Valid only for ambulatory prenatal care services. Comprehensive family planning services for low income residents of California with no other source of health care coverage. CountyMedical Services Program (CMSP). Aid to the Aged Long Term Care (LTC). 0000000016 00000 n
Former SSI No Longer Disabled in SSI Appeals Status. NOTE:Unless stated otherwise, these aid codes cover United States citizens, United States Nationals, and immigrants in a satisfactory immigration status. Share of cost is also not a premium; it is an amount that a recipient is responsible for only during a month in which Medi-Cal's assistance with health care expenses is needed. 0000010401 00000 n
18-months (breast) and 24-months (cervical). <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 63 0 R 64 0 R 70 0 R 71 0 R 72 0 R 73 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Medi-Cal In-Home Operations (IHO) Waiver (No SOC). =\=4\(T]^+a{)WIi8,R]%qr255%&iyeY>g J[ Continuing TMC. %PDF-1.6
For more information, refer to the Share of Cost (SOC) section of the Part 1 manual. endobj
pregnancy-related and postpartum services if family income is at or below 200 percent of the federal poverty level. The individual may be eligible for Medi-Cal benefits in another MBU where the person is not identified as RR. This option allows the Qualified Provider (QP) to make a determination of PE for outpatient prenatal care services based on preliminary income information. Provides six months of coverage for eligible aliens without satisfactory immigration status who have been discontinued from Section 1931(b) due to increased earnings from employment. This coverage begins on the last day of pregnancy and ends the last day of the month in which the 60th day occurs. Aid to Families with Dependent Children (AFDC) 1931(b)
Covers persons aged 21 or older, with confirmed pregnancy, which meet the eligibility requirements of medically indigent but are not eligible for 185 percent/200 percent or the MN programs. The eligibility response returns a message indicating whether or not the recipient is eligible, and for what services. Covers eligible persons age 21 or older and under 65 years of age who are residing in a Nursing Facility Level A or B with or without SOC. Covers children in the state program for children in relative placement receiving cash assistance. Covers emergency and pregnancy-related services to otherwise eligible children, without satisfactory immigration status who are ages 6 to 19 or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the federal poverty level. Adoption Assistance Program/Aid for Adoption of Children (AAP/AAC). Does not cover individuals with creditable insurance. CalWORKS Legal Immigrant Family Group. 0000002404 00000 n
Covers eligible individuals who are
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200 Percent FPL Infant (Income Disregard Program Infant). Covers children on whose behalffinancial assistance is provided for state only foster care placement. Cancer Detection Programs:Every Woman Counts offers benefits to uninsured and underinsured women, 25 years and older, whose household income is at or below 200 percent of the Federal poverty level. Cervical cancer-related services covered for 24 months. Interstate Compact on the Placement of Children (ICPC) Child. RR Responsible Relative:An RR is allowed to use medical expenses to meet the SOC for other family members for whom he/she is responsible. SB 87 Pending Disability. Covers children for whom there is a state-only AAP agreement between any state other than California and adoptive parents. Minor Consent Program. Covers child welfare cases placed in EA foster care. Covers children in the federal program for children in relative placement receiving cash assistance. 0000005351 00000 n
