Appendix E: Medical Assistance Cascade Table

Effective 03/14/2016

CATEGORY

PROGRAM CODE

TT

DESCRIPTION

MG

17

F

Hospital Based Presumptive Eligibility

MG

17

I

Hospital Based Presumptive Eligibility

MG

17

C

Hospital Based Presumptive Eligibility

MG

17

Y

Hospital Based Presumptive Eligibility

MG

17

T

Hospital Based Presumptive Eligibility

MG

17

A

Hospital Based Presumptive Eligibility

PS

17

 

NMP SMA Presumptive Eligibility

PC

31

 

NMP TANF Federal Foster Care

PC

32

 

NMP TANF Federal Adoption Assistance

PC

33

 

NMP TANF State Foster Care

PC

34

 

NMP TANF State Adoption Assistance

PC

35

 

Adoption ASST-FSTR Care Other State

PC

36

 

Out of State Adoption Assistance

PC

37

 

NMP SPLC

PCN

31

 

Federal Foster Care Long Term Care

PCN

32

 

Federal Adoption Assistance Long Term Care   

PCN

33

 

State Foster Care Long Term Care

PCN

34

 

State Adoption Assistance Long Term Care

PCN

35

 

Out of State Foster Care Long Term

PCN

36

 

Out of State Adoption Assistance Long Term Care

PCN

37

 

Subsidized SPLC Long Term Care

PAN

80

 

Aged Long Term Care w/ Buy-In  (NMP)

PMN

80

 

Blind Long Term Care w/Buy-In  (NMP)

PJN

80

 

Disabled Long Term Care w/ Buy-In  (NMP)

PVN

80

 

VA Long Term care w/Buy-In  (NMP)

PAN

66

 

Aged Long Term Care w/Buy-In  (NMP)

PJN

66

 

Disabled Long Term Care w/Buy-In  (NMP)

PVN

66

 

VA Long Term Care w/Buy-In  (NMP)

PAN

00

 

Aged Long Term Care  (NMP)

PMN

00

 

Blind Long Term Care  (NMP)

PJN

00

 

Disabled Long Term Care  (NMP)

PVN

00

 

VA Long Term Care  (NMP)

TAN

80

 

Aged Long Term Care w/Buy-In  (MNO)

TJN

80

 

Disabled Long Term Care w/Buy-In  (MNO)

TVN

80

 

VA Long Term Care w/ Buy-In  (MNO)

TAN

66

 

Aged Waiver Program  (MNO)

TJN

66

 

Disabled Waiver Program  (MNO)

TVN

66

 

VA Long Term Care w/ Buy-In  (MNO)

TAN

00

 

Aged Waiver Program   (MNO)

TJN

00

 

Disabled Waiver Program  (MNO)

TVN

00

 

VA Long Term Care   (MNO)

PCN

02

 

Refugee  LTC

PAW

81

 

Special SSI Waiver- AGED- DAC

PMW

81

 

Special SSI Waiver- Blind- DAC

PJM

81

 

Special SSI Waiver- Disabled- DAC

PJW

83

 

Special SSI Waiver- Disabled Widow

PAW

84

 

Special SSI Waiver- AGED- PICKLE

PMW

84

 

Special SSI Waiver- BLIND- PICKLE

PJW

84

 

Special SSI Waiver- DISABLED- PICKLE

PAW

85

 

Special SSI Waiver- AGED- Disabled Employee

PMW

85

 

Special SSI Waiver- BLIND- Disabled Employee

PJW

85

 

Special SSI Waiver- Disabled- Disabled Employee

PAW

80

 

Aged Waiver Program w/Buy-In   (NMP)

PMW

80

 

Blind Waiver Program w/ Buy-In  (NMP)

PJW

80

 

Disabled Waiver Program  w/ Buy-In  (NMP)

PAW

66

 

Aged Waiver Program w/Buy-In   (NMP)

PMW

66

 

Blind Waiver Program w/Buy-In   (NMP)

PJW

66

 

Disabled Waiver Program w/Buy-In   (NMP)

PAW

00

 

Aged Waiver Program   (NMP)

PMW

00

 

Blind Waiver Program   (NMP)

PJW

00

 

Disabled Waiver Program  (NMP)

TAW

80

 

Aged Waiver Program w/Buy-In   (MNO)

TJW

80

 

Disabled Waiver Program  w/ Buy-In  (MNO)

