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O : The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit an inquiry to AEVS to verify a recipients eligibility for
services. The eligibility response returns a message indicating whether the recipient is eligible, and for what services. The message includes an aid code if the recipient is eligible. If a recipient has an unmet Share of Cost (SOC), an aid code is not returned, since the recipient is not considered eligible until the SOC is met. A recipient may have more than one aid code, and may be eligible for multiple programs and services.
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. The chart includes only aid codes used to bill for services through the Medi-Cal claims processing system and for other non Medi-Cal programs that
need to verify eligibility through AEVS.
Note: Unless stated otherwise, these aid codes cover United States citizens, United States nationals and immigrants in a satisfactory immigration status. Satisfactory immigration status includes lawful
permanent residents, Permanent Residence Under Color of Law (PRUCOL) aliens and certain
amnesty aliens.
CodeBenefitsSOCProgram/DescriptionC1Restricted to pregnancy-related, postpartum and emergency servicesNoOmnibus Budget Reconciliation Act (OBRA) Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Aid to the Aged Medically Needy (MN).
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C2Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Aid to the Aged MN, SOC.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C3Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Blind MN.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C4Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Blind MN, SOC.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
CodeBenefitsSOCProgram/DescriptionC5Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Aid to Families with Dependent Children (AFDC) MN.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C6Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
AFDC MN, SOC.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C7Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Disabled MN.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C8Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Disabled MN, SOC.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.C9Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
Medically Indigent (MI) Child. Covers MI persons age 21 or younger 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 to be eligible under aid code 82 until age 22 if they have filed for a State hearing.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D1Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens. Covers eligible aliens who do not have satisfactory immigration status and unverified citizens.
MI Child, SOC. Covers MI persons age 21 or younger who meet the eligibility requirements of MI.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
CodeBenefitsSOCProgram/DescriptionD2Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens Not PRUCOL and Unverified Citizens Long Term Care (LTC) services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Aid to the Aged LTC. Covers persons age 65 or older who are MN and in LTC status.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D3Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens Not PRUCOL and Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Aid to the Aged LTC, SOC. Covers persons age 65 or older who are MN and in LTC status.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D4Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens Not PRUCOL and Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Blind LTC.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
CodeBenefitsSOCProgram/DescriptionD5Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens Not PRUCOL and Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Blind LTC, SOC.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D6Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens Not PRUCOL and Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Disabled LTC.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D7Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens Not PRUCOL and Unverified Citizens LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL and unverified citizens. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Disabled LTC, SOC.
Note: LTC 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 pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
CodeBenefitsSOCProgram/DescriptionD8Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Aliens and Unverified Citizens Pregnant Woman. Covers eligible pregnant alien women who do not have satisfactory immigration status and unverified citizens.
MI Confirmed Pregnancy. Covers persons age 21 or older, with confirmed pregnancy, who meet the eligibility requirements of MI.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.D9Restricted to pregnancy-related, postpartum and emergency servicesYesOBRA Aliens and Unverified Citizens Pregnant Woman. Covers eligible pregnant alien women who do not have satisfactory immigration status and unverified citizens.
MI Confirmed Pregnancy, SOC. Covers persons age 21 or older, with confirmed pregnancy, who meet the eligibility requirements of MI but are not eligible for 185 percent/200 percent or the MN programs.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.E1Restricted to pregnancy-related, postpartum and emergency servicesNoUnverified Citizens. Covers eligible unverified citizen children.