Provides emergency, pregnancy-related and Long Term Care (LTC) services to females younger than 65 years of age with unsatisfactory immigration status who have been diagnosed with breast and/or cervical cancer. Limited to services related to Sexually Transmitted Diseases, sexual assault, drug and alcohol abuse, family planning, and outpatient mental health treatment. Covers children on whose behalffinancial assistance is provided for state only foster care placement. 200 Percent FPL Pregnant Omnibus Budget Reconciliation Act (OBRA) (Income Disregard Program Pregnant OBRA). BCCTP Undocumented Aliens. 0000000974 00000 n
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Limited to services related to pregnancy and family planning. CCS-eligible Healthy Families child. 0000013647 00000 n
Presumptive Eligibility (PE) Ambulatory Prenatal Care. %PDF-1.7
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o. Medi-Cal Dialysis Only Program/Medi-Cal Dialysis Supplement Program (DP/DSP). Covers CHDP eligible children who are also eligible for Medi-Cal emergency, pregnancy-related and Long Term Care (LTC) services. endobj
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CalWORKs Legal Immigrant Aid to families. Covers persons until the age of 22 who were in an institution for mental disease before age 21. Covers children supported by public funds other than AFDC-FC. Paper Medi-Cal ID Card issued. One-Month Medi-Cal to Healthy FamiliesBridge. x][s~xRc ^R[2%N#6OWn\etNjG@7|h0^/zy^?ua}^n{z_\/(4!1IkV$d~D/_\}zJn^QL(qedG^6Vr@rr//_6Y"g[K5/^KJxtDQ#dD' IY]y$R%)slw'JG^Y]zw_vz1ayy%J53~$KOx/^L4O'q +W|F;JUMy6jId1g;AK{""`MJY3T=FhU,Gx-v5PZw1oM}F:#@#kk`P\
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HF covers medical, dental and vision services to enrolled children. Upon certification of the SOC, the IE individual is not eligible for Medi-Cal benefits in this case. Cancer Detection Programs:Every Woman Counts only. Aid to the Aged Multipurpose Senior Services Program (MSSP). An IE person may be eligible for Medi-Cal benefits in another case where the person is not identified as IE. Severely Impaired Working Individual (SIWI). Provides 18 months of breast cancer treatments and 24 months of cervical cancer treatments for eligible all-age males and females 65 years of age or older, regardless of citizenship, who have been diagnosed with breast and/or cervical cancer. 200 Percent Infant OBRA. The Cancer Detection Programs:Every Woman Counts recipient identifier. CHDPTriZetto (formerly Gateway) Deemed Infant SOC. %
Provides for the pre-enrollment of children into the Medi-Cal program who are screened as probable for Medi-Cal eligibility. ("naturalWidth"in a&&"naturalHeight"in a))return{};for(var c=0;a=d[c];++c){var e=a.getAttribute("pagespeed_url_hash");e&&(! Please note:Cancer Detection Programs:Every Woman Counts and Medi-Cal are separate programs; however, Cancer Detection Programs:Every Woman Counts relies on the Medi-Cal billing process (with few exceptions). Provides full-scope benefits to children up to 3 months of age who were voluntarily surrendered within 72 hours of birth pursuant to the Safe Arms for Newborns Act. s:xS>X;OJd7JJxgtR! Um\-\y2$9!y//zOQdqHemy?HnMQ% &C>)#)7 i,r`F\v. 0000003263 00000 n
Restricted to CMSP emergency services only. Special Share of Cost (SOC) Case Indicators:These indicators, which appear on a recipients SOC Case Summary Form, are used to identify the following: IE Ineligible:A person who is ineligible for Medi-Cal benefits in the case. Covers children receiving federal cash grants under Title IV-E to facilitate the adoption of hard-to-place children who would require permanent foster care placement without such assistance. Covers eligible minors at least 12 years of age and under the age of 21. The aid codes in this chart are meant to assist providers in identifying the types of services for which Medi-Cal and Public Health Program recipients are eligible.
