disability linkage Medi-Cal are claiming disability. Medi-Cal coverage continues uninterrupted during the determination period. 6U Federal Poverty Level Disabled ( FPL-Disabled). Provides emergency pregnancy-related benefits (no share of cost) qualified disabled individuals/couples who do not have satisfacry immigration status 6V Full Aid the Disabled DDS Waiver (FFP). Covers persons who qualify for the Department of Developmental (DDS) Regional Waiver. 6W Full Aid the Disabled DDS Waiver SOC (FFP). Covers persons who qualify for the DDS Regional Waiver. 6X Full Aid the Disabled Model Waiver (FFP). Covers persons who qualify for the Model Waiver. 6Y Full Aid the Disabled Model Waiver SOC (FFP). Covers persons who qualify for the Model Waiver. 60 Full SSI/SSP Aid the Disabled (FFP). A cash assistance program administered by the SSA that pays a cash grant needy persons who meet the federal definition of disability. 63 Full Y/N Aid the Disabled LTC Status (FFP). Covers persons who meet the federal definition of disability who are medically needy in LTC status. 64 Full Aid the Disabled Medically Needy (FFP). Covers persons who meet the federal definition of disability do not wish or are not eligible for cash grant, but are eligible for Medi-Cal only. 66 Full Aid the Disabled Pickle Eligibles (FFP). Covers persons who meet the federal definition of disability are covered by the provisions of the Lynch v. Rank lawsuit. age limit for this aid code. 67 Full Aid the Disabled Medically Needy, SOC (FFP). (See aid code 64 for definition of Disabled Medically Needy). 68 Full Aid the Disabled IHSS (FFP). Covers persons who meet the federal definition of disability are eligible for IHSS. (See aid code 18 for definition of eligibility for IHSS). 69 Income Disregard Program. Infant (FFP) Undocumented/nimmigrant Alien (but otherwise eligible). Provides emergency services only for infants under 1 year of age beyond 1 year when inpatient status, which began before 1 st birthday, continues family income is at or below 200 percent of the federal poverty level. 7A Full 100 Percent Program. Child (FFP) United States Citizen, Lawful Permanent Resident/PRUCOL/(IRCA Amnesty Alien [ABD or Under 18]). Provides full benefits otherwise eligible children, ages 6 19 beyond 19 when inpatient status began before the 19 th birthday family income is at or below 100 percent of the federal poverty level. Aid Code Typeface Legend: Page 9 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

10 Department of Alcohol Drug Programs Aid Codes Master Chart 7C 100 Percent Program. Child Undocumented/nimmigrant Status/[IRCA Amnesty Alien (t ABD or Under 18)]. Covers emergency pregnancy related services otherwise eligible children, ages 6 19 beyond 19 when inpatient status begins before the 19 th birthday family income is at or below 100 percent of the federal poverty level. 7J Full Continuous Eligibility for Children (CEC) program. Provides full-scope benefits children up the 19 years of age who would otherwise lose their share of cost 7K Continuous Eligibility for Children (CEC) program. Provides emergency pregnancy-related benefits (no share of cost) children up 19 years of age who would otherwise lose their no share of cost Medi-Cal. 72 Full 133 Percent Program. Child-United States Citizen, Permanent Resident Alien/PRUCOL Alien (FFP). Provides full Medi-Cal benefits children ages 1 up 6, beyond 6 years when inpatient status, which began before 6 th birthday, continues, family income is at or below 133 percent of the federal poverty level Day Postpartum Program (FFP). Provides Medi-Cal at no SOC women who, 60-day while pregnant, were eligible for, applied for, received Medi-Cal benefits. They Postpartum may continue be eligible for all-postpartum services family planning. This coverage begins on the last day of pregnancy ends the last day of the month in which the 60 th day occurs. 8E Full Accelerated Enrollment. Provides immediate, temporary, fee-for-service, full scope Medi-Cal benefits children under the age of 19. 8G Full Qualified Severely Impaired Working Individual Program Aid Code. Allows recipients of the Qualified Severely Impaired Working Individual Program continue their Medi- Cal eligibility. 8W Full Medically Indigent (MI)-Accelerated Enrollment (AE)- CHDP Gateway for Medi-Cal. Provides for the pre-enrollment of CHILDREN in the Medi-Cal program who are Screened as Cost Medi-Cal Eligibles. Provides Temporary, full scope Medi- 80 Medicare Expenses Cal benefits with no SOC. Qualified Medicare Beneficiary (QMB). Provides payment of Medicare Part A premium Part A B coinsurance deductibles for eligible low income aged, blind, or disabled individuals. 82 Full MI-Person (FFP). Covers medically indigent persons under 21 who meet the eligibility requirements of medical indigence. Covers persons until the age of 22 who were in an institution for mental disease before age 21. Persons may continue be eligible under aid code 82 until age 22 if they have filed for a State hearing. 83 Full MI-Person SOC (FFP). Covers medically indigent persons under 21 who meet the eligibility requirements of medical indigence. 86 Full MI-Confirmed (FFP). Covers persons aged 21 years or older, with confirmed pregnancy, who meets the eligibility requirements of medical indigence. 87 Full MI-Confirmed SOC (FFP). Covers person s aged 21 or older, with confirmed pregnancy, who meet the eligibility requirements of medical indigence but C1 are not eligible for 185 percent/200 percent or the Medically Needy programs. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Aid the Aged Medically Needy (FFP). Covers persons 65 years of age or older who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. Aid Code Typeface Legend: Page 10 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