One-Month Medi-Cal to Healthy Families (HF) Bridge.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services. Covers services only to eligible children age 19 or younger, who are unverified citizens.E6FullNoMedi-Cal Access Program (MCAP)-linked (Title XXI). Infants and children age 0 through 1 year old in the Medi-Cal Optional Targeted Low-Income Childrens Program (OTLICP). Provides full-scope, no-cost Medi-Cal coverage to MCAP-linked infants and children age 0 through 1 year old whose family income is above 213 percent up to and including 266 percent of the Federal Poverty Level (FPL).E7FullNoMCAP (Title XXI). Infants and children age 0 through 2 years old. Provides health care services (medical, dental and vision) through Medi-Cal Managed Care Plans with a premium to children whose family income is above 266 percent up to and including 322 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionF3LimitedNoAdult County Inmate Program (ACIP) (Title XIX). Limited to full scope inpatient hospital and inpatient mental health services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.F4RestrictedNoACIP Title (XIX/Title XXI). Restricted to covered inpatient hospital emergency, inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for undocumented inmates in correctional facilities who receive those services off the grounds of the correctional facility.G3LimitedYesACIP (Title XIX). Limited to full scope inpatient hospital and inpatient mental health services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.G4RestrictedYesACIP (Title XIX/Title XXI). Restricted to covered inpatient hospital emergency, inpatient mental health emergency (Title XIX), and inpatient pregnancy-related (Title XXI) services only, for undocumented inmates in correctional facilities who receive those services off the grounds of the correctional facility.G5LimitedNoJuvenile County Ward Program (JCWP) (Title XIX). Limited to all covered inpatient hospital and inpatient mental health services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.G6Restricted NoJCWP (Title XIX/Title XXI). Restricted to covered inpatient hospital emergency, inpatient mental health emergency (Title XIX), and inpatient pregnancy-related (Title XXI) services only, for undocumented juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility. G7Limited YesJCWP (Title XIX). Limited to all covered inpatient hospital and inpatient mental health services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
CodeBenefitsSOCProgram/DescriptionG8Restricted YesJCWP (Title XIX/Title XXI). Restricted to all covered inpatient hospital emergency, inpatient mental health emergency (Title XIX), and inpatient pregnancy-related (Title XXI) services only, for undocumented juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.H1FullNoMedi-Cal OTLICP (Title XXI). Infants. Provides full-scope, no-cost Medi-Cal coverage for infants age 0 through 12 months old, whose familys household income is above 200 percent up to and including 250 percent of the FPL.H2FullNoMedi-Cal OTLICP (Title XXI). Children age 1 through 6 years old. Provides full-scope, no-cost Medi-Cal coverage to children whose familys household income is above 133 percent up to and including 150 percent of FPL.H3FullNoMedi-Cal OTLICP (Title XXI). Children age 1 through 6 years old. Provides full-scope Medi-Cal coverage with a premium payment to children whose familys household income is above 150 percent up to and including 250 percent of the FPL.H4FullNoMedi-Cal OTLICP (Title XXI). Children age 6 through 19 years old. Provides full-scope, no-cost Medi-Cal coverage to children whose familys household income is above 100 percent up to and including 150 percent of the FPL.H5FullNoMedi-Cal OTLICP (Title XXI). Children age 6 through 19 years old. Provides full-scope Medi-Cal coverage with a premium payment to children whose familys household income is above 150 percent up to and including 250 percent of the FPL.H6FullNoHospital Presumptive Eligibility (HPE) (Title XXI). Provides full-scope, no cost Medi-Cal coverage for infants age 0 through 12 months old whose family income is 209 up to and including 266 percent of the FPL.H7FullNoHPE (Title XIX). Provides full-scope, no cost Medi-Cal coverage for children age 1 through 6 years old whose family income is 0 up to and including 142 percent of the FPL.H8FullNoHPE (Title XIX). Provides full-scope, no cost Medi-Cal coverage for children age 6 through 19 years old whose family income is 0 up to and including 133 percent of the FPL.H9FullNoHPE (Title XXI). Provides full-scope, no cost Medi-Cal coverage for children age 1 through 6 years old whose family income is 143 up to and including 266 