MMIS AID CATEGORIES
Medicaid and PeachCare aid categories are three digits in length with the first digit representing the type of eligibility.
First Digit Categories:
1 = Family Medicaid 4 = SSI ExParte Determination 7 = PeachCare
2 = A B D Medicaid 5 = Refugee 8 = Presumptive
3 = SSI 6 = Q Track 9 = Conversion
Note: Categories circled qualify for source/ccsp payment. Category 136 PCK/MA also pays former peachcare for kids eligible for mdcd due to fpl changes. Birth-19.
FAMILY MEDICAID
| SUCCESS | DCH | Description |
|---|---|---|
| P01 | 104 | LIM - ADULT (Parent Caretaker) new name |
| F01 | 105 | LIM - CHILD |
| F07 | 118 | LIM 1st YR, Trans Med Assist- Adult |
| F07 | 119 | LIM 1st YR, Trans Med Assist- Child |
| 120 | LIM 2nd YR Trans Med Assist- Adult | |
| 121 | LIM 2nd YR Trans Med Assist- Child | |
| F09 | 122 | 4 MO EXTENDED - CS ADULT |
| F09 | 123 | 4 MO EXTENDED - CS CHILD |
| F24 | 124 | FCCP UNCOMPENSATED CARE POOL ADULT |
| F24 | 125 | FCCP UNCOMPENSATED CARE POOL CHILD |
| F26 | 126 | STEPCHILD |
| F22 | 131 | CHILD WELFARE FOSTER CARE |
| D02 | 132 | STATE FUNDED ADOPTION ASSIST |
| F11 | 133 | IV-E FOSTER CARE |
| F13 | 134 | IV-E ADOPTION ASSISTANCE |
| F15 | 135 | DEEMED NEWBORN CHILD |
| F99 | 147 | FAMILY MEDICALLY NEEDY SPEND DOWN - CHILD |
| F99 | 148 | PREG. WOMAN MEDICALLY NEEDY SPENDDOWN |
| 150 | Department of Juvenile Justice | |
| 151 | CHAMP Medicaid | |
| 152 | Former Foster Care Children | |
| 153 | A waiver child with a Foster Care placement | |
| 154 | A waiver child with a Dept of Juvenile Justice placement | |
| 155 | A waiver child with an Adoption Assistance placement | |
| 156 | A waiver child who lost Foster Care placement | |
| 157 | A waiver child who lost Dept of Juvenile Justice placement | |
| 158 | Department of Juvenile Justice - in RYDC (awaiting placement) | |
| 159 | IV-B FC Children | |
| P01 | 170 | RSM PREGNANT WOMAN |
| F22 | 171 | RSM CHILD |
| 172 | RSM 150% Expansion | |
| F77 | 177 | FAMILY PLANNING WAIVER |
| 180 | P4HB INTER PREGNANCY CARE | |
| 181 | P4HB FAMILY PLANNING ONLY | |
| 182 | P4HB ROMC - LIM | |
| 183 | P4HB ROMC -ABD | |
| P01 | 194 | RSM EXPANSION PREGNANT WOMAN |
| F22 | 195 | RSM EXPANSION CHILD < 1 |
| F22 | 196 | RSM EXPANSION CHILD WITH DOB |
| P01 | 197 | RSM PREG WOMAN, INCOME > 185 FPL |
ABD MEDICAID
| SUCCESS | DCH | Description |
|---|---|---|
| L01 | 210 | NURSING HOME – AGED |
| L01 | 211 | NURSING HOME – BLIND |
| L01 | 212 | NURSING HOME – DISABLED |
| L02 | 215 | 30 DAY HOSPITAL - AGED |
| L02 | 216 | 30 DAY HOSPITAL – BLIND |
| L02 | 217 | 30 DAY HOSPITAL - DISABLED |
| S01 | 218 | PROTECTED MED /1972 COLA - AGED |
| S01 | 219 | PROTECTED MED/1972 COLA - BLIND |
| S01 | 220 | PROTECTED MED/1972 COLA - DISABLED |
| S02 | 221 | DISABLED WIDOWER 1984 COLA - AGED |
| S02 | 222 | DISABLED WIDOWER 1984 COLA - BLIND |
| S02 | 223 | DISABLED WIDOWER 1984 COLA-DISABLED |
| S03 | 224 | PICKLE – AGED |
| S03 | 225 | PICKLE – BLIND |
| S03 | 226 | PICKLE - DISABLED |
| S04 | 227 | DISABLED ADULT CHILD – AGED |
| S04 | 228 | DISABLED ADULT CHILD – BLIND |
| S04 | 229 | DISABLED ADULT CHILD – DISABLED |
| S05 | 230 | DISABLED WIDOWER AGE 50-59, AGED |
| S05 | 231 | DISABLED WIDOWER AGE 50-59, BLIND |
| S05 | 232 | DISABLED WIDOWER AGE 50-59, DISABLED |