11 Department of Alcohol Drug Programs Aid Codes Master Chart C2 C3 C4 C5 C6 C7 C8 C9 D1 OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Aid the Aged Medically Needy SOC (FFP). Covers persons 65 years of age or older who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Blind Medically Needy (FFP). Covers persons who meet the federal criteria for blindness who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Blind Medically Needy SOC (FFP). Covers persons who meet the federal criteria for blindness who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. AFDC Medically Needy (FFP). Covers families with deprivation of parental care or support who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. AFDC Medically Needy SOC (FFP). Covers families with deprivation of parental care or support who do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Disabled Medically Needy (FFP). Covers persons who meet the federal definition of disability do not wish or are not eligible for a cash grant, but are eligible for Medi-Cal only. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. Aid the Disabled Medically Needy SOC (FFP). OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. MI person (FFP). Covers medically indigent persons under age 21 who meet the eligibility requirements of medical indigence. Covers persons until the age of 22 who were in an institution for mental disease before age 21. Persons may continue be eligible under aid code 82 until age 22 if they have filed for a State hearing. OBRA Aliens Unverified Citizens. Covers eligible aliens who do not have satisfacry immigration status unverified citizens. MI Child SOC (FFP). Covers medically indigent persons under age 21 who meet the eligibility requirements of medical indigence. Aid Code Typeface Legend: Page 11 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

12 Department of Alcohol Drug Programs Aid Codes Master Chart D2 D3 D4 OBRA Aliens t PRUCOL Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Aged LTC (FFP). Covers persons 65 years of age or older who are medically needy in LTC status. Providers te: LTC services refer both those services included in the per diem base rate of the LTC provider, those medically necessary services required as part of the patient s day day plan of care in the LTC facility (for example, pharmacy, support services therapies). OBRA Aliens t PRUCOL Unverified Citizens Long Term Care (LTC) services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Aged LTC (FFP) SOC. Covers persons 65 years of age or older who are medically needy in LTC status. Providers te: LTC services refer both those services included in the per diem base rate of the LTC provider, those medically necessary services required as part of the patient s day day plan of care in the LTC facility (for example, pharmacy, support services therapies). OBRA Aliens t PRUCOL Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Blind LTC Status (FFP). Covers persons who meet the federal criteria for blindness, are medically needy, are in LTC status. D5 D6 OBRA Aliens t PRUCOL Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Blind LTC, SOC (FFP). Covers persons who meet the federal criteria for blindness, are medically needy, are in LTC status. Providers te: LTC services refer both those services included in the per diem base rate of the LTC provider, those medically necessary services required as part of the patient s day day plan of care in the LTC facility (for example, pharmacy, support services therapies). OBRA Aliens t PRUCOL Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Disabled LTC status (FFP). Covers persons who meet the federal definition of disability, are medically needy, are in LTC status. D7 OBRA Aliens t PRUCOL Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer the OBRA IRCA section in the Medi-Cal Provider Manual. Aid the Disabled LTC, SOC (FFP). Covers persons who meet the federal definition of disability, are medically needy, are in LTC status. Providers te: LTC services refer both those services included in the per diem base rate of the LTC provider, those medically necessary services required as part of the patient s day day plan of care in the LTC facility (for example, pharmacy, support services therapies). Aid Code Typeface Legend: Page 12 of 13 Rev: 8/4/10 Stard - Black, Benefits Green

13 Department of Alcohol Drug Programs Aid Codes Master Chart D8 D9 OBRA Aliens Unverified Citizens Pregnant Women. Covers eligible pregnant alien women who do not have satisfacry immigration status unverified citizens. MI Confirmed (FFP). Covers persons aged 21 or older, with confirmed pregnancy, who meet the eligibility requirements of medical indigence but are not eligible for 185 percent/200 percent or the Medically Needy programs. OBRA Aliens Unverified Citizens Pregnant Women. Covers eligible pregnant alien women who do not have satisfacry immigration status unverified citizens. MI Confirmed SOC (FFP). Covers persons aged 21 or older, with confirmed pregnancy, who meet the eligibility requirements of medical indigence but are not eligible for 185 percent/200 percent or the Medically Needy programs. State Funds Only (Zero FFP) 7M 7N 7P Valid for Minor Consent Valid for Minor Consent Valid for Minor Consent Y/N Y/N Minor Consent Program. Covers minors age 12 under 21. Limited services related sexually transmitted diseases, sexual assault, drug alcohol abuse, family planning. Minor Consent Program. Covers pregnant female minors under age 21. Limited services related pregnancy family planning. Minor Consent Program. Covers minors age 12 under 21. Limited services related sexually transmitted diseases, sexual assault, drug alcohol abuse, family planning, outpatient mental health treatment. Aid Code Typeface Legend: Page 13 of 13 Rev: 8/4/10 Stard - Black, Benefits Green