percent of the FPL.H0FullNoHPE (Title XXI). Provides full-scope, no cost Medi-Cal coverage for children age 6 through 19 years old whose family income is above 133 up to and including 266 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionJ1FullNoCounty Compassionate Release/Medical Probation (CCRP/CMPP) (Title XIX). Recipients eligible for all covered Medi-Cal services.J2FullYesCCRP/CMPP (Title XIX). Recipients eligible for all covered Medi-Cal services.J3RestrictedNoCCRP/CMPP (Title XIX/Title XXI). Restricted to all undocumented recipients covered for emergency, mental health emergency and pregnancy-related (Title XXI) services only.J4RestrictedYesCCRP/CMPP (Title XIX/Title XXI). Restricted to all covered for emergency, mental health emergency (Title XIX) and pregnancy-related (Title XXI) services only. For undocumented recipients who do not have satisfactory immigration status.J5LimitedNoCCRP/CMPP (Title XIX), SOC for the recipients age 65 or older who reside in LTC facilities. Recipients are eligible for all Medi-Cal covered LTC services only.J6RestrictedNoCCRP/CMPP (Title XIX/Title XXI). SOC for undocumented recipients age 65 or older who reside in LTC facilities. Restricted to covered emergency, mental health emergency (Title XIX), and pregnancy-related (Title XXI) services only. Covers all Medi-Cal covered LTC services.J7LimitedNoCCRP/CMPP (Title XIX), SOC for disabled not on supplemental security income (SSI) recipients who reside in LTC facilities. Recipients eligible for all Medi-Cal covered LTC services only.J8RestrictedNoCCRP/CMPP (Title XIX/Title XXI), SOC for disabled, not on SSI, undocumented recipients who reside in LTC facilities. Restricted to all Medi-Cal covered emergency, mental health emergency (Title XIX), and pregnancy-related (Title XXI) services only. Covers all Medi-Cal covered LTC services.
CodeBenefitsSOCProgram/DescriptionK1FullNoCalifornia Work Opportunity and Responsibility to Kids (CalWORKs) Single-Parent Safety Net and Drug/Fleeing Felon Family.K6FullNoCounty Compassionate Release Program (CCRP) and County Medical Probation Program (CMPP) (Title XIX). Newly-eligible, citizen/satisfactory immigration status recipients age 19 through 64 years old with income less than or equal to 138 percent of the FPL, including disabled/blind recipients, with income above 128 up to and including 138 percent of the FPL. Recipients eligible for all covered Medi-Cal services, including mental health services.K7RestrictedNoCCRP and CMPP (Title XIX /Title XXI). Newly-eligible, undocumented recipients age 19 through 64 years old with income less than or equal to 138 percent of the FPL, including disabled/blind recipients, with income above 128 up to and including 138 percent of the FPL. Restricted to all covered emergency services, including labor/delivery and mental health (Title XIX), and all pregnancy-related (Title XXI) services only.K8FullNoCCRP and CMPP (Title XIX). Not newly-eligible, citizen/satisfactory immigration status recipients age 19 through 64 years old, including disabled/blind recipients without Medicare, with income less than or equal to 128 percent of the FPL. Recipients eligible for all covered Medi-Cal services, including mental health services.K9RestrictedNoCCRP and CMPP (Title XIX/Title XXI). Not newly-eligible, undocumented recipients age 19 through 64 years old, including disabled/blind recipients without Medicare, with income less than or equal to 128 percent of the FPL. Restricted to all covered emergency, including mental health (Title XIX) and all covered pregnancy-related (Title XXI) services only.
CodeBenefitsSOCProgram/DescriptionL1FullNoLow Income Health Program (LIHP) Medicaid Covered Expansion (MCE) transition to Medi-Cal (Title XIX). Eligible recipients age 19 through 65 years old enrolled in the LIHP MCE program on December 31, 2013, whose familys income is at or below 138 percent of the FPL.L6FullNoTitle XIX. Expansion adults who are disabled/blind, Eligible recipients age 19 up to 65 years old, with income at or below 128 percent of the FPL, and are citizens or lawfully present.L7RestrictedNoTitle XIX. Expansion adults who are disabled/blind, Eligible recipients age 19 up to 65 years old, with income at or below 128 percent of the FPL, and are undocumented.M1FullNoTitle XIX. Adults Eligible recipients age 19 through 65 years old. Provides full-scope, no-cost Medi-Cal coverage to adults with income at or below 138 percent of the FPL.M2Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoTitle XIX. Adults Eligible recipients age 19 through 65 years old. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to undocumented adults with income at or below 138 percent of the FPL.