| S06 | 233 | WIDOWER AGED 60-64 – AGED |
| S06 | 234 | WIDOWER AGED 60-64 – BLIND |
| S06 | 235 | WIDOWER AGED 60-64 - DISABLED |
| S10 | 236 | 3 MO. PRIOR MEDICAID - AGED |
| S10 | 237 | 3 MO PRIOR MEDICAID – BLIND |
| S10 | 238 | 3 MO PRIOR MEDICAID - DISABLED |
| S95 | 239 | ABD MED. NEEDY DEFACTO - AGED |
| S95 | 240 | ABD MED. NEEDY DEFACTO - BLIND |
| S95 | 241 | ABD MED. NEEDY DEFACTO - DISABLED |
| S99 | 242 | ABD MED. NEEDY SPENDDOWN - AGED |
| S99 | 243 | ABD MED. NEEDY SPENDDOWN- BLIND |
| S99 | 244 | ABD MED. NEEDY SPENDDOWN - DISABLED |
| 245 | Woman's Health Medicaid | |
| 246 | TICKET TO WORK | |
| 248 | Disabled Child-1996 | |
| W01 (D) | 250 | DEEMING WAIVER (Katie Beckett) |
| W01 | 251 | ICWP-Community Care Waiver |
| W01 | 252 | MENTAL RETARDATION WAIVER |
| 253 | Laurens CO. Waiver | |
| 254 | HIV Waiver | |
| 255 | Cystic Fibrosis Waiver | |
| W01 (N) | 256 | NOW – New Option Wavier Services |
| W01 (C) | 257 | COMP – Comprehensive Service |
| W01 | 258 | CBAY – Community Based Alternative for Youth Waiver |
| W01 (W) | 259 | CCW-COMMUNITY CARE WAIVER |
| W01 | 280 | HOSPICE -AGED |
| W01 | 281 | HOSPICE - BLIND |
| W01 | 282 | HOSPICE - DISABLED |
| L95 | 283 | LTC MED. NEEDY DEFACTO |
| L95 | 284 | LTC MED. NEEDY DEFACTO - Blind |
| L95 | 285 | LTC MED. NEEDY DEFACTO - DISABLED |
| L99 | 286 | LTC MED. NEEDY SPENDDOWN - AGED |
| L99 | 287 | LTC MED. NEEDY SPENDDOWN - BLIND |
| L99 | 288 | LTC MED. NEEDY SPENDDOWN – DISABLED |
| W01 | 289 | INSTITUTIONAL HOSPICE - AGED |
| W01 | 290 | INSTITUTIONAL HOSPICE - BLIND |
| W01 | 291 | INSTITUTIONAL HOSPICE - DISABLED |
Important Note: Anyone with 280-282 must also be either SSI or have EDWP from DFCS. These categories require a waiver category of aid on Gateway.
SSI MEDICAID
| DCH | Description |
|---|---|
| 301 | SSI – AGED |
| 302 | SSI – BLIND |
| 303 | SSI – DISABLED |
| 304 | SSI APPEAL – AGED |
| 305 | SSI APPEAL – BLIND |
| 306 | SSI APPEAL – DISABLED |
| 307 | SSI WORK CONTINUANCE - AGED |
| 308 | SSI WORK CONTINUANCE – BLIND |
| 309 | SSI WORK CONTINUANCE - DISABLED |
| 315 | SSI ZEBLEY CHILD |
| 321 | SSI E02 MONTH – AGED |
| 322 | SSI E02 MONTH - BLIND |
| 323 | SSI E02 MONTH - DISABLED |
| 387 | SSI TRANS. MEDICAID - AGED |
| 388 | SSI TRANS. MEDICAID – BLIND |
| 389 | SSI TRANS. MEDICAID - DISABLED |
SSI EX-PARTE DETERMINATION MEDICAID
| DCH | Description |
|---|---|
| 410 | NURSING HOME - AGED |
| 411 | NURSING HOME – BLIND |
| 412 | NURSING HOME – DISABLED |
| 424 | PICKLE – AGED |
| 425 | PICKLE – BLIND |
| 426 | PICKLE - DISABLED |
| 427 | DISABLED ADULT CHILD – AGED |
| 428 | DISABLED ADULT CHILD – BLIND |
| 429 | DISABLED ADULT CHILD – DISABLED |
| 445 | N07 CHILD |
| 446 | WIDOWER – AGED |
| 447 | WIDOWER - BLIND |
| 448 | WIDOWER - DISABLED |
| 449 | PA Waiver Services (added 11 2020) |
| 460 | QUALIFIED MEDICARE BENEFICIARY |
| 466 | SPECIFIED LOW INCOME MEDICARE BENEFICIARY |
| 471 | RSM CHILD |
REFUGEE MEDICAID
| SUCCESS | DCH | Description |
|---|---|---|
| R01 | 506 | REFUGEE (DMP) - ADULT |
| R01 | 507 | REFUGEE (DMP) - CHILD |
| R02 | 508 | POST REF EXTENDED MED - ADULT |
| R02 | 509 | POST REF EXTENDED MED - CHILD |
| R03 | 510 | REFUGEE MAO - ADULT |
| R03 | 511 | REFUGEE MAO – CHILD |
| R22 | 571 | REFUGEE RSM CHILD |
| R99 | 575 | REFUGEE MED. NEEDY SPEND DOWN |