BCCTP. MI Adult. Limited to services related to Sexually Transmitted Diseases, sexual assault, drug and alcohol abuse, and family planning. Covers the aged in the Aged and Disabled FPL program. Out-of-State Adoption Assistance Program (AAP). Express Enrollment National School Lunch Program (NSLP). Limited to services related to family planning and sexual assault. Medically Indigent Long Term Care (LTC) services. Provides emergency services only for eligible children without satisfactory immigration status who are ages 1 up to 6 or beyond 6 years when inpatient status, which began before 6th birthday, continues, and family income is at or below 133 percent of the federal poverty level. Persons may continue to be eligible under aid code 82 until age 22 if they have filed for a State hearing. Covers medically indigent persons under 21 who meet the eligibility requirements of medical indigence. Covers persons aged 21 years or older, with confirmed pregnancy, which meet the eligibility requirements of medically indigent. Medi-Cal ID card issued. 7F is valid for pregnancy test, initial visit, and services associated with the initial visit. Recipients remain in this aid code even if they leave LTC. State-funded cancer treatment services are
Accelerated Enrollment. startxref
Provides temporary AE for full-scope, no SOC Medi-Cal while an eligibility determination is made for eligible females younger than 65 years of age without creditable health coverage who have been diagnosed with breast and/or cervical cancer. Provides Medi-Cal at no SOC to women who, while pregnant, were eligible for, applied for, and received Medi-Cal benefits. MI Adult Disability Pending. Aid Code 8F appears as a special aid code and entitles the eligible client to acute inpatient services only while residing in a Nursing Facility Level A or B. Eligible for CCS only if concurrently eligible for full-scope, no SOC Medi-Cal. Covers medically indigent adults aged 21 and over but under 65 years that meet the eligibility requirements of medically indigent. They may continue to be eligible for all postpartum services and family planning. 133 Percent Excess Property Child. 0000002893 00000 n
Covers Cuban/Haitian entrants during their first eight months in the United States who are receiving ECA benefits, including unaccompanied children who are not subject to the eight-month provision. Provides an additional six months of emergency services coverage for those beneficiaries who received six months of initial TMC coverage under aid code 3T. Covers eligible persons of any age who are eligible only for dialysis and related services. Restricted to pregnancy and emergency services. Infants from a family with an income of 200 to 300 percent of the federal poverty level, born to a mother enrolled in AIM. QP issues paper PE ID Card. Initial Transitional Medi-Cal (TMC) (6 months). 0000020957 00000 n
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x[msF)FIiN-V#d5L,i `xy _l7zjH]oU++sU$i*"Qqj,Ea&:1TJ0uY1{cl(GY They remain eligible while still in need of treatment and meet all other eligibility requirements. The message includes an aid code if the recipient is eligible. Provides full-scope benefits to otherwise eligible children, ages 6 to 19 or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the Federal poverty level. Share of cost is not the same as cost-sharing. Restricted Federal Poverty Level Aged. Allows special institutional deeming rules (spousal impoverishment) for MSSP transitional and non-transitional services for individuals 65 years of age or older. The infant's enrollment in the HF program is based on their mother's participation in AIM. Covers the aged in the Aged and Disabled FPL program that do not have satisfactory immigration status. Covers persons discontinued from CalWORKs or Section 1931(b) due to the increased collection of child/spousal support. Covers medically indigent adults aged 21 and over but under 65 years that meet the eligibility requirements of medically indigent and have a pending Medi-Cal disability application. [CDATA[ Provides limited-scope no SOC Medi-Cal emergency, pregnancy-related and Long Term Care (LTC) services for females younger than 65 years of age with unsatisfactory immigration status and without creditable health insurance coverage who have exhausted their 18-month (breast) or 24-month (cervical) period of cancer treatment coverage under aid code 0U. OBRA Not PRUCOL Long Term Care (LTC) services. Adoption Assistance Program (AAP) Child. Covers children receiving federal AAP cash subsidies from out of state. Provides full Medi-Cal benefits to eligible infants up to 1 year old or continues beyond 1 year when inpatient status, which began before first birthday, continues and family income is at or below 200 percent of the federal poverty level. MI Adult. OBRA Aliens. MI Adult Disability Pending SOC. 2 0 obj