Note: LTC 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).M3FullNoTitle XIX. Parents/caretaker relatives. Provides full-scope, no-cost Medi-Cal coverage to citizens/lawfully present parent/caretaker relatives with income at or below 109 percent of the FPL.M4Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoTitle XIX. Parents/caretaker relatives. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to undocumented parents/caretaker relatives with income at or below 109 percent of the FPL.
Note: LTC 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).
CodeBenefitsSOCProgram/DescriptionM5FullNoTitle XXI. Children age 6 through 19 years old. Provides full-scope, no-cost Medi-Cal coverage to citizens/lawfully present children with family income of 108 up to and including 133 percent of the FPL.M6Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoTitle XXI. Children age 6 through 19 years old. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to undocumented children with family income at 108 up to and including 133 percent of the FPL.
Note: LTC 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).M7FullNoTitle XIX. Pregnant women. Provides full-scope, no-cost Medi-Cal coverage to citizens/lawfully present pregnant women with income up to and including 138 percent of the FPL.M8Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoTitle XIX. Pregnant women. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to undocumented pregnant women with income up to and including 138 percent of the FPL.
Note: LTC 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).M9Limited to family planning, pregnancy-related, postpartum and emergency servicesNoTitle XIX. Pregnant women. Provides family planning, pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services to citizens/lawfully present pregnant women with income at 139 up to and including 213 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionM0Limited to family planning, pregnancy-related, postpartum and emergency servicesNoTitle XIX. Pregnant women. Provides family planning, pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services to undocumented pregnant women with income at 139 up to and including 213 percent of the FPL.N7Limited NoACIP (Title XIX). Adult inmates age 19 through 64 years old in county correctional facilities who receive those services off the grounds of the correctional facility, with income 0 percent to 138 percent FPL. Limited to all covered inpatient hospital and inpatient mental health services only.N8RestrictedNoACIP (Title XIX/Title XXI). Adult inmates age 19 through 64 years old in county correctional facilities who receive those services off the grounds of the correctional facility, with income 0 percent to 138 percent FPL. Restricted to covered undocumented inpatient hospital emergency, inpatient mental health emergency (Title XIX), and inpatient pregnancy-related (Title XXI) services only.N0LimitedNoACIP (Title XIX). Adult inmates age 19 through 64 years old enrolled in the Low Income Health Program on December 31, 2013, with income 0 percent to 138 percent FPL. Limited to inpatient hospital services and inpatient mental health services off the grounds of the correctional facility.P1FullNoHPE (Title XIX). Provides full-scope, no cost Medi-Cal coverage for infants age 0 through 12 months old whose family income is at or below 208 percent of the FPL.P2FullNoHPE (Title XIX). Provides full-scope, no cost Medi-Cal coverage for parent-caretakers with income at or below 109 percent of the FPL.P3FullNoHPE (Title XIX). Provides full-scope, no cost Medi-Cal coverage for adults age 19 through 65 years old with income at or below 138 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionP4Limited to specific prenatal ambulatory servicesNoHPE (Title XIX). Provides no cost Medi-Cal coverage limited to specific prenatal ambulatory services for pregnant women with income at or below 213 percent of the FPL.P5FullNoTitle XIX. Children age 6 through 19 years old. Provides full-scope, no-cost Medi-Cal coverage with income at or below 133 percent of the FPL.P6Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoTitle XIX. Children age 6 through 19 years old. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to undocumented children with income at or below 133 percent of the FPL.