| R22 | 595 | REFUGEE RSM |
| R22 | 596 | REFUGEE RSM EXPANSION CHILD WITH DOB |
Q MEDICAID
| SUCCESS | DCH | Description |
|---|---|---|
| Q01 | 660 | QUALIFIED MEDICARE BENEFICIARY |
| Q03 | 661 | SPECIFIED LOW INCOME MEDICARE BENEFICIARY |
| Q01 | 662 | QI1 BENEFICIARY |
| Q12 | 663 | QI2 BENEFICIARY |
| Q05 | 664 | QUAL. WORKING DISABLED INDIVIDUAL |
PEACHCARE
| DCH | Description |
|---|---|
| 790 | PEACHCARE 101 – 150 % FPL |
| 791 | PEACHCARE 151 – 200% FPL |
| 792 | PEACHCARE 201 – 235% FPL |
| 793 | PEACHCARE > 235% FPL |
| 794 | 360 FC Peach 101 - 150% FPL |
| 795 | 360 FC Peach 151 - 200% FPL |
| 796 | 360 FC Peach 201 - 235% FPL |
| 797 | 360 FC Peach > 235% FPL |
PRESUMPTIVE / OTHER MEDICAID
| DCH | Description |
|---|---|
| 800 | PRESUMPTIVE BCC |
| 804 | LIM REI ADULT |
| 805 | LIM REI CHILD |
| 815 | AGED INMATE |
| 817 | DISABLED INMATE |
| 818 | TMA REI ADULT |
| 819 | TMA REI CHILD |
| 835 | NEWBORN |
| 836 | NEWBORN (DHACS/PSI) |
| 865 | PRESUMPTIVE PREG. WOMAN |
| 870 | EMERGENCY ALIEN – ADULT |
| 871 | RSM (DHACS) |
| 873 | EMERGENCY ALIEN – CHILD |
| 874 | Pregnant Adult Inmate |
| 875 | Child Inmate |
| 876 | RSM PREG WOMAN (DHACS/PSI) |
| 894 | RSM EXPANSION PREG. WOMAN (DHACS) |
| 895 | RSM EXPANSION CHILD < 1 (DHACS/PSI) |
| 897 | RSM PREG WOMAN Income > 185 % FPL (DHACS/PSI) |
| 898 | RSM Child < 1, Mother has Aid cat = 897 (DHACS/PSI) |
CONVERSION / DEFAULT
| DCH | Description |
|---|---|
| 915 | AGED MAO |
| 916 | BLIND MAO |
| 917 | DISABLED MAO |
| 918 | LIM ADULT |
| 919 | LIM CHILD |
| 920 | REFUGEE ADULT |
| 921 | REFUGEE CHILD |
| 924 | FOSTER CARE |
| 931 | CHILD WELFARE FOSTER CARE |
| 983 | AGED MEDICALLY NEEDY |
| 984 | BLIND MEDICALLY NEEDY |
| 985 | DISABLED MEDICALLY NEEDY |
HISTORIC AID CATEGORIES
| Category | DCH | Description |
|---|---|---|
| F0 | 120 | LIM 2nd YR TRANS MED ASSIST - ADULT |
| F0 | 121 | LIM 2ndYR TRANS MED ASSIST - CHILD |
| F | 172 | RSM 150 % EXPANSION |
| 247 | DISABLED CHILD - 1996 | |
| W01 | 253 | LAURENS CO. WAIVER |
| W01 | 254 | HIV WAIVER |
| W01 | 255 | CYSTIC FIBROSIS WAIVER |
| 872 | RSM 150 % EXPANSION (DHACS) | |
| 874 | PREGNANT ADULT INMATE | |
| 875 | CHILD INMATE | |
| 896 | RSM EXPANSION CHILD WITH DOB |
MMIS BENEFIT PLAN HIERARCHY
| Code | Description |
|---|---|
| SSI | Supplemental Security Income |
| TXIX | Title XIX Medicaid |
| PEACH | PeachCare SCHIP |
| PEPW | Presumptive Eligible Pregnant Woman |
| CCSP | Community Care Service Program |
| ICWP | Independent Care Waiver Program |
| CHMRP | Comm Hab Support Svc/Mental Retardation |
| CPNOW | Comprehensive Services/New Option |
| CBAY | Community Based Alternative for Youth |
| GAPP2 | GAPP2 Waiver |
| EMA | Emergency Medical Assistance |
| BCC | Breast and Cervical Cancer |
| FPLAN | Family Planning Waiver |
| QMB | Qualified Medicare Beneficiaries |
| SLQI1 | SLMB and QI1 Medicare Beneficiary |
Document Information: Created on 12/30/2014 (update 12/14). This document contains updated SOURCE Medicaid Categories with no changes – just a more current list. Available categories are SSI, the Public Laws (S01-S06), KB (W01), and Medically Needy Defacto (S95). These and only these categories are eligible. Some of these categories actually indicate they are terminating like SSI transitional.