Access for Infants and Mothers (AIM) Infants enrolled in Healthy Families (HF). CHDPTriZetto (formerly Gateway) Medi-Cal. Covers juvenile probation cases placed in foster care. Covers former Supplemental Security Income/State Supplementary Payment recipients who are aged, until the county redetermines their Medi-Cal eligibility. Covers eligible pregnant minors under the age of 21. Provides four months of emergency services for aliens without satisfactory immigration status who are no longer eligible for Section 1931(b) due to the collection or increased collection of child/spousal support. <>/ExtGState<>/ProcSet[/PDF/Text]/Font<>>>/MediaBox[ 0 0 612 792]/Type/Page/Parent 473 0 R /Contents 2 0 R /Rotate 0/CropBox[ 0 0 612 792]/Annots 111 0 R /Tabs/S>>
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The chart includes only aid codes used to bill for services through the Medi-Cal claims processing systems and for other non-Medi-Cal programs that need to verify eligibility through EVS. 1 0 obj
Eligible for GHPP benefits and case management. Covers emergency and pregnancy-related services only to otherwise eligible children without satisfactory immigration status who are ages 6 to 19 or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the Federal poverty level. 0000007171 00000 n
Refugee Cash Assistance (RAC). Provides temporary full-scope Medi-Cal benefits with no SOC. trailer
CalWORKS Timed-Out, Safety Net Two-Parent Families. 100 Percent OBRA Child. If a recipient has an unmet Share of Cost, an aid code is not returned, since the recipient is not considered eligible until the Share of Cost//
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HAP Card Issued. BCCTP State-funded. 0000001372 00000 n
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Covers all eligible refugees during their first eight months in the United States, including unaccompanied children who are not subject to the eight-month limitation. stream
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Also provides eligibility for the Former Foster Care Children (FFCC) program (aid code 4M) at age 18. For more information about LTC services, refer to the OBRA and IRCA section in this manual. %
Providers NOTE:Long Term Care services refers to both those services included in the per diem base rate of the LTC provider, and those medically necessary services required as part of the patients day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies). Provides eligible pregnant women of any age with family planning. Covers eligible aliens who do not have satisfactory immigration status. For more information about Long Term Care (LTC) services, refer to the County Medical Services Program (CMSP) section in this manual. Provides full Medi-Cal benefits to eligible children ages 1 up to 6 or beyond 6 years when inpatient status, which began before 6th birthday, continues and family income is at or below 133 percent of the federal poverty level. Healthy Families Child. Provides payment of Medicare Part A premium and Part A and B coinsurance and deductibles for eligible low income aged, blind or disabled individuals. Covers with no SOC beneficiaries ages 21 to 65 who have lost their non-disability linkage to Medi-Cal and are claiming disability. Temporary Assistance to Needy Families (TANF) Timed-Out, Mixed Case. SB 87 Pending Disability (SOC). Four-Month Continuing Pregnancy and Emergency Services Only. <>
Provides emergency services only for eligible infants without satisfactory immigration status who are under 1 year of age or beyond 1 year when inpatient status, which began before 1st birthday, continues and family income is at or below 200 percent of the federal poverty level. Federal Poverty Level Aged (FPL-Aged). Total Parenteral Nutrition (TPN). Presumptive Eligibility (PE) Pregnancy Verification. Provides emergency services only for eligible children without satisfactory immigration status who are ages 1 up to 6 or beyond 6 years when inpatient status, which began before 6th birthday, continues and family income is at or below 133 percent of the federal poverty level. Provides payment of premiums, co-payments, deductibles and coverage for non-covered cancer-related services for eligible all-age males and females, including undocumented aliens, who have been diagnosed with breast and/or cervical cancer, if premiums, co-payments and deductibles are greater than $750. Provides a comprehensive health insurance plan for uninsured children from 1 to 19 years of age whose familys income is at or below 200 percent of the Federal poverty level. Cancer Detection Programs:Every Woman Counts offers reimbursement for screening, diagnostic and case management services. Covers children receiving cash grants under the state-only AAP/AAC program. Kinship Guardianship Assistance Payment (Kin-GAP) Cash Assistance. 100 Percent Child. Provides eligible pregnant aliens of any age without satisfactory immigration status with family planning, pregnancy-related and postpartum, if family income is at or below 200 percent of the federal poverty level. Restricted Federal Poverty Level Disabled. 0
0?+Xs_7;9~%7 a~nd
'?FBjx35! Persons placed in 7F have pregnancy test results that are negative. CMSP Companion Aid Code. Covers eligible refugees and entrants who are not eligible for Medi-Cal or Healthy Families and do not qualify for or want cash assistance. Upon certification of the SOC, an RR individual is not eligible for Medi-Cal benefits in this Medi-Cal Budget Unit (MBU).
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