Note: LTC 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).P7FullNoTitle XIX. Children age 1 through 6 years old. Provides full-scope, no-cost Medi-Cal coverage with income at or below 142 percent of the FPL.P8Restricted to emergency and LTC servicesNoTitle XIX. Children age 1 through 6 years old. Provides emergency and LTC services to undocumented children with income at or below 142 percent of the FPL.P9FullNoTitle XIX. Infants age 0 through 12 months old. Provides full-scope, no-cost Medi-Cal coverage with income at or below 208 percent of the FPL.P0Restricted to emergency and LTC servicesNoTitle XIX. Infants age 0 through 12 months old. Provides emergency and LTC services to undocumented children with income at or below 208 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionR1FullNoFull-scope Medi-Cal benefits with no SOC for non-citizens eligible for the Trafficking and Crime Victims Assistance Program (TCVAP).
Covers eligible non-citizen individuals who have been the victim of human trafficking, domestic violence or other serious crimes.
TCVAP services and benefits also include English language training, employment-related services and cash assistance. Services and benefits under TCVAP are equivalent to federal benefits available to persons who enter this country with the immigration status of refugee.T1FullNoOTLICP (Title XXI). Children age 6 through 19 years old. Provides full-scope, no cost Medi-Cal benefits to children whose family income is above 160 up to and including 266 percent of the FPL. OTLICP premiums apply.T2FullNoOTLICP (Title XXI). Children age 6 through 19 years old. Provides full-scope, no cost Medi-Cal benefits to children whose family income is above 133 up to and including 160 percent of the FPL.T3FullNoOTLICP (Title XXI). Children age 1 through 6 years old. Provides full-scope, no cost Medi-Cal benefits to children whose family income is above 160 up to and including 266 percent of the FPL. OTLICP premiums apply.T4FullNoOTLICP (Title XXI). Children age 1 through 6 years old. Provides full-scope, no cost Medi-Cal benefits to children whose family income is above 142 up to and including 160 percent of the FPL.T5FullNoOTLICP (Title XXI). Infants age 0 through 12 months old. Provides full-scope, no cost Medi-Cal benefits to children whose family income is above 208 up to and including 266 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionT6Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoOTLICP (Title XXI). Children age 6 through 19 years old, without satisfactory immigration status. Provides no cost benefits restricted to pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and state-funded LTC services to children whose family income is above 160 up to and including 266 percent of the FPL. OTLICP premiums apply.
Note: LTC 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).T7Restricted to pregnancy-related, postpartum, emergency and LTC servicesNoOTLICP (Title XXI). Children age 6 through 19 years old, without satisfactory immigration status. Provides no cost benefits restricted to pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and state-funded LTC services to children whose family income is above 133 up to and including 160 percent of the FPL.
Note: LTC 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).T8Restricted to emergency and LTC servicesNoOTLICP (Title XXI). Children age 1 through 6 years old, without satisfactory immigration status. Provides no cost benefits restricted to emergency and state-funded LTC services to children whose family income is above 160 up to and including 266 percent of the FPL. OTLICP premiums apply.T9RestrictedNoOTLICP (Title XXI). Children age 1 through 6 years old, without satisfactory immigration status. Provides no cost benefits restricted to emergency and state-funded LTC services to children whose family income is above 142 up to and including 160 percent of the FPL.T0RestrictedNoOTLICP (Title XXI). Infants age 0 through 12 months old without satisfactory immigration status. Provides no cost benefits restricted to emergency and state-funded LTC services to children whose family income is above 208 up to and including 266 percent of the FPL.
CodeBenefitsSOCProgram/DescriptionV2LimitedNoPresumptive Eligibility for Coronavirus (COVID-19) Diagnostic Testing, Testing-Related, and Treatment Services Only - Limited Scope. There are no age, income, or resources limits. Satisfactory immigration status is not required.