TAW

66

 

MNO TANF

TJW

66

 

Disabled Waiver Program w/Buy-In   (MNO)

TAW

00

 

TANF MNO Abs/Inc Spend-down

TJN

00

 

Disabled Waiver Program   (MNO)

PCW

02

 

Refugee Waiver Group

PA

81

 

Aged Disabled Adult Child

PM

81

 

Blind Disabled  Adult Child

PJ

81

 

Disabled Adult Child

PJ

83

 

Disabled Widow (er)

PA

84

 

Aged Pickle Individual

PM

84

 

Blind Pickle Individual

PJ

84

 

Disabled Pickle Individual

PA

85

 

Aged Disabled Employed Individual

PM

85

 

Blind Disabled Employed Individual

PJ

85

 

Disabled  Employed Individual

PA

86

 

Aged QDWI Individual

PM

86

 

Blind QDWI Individual

PJ

86

 

Disabled QDWI Individual

PC

03

 

NMP TANF Refugee Unaccompanied Minor

PH

80

A

Categorically Needy Healthy Horizon w/Buy-In

PH

80

D

Categorically Needy Healthy Horizon w/Buy-In

PH

00

M

Healthy Horizons- Disability Verified by SSA or MRT

MG

27

I

MAGI Infant         (Below TANF NMP Limit)

MG

27

C

MAGI Child         (Below TANF NMP Limit)

MG

27

Y

MAGI Youth        (Below TANF NMP Limit)

MG

27

T

MAGI Caretaker   (Below TANF NMP Limit)

MG

71

I

TMA MAGI   Infant

MG

71

C

TMA MAGI   Child

MG

71

Y

TMA MAGI   Youth

MG

71

T

     TMA MAGI   Caretaker

MG

19

Y

MAGI Youth    (Newly Eligible)

MG

00

P

MAGI    Pregnant Woman

MG

00

I

MAGI   Infant

MG

00

C

MAGI  Child

MG

00

Y

MAGI   Youth

PC

40

 

Former Foster Care

MG

90

N

Enhanced FMAP- Age 19 to 20

MG

90

D

Enhanced FMAP - Permanently Disabled

MG

90

P

Enhanced FMAP - Pregnancy Reported

MG

91

P

Newly Eligible - Pregnancy Reported

MG

91

 

Newly Eligible

PH

00

A

Healthy Horizons    (Aged)

PH

00

D

Healthy Horizons    (Disabled)

PA

00

 

NMP Aged

PM

00

 

NMP Blind

PJ

00

 

NMP Disabled

PA

22

 

NMP Aged Spend-Down  (Ongoing Auth)

PM

22

 

NMP Blind Spend-Down   (Ongoing Auth)

PJ

22

 

NMP Disabled Spend-Down (Ongoing)

PA

21

 

NMP Aged Spend-Down   (Monthly Auth)

PM

21

 

NMP Blind Spend-Down   (Monthly)

PJ

21

 

NMP Disabled Spend-Down   (Monthly)

PC

02

A

NMP TANF Refugee  (RMA)

PD

00

F

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

00

D

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

00

H

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

00

A

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

00

V

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

22

F

NMP GA Chron Need Spend-Down (Ongo) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

22

D

NMP GA Chron Need Spend-Down (Ongo) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

22

H

NMP GA Chron Need Spend-Down (Ongo) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

22

A

NMP GA Chron Need Spend-Down (Ongo) Perm res Subject to the 5 Year Bar and Temp Aliens

PD

22

V

NMP GA Chron Need Spend-Down (Ongo) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

F

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

D

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

H

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

A

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

V

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

PH

20

 

Breast & Cervical Cancer

MG

18

P

MAGI Inc Ineligible Pregnant Woman/Newborn

PW

80

 

MAWD eligible for Medicare Buy-In

PW

66

 

MAWD eligible for SLMB

PW

00

 

MAWD

PI

80

 

Medically Improved MAWD Eligible for Buy-In

PI

66

 

Medically Improved MAWD Eligible for SLMB

PI

00

 

Medically Improved MAWD

PAW

80

A

Aged Waiver Program w/Buy-In    (NMP)

PAW

66

A

Aged Waiver Program w/Buy-In    (NMP)

PAW

00

A

Aged Waiver Program      (NMP)

PMW

80

A

Blind Waiver Program  w/Buy-In   (NMP)

