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