Provides limited scope benefits to California residents seeking diagnostic testing, testing-related services and treatment related services. Including all medically necessary care such as associated office, clinic, or emergency room visit related to COVID-19.0AFullNoRefugee Cash Assistance. 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. 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.0CHF services only (no Medi-Cal)NoMCAP. Infants enrolled in HF whose familys income is 200 up to and including 300 percent of the FPL, born to a mother enrolled in MCAP. The infant's enrollment in HF is based on the mother's participation in MCAP.0EFullNoMCAP (Title XXI). Provides full-scope, no SOC health care services (medical, dental and vision), through the Medi-Cal managed care delivery system, to pregnant women who are California residents with a modified adjusted gross income (MAGI) above 213 percent and up to and including 322 percent of the FPL. This code is not valid for an infant using the mothers ID.0GFullNoMCAP (Title XXI). Provides full-scope, no SOC health care services (medical, dental, and vision), through fee-for-service Medi-Cal, to pregnant women who are California residents with a MAGI above 213 percent and up to and including 322 percent of the FPL. This code is not valid for an infant using the mothers ID.
CodeBenefitsSOCProgram/Description0LRestricted to pregnancy-related, postpartum, emergency and LTC servicesNoBreast and Cervical Cancer Treatment Program (BCCTP) Transitional coverage until the County makes a determination of Medi-Cal eligibility. It covers:
BCCTP recipients formerly in aid code 0U, without satisfactory immigration status, who are no longer in need of treatment, and/or have creditable health coverage and are not eligible for state-funded BCCTP.
BCCTP recipients formerly in aid code 0V, without satisfactory immigration status, who have turned 65 years old, have other health coverage (OHC), and/or are no longer in need of treatment and have exhausted their 18-month (breast cancer) or 24-month (cervical cancer) time limit.
BCCTP recipients formerly in aid code 0X with creditable health coverage who have exhausted their 18 months (breast cancer) or 24 months (cervical cancer) of state eligibility.
BCCTP recipients formerly in aid code 0Y, age 65 or older who have exhausted their 18 months (breast cancer) or 24 months (cervical cancer) of state eligibility.
Recipients eligible only for transitional federal pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and state-only LTC services.
Note: LTC 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 recipients day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).0MFullNoBCCTP Accelerated Enrollment (AE). Provides temporary AE for full-scope, no SOC Medi-Cal for eligible individuals age 65 or younger who have been diagnosed with breast and/or cervical cancer. Limited to two months.0NFullNoBCCTP AE. Provides temporary AE for full-scope, no SOC Medi-Cal while an eligibility determination is made for eligible individuals age 65 or younger without creditable health coverage who have been diagnosed with breast and/or cervical cancer.0PFullNoBCCTP. Provides full-scope, no SOC Medi-Cal for eligible individuals age 65 or younger who are diagnosed with breast and/or cervical cancer and are without creditable insurance coverage. They remain eligible while still in need of treatment and meet all other eligibility requirements.
CodeBenefitsSOCProgram/Description0RRestricted ServicesNoBCCTP High Cost OHC. State-funded. Provides payment of premiums, co-payments, deductibles and coverage for non-covered cancer-related services for eligible all-age individuals, including undocumented aliens, who have been diagnosed with breast and/or cervical cancer, if premiums, co-payments and deductibles are greater than $750. Breast cancer-related services covered for 18 months. Cervical cancer-related services covered for 24 months.0TRestricted ServicesNoBCCTP State-funded. Provides 18 months of breast cancer treatments and 24 months of cervical cancer treatments for eligible individuals age 65 or older, regardless of citizenship, who have been diagnosed with breast and/or cervical cancer. Does not cover individuals with expensive, creditable insurance. Breast cancer-related services covered for 18 months. Cervical cancer-related services covered for 24 months.0URestricted to pregnancy-related, postpartum, emergency and LTC servicesNoBCCTP Undocumented Aliens. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services to individuals age 65 or younger with unsatisfactory immigration status who have been diagnosed with breast and/or cervical cancer. Does not cover individuals with creditable insurance. State-funded cancer treatment services are covered for 18 months (breast) and 24 months (cervical).
Note: LTC 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 recipients day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).0VRestricted to pregnancy-related, postpartum, emergency and LTC servicesNoPost-BCCTP. Provides limited-scope no SOC Medi-Cal pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services and LTC services for individuals age 65 or younger 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. No cancer treatment. Continues as long as the individual is in need of treatment and, other than immigration, meets all other eligibility requirements.