PMW

66

A

Blind Waiver Program  w/Buy-In   (NMP)

PMW

00

A

Blind Waiver Program                   (NMP)

PJW

80

A

Disabled Waiver Program  w/Buy-In   (NMP)

PJW

66

A

Disabled Waiver Program  w/Buy-In   (NMP)

PJW

00

A

Disabled Waiver Program

PCW

02

A

Refugee Waiver

TA

80

 

With Buy-In/ Aged Long Term Care (MNO)/ Aged Long Term Care w/Buy-In   (MNO)

TJ

80

 

With Buy-In/ Disabled Long Term Care (MNO)/ Disabled Long Term Care  w/Buy-In   (MNO)

TA

66

 

Specified Low Income Med  Benefit.    Buy-In/ MNO  

TJ

66

 

Specified Low Income Med  Benefit.    Buy-In/ MNO  

TA

00

 

MNO Aged

TJ

00

 

MNO Disabled

TU

00

T

MNO TANF/CU

TU

00

P

TANF- Related MNO UPWE Deprived Pregnant Women

TC

00

T

MNO- TANF/  MNO GA Chronically Needy/ MNO Disabled

TC

00

N

MNO- TANF/  MNO GA Chronically Needy

TC

00

P

MNO - TANF

PD

00

C

GA NMP Perm Res Subject to 5 Year Bar and Temp Aliens

PD

22

C

NMP GA Chron Need Spend-Down (Ongo) Perm Res Subject to the 5 Year Bar and Temp Aliens

PD

21

C

NMP GA Chron Need Spend-Down (Monthly) Perm Res Subject to the 5 Year Bar and Temp Aliens

TD

00

C

MNO GA Chronically Needy Perm Res Subject to 5 Year Bar and Temp Aliens

TD

00

A

MNO GA Chronically Needy Perm Res Subject to 5 Year Bar and Temp Aliens

TD

00

W

MNO GA Chronically Needy Perm Res Subject to 5 Year Bar and Temp Aliens

TA

22

 

SSI MNO Aged Spend-Down

TJ

22

 

SSI MNO Disabled Spend-Down

TU

22

T

TANF MNO UPWE Spend-Down

TU

22

P

TANF-  Related MNO UPWE Deprived Child- Ongoing Spend-Down

TC

22

T

MNO - TANF

TC

22

N

MNO - TANF

TC

22

P

MNO - TANF

TD

22

C

GA MNO Spend-Down Perm Res Subject to 5 Year Bar and Temp Aliens

TD

22

A

GA MNO Spend-Down Perm Res Subject to 5 Year Bar and Temp Aliens

TD

22

W

GA MNO Spend-Down Perm Res Subject to 5 Year Bar and Temp Aliens

MG

18

N

NMP SMA Inc Ineligible Pregnant Women/ Newborn

PC

02

C

NMP TANF Refugee  (RMA)

PSF

15

 

Family Planning Services

PSF

14

 

Family Planning Services  (Good Cause)

PH

97

 

SSI Pending / Child/ Special Needs

PH

95

 

Categorically Needy Child with Special Needs

PG

00

A

Elderly Med Cost Sharing Healthy Horizons

PG

00

D

Categorically Needy Healthy Horizons

TA

65

 

Specified Low Income Med Benefits.   Part B Buy-In

TJ

65

 

Specified Low Income Med Benefits.   Part B Buy-In

TA

67

 

Qualified Individual (QI-1)  Buy-In Only

TJ

67

 

Qualified Individual (QI-1)  Buy-In Only

TA

68

 

Qualified Individual (QI-2)  Buy-In Only

TJ

68

 

Qualified Individual (QI-2)  Buy-In Only

PC

30

 

Release from YDC

PH

38

 

SSA Disabled SCI Inmates

PH

39

 

SSA Disabled County Inmates

PC

38

 

NMP TANF SCI Inmates

PC

39

 

NMP TANF County Inmates

PD

38

 

NMP GA Disabled SCI Inmates-  Perm Res Subject to 5 Year Bar and Temp Aliens  

PD

39

 

NMP GA Disabled County Inmates-  Perm Res Subject to 5 Year Bar and Temp Aliens

MG

38

 

SCI Inpatient Inmates

MG

39

 

County Inpatient Inmates

 

Updated April 5, 2016   Replacing September 26, 2013