Note: LTC 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 recipients day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).
CodeBenefitsSOCProgram/Description0WFullNoBCCTP Transitional Coverage. Covers recipients formerly in aid code 0P who no longer meet federal BCCTP requirements due to reaching age 65, are no longer in need of treatment for breast and/or cervical cancer, or have obtained creditable health coverage. Recipients in aid code 0W will continue to receive transitional full-scope Medi-Cal services until the county completes an eligibility determination for other Medi-Cal programs.0XRestricted to pregnancy-related, postpartum, emergency and LTC servicesNoBCCTP Transitional Coverage. Covers recipients formerly in aid code 0U who do not have satisfactory immigration status, have obtained creditable health coverage, still require treatment for breast and/or cervical cancer and have not exhausted their 18 months (breast cancer) or 24 months (cervical cancer) of coverage under state-funded BCCTP.
Recipients eligible only for transitional pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services, state-only LTC services, and co-pays, deductibles and/or non-covered breast and/or cervical cancer treatment and related services.
Note: LTC 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).0YRestricted to pregnancy-related, postpartum, emergency and LTC servicesNoBCCTP Transitional Coverage. Covers recipients formerly in aid code 0U who do not have satisfactory immigration status, have reached 65 years old, still require treatment for breast and/or cervical cancer and have not exhausted their 18 months (breast cancer) or 24 months (cervical cancer) state-funded BCCTP.
Recipients eligible only for transitional pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, emergency services, state-only LTC services, and state-funded cancer treatment and related services.
Note: LTC 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).02FullY/NRefugee Medical Assistance (RMA)/Entrant Medical Assistance. Covers eligible refugees and entrants who are not eligible for Medi-Cal or HF and do not qualify for or want cash assistance.
CodeBenefitsSOCProgram/Description03FullNoAdoption Assistance Program (AAP). 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 (FC) placement without such assistance.04FullNoAAP/Aid for Adoption of Children (AAC). Covers children receiving cash grants under the state-only AAP/AAC program.06FullNoAAP Child. Covers children receiving federal AAP cash subsidies from out of state. Provides eligibility for Continuous Eligibility for Children (CEC) if for some reason the child is no longer eligible under AAP prior to his/her 18th birthday.07FullNoTitle IV-E Extended AAP/FFP Medi-Cal. AAP Federal: A cash grant program to facilitate the ongoing adoptive placement of hard-to-place non-minors, whose initial AAP payment occurred on or after age 16 and are over age 18 but under age 21, and participating in one of five conditions who would require permanent FC placement without such assistance.08FullNoEntrant Cash Assistance (ECA). 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.1EFullNoCraig v. Bonta Aged Pending SB 87 Redetermination. Covers former Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients who are aged, until the county redetermines their Medi-Cal eligibility.1HFullNoFPL Aged. Covers the aged in the Aged and Disabled (A&D) FPL program.1URestricted to pregnancy-related, postpartum and emergency servicesNoRestricted FPL Aged. Covers the aged in the A&D FPL program that do not have satisfactory immigration status.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.1XFullNoAid to the Aged Multipurpose Senior Services Program (MSSP). Allows special institutional deeming rules (spousal impoverishment) for MSSP transitional and non-transitional services individuals age 65 or older.
CodeBenefitsSOCProgram/Description1YFullYesAid to the Aged MSSP. Allows special institutional deeming rules (spousal impoverishment) for MSSP transitional and non-transitional services for individuals age 65 or older.10FullNoAid to the Aged SSI/SSP.13FullY/NAid to the Aged LTC. Covers individuals age 65 or older who are MN and in LTC status.14FullNoAid to the Aged MN.16FullNoAid to the Aged Pickle Eligibles.17FullYesAid to the Aged MN, SOC.18FullNoAid to the Aged In-Home Support Services (IHSS).2AFullNoAbandoned Baby Program. Provides full-scope benefits to children up to three months of age who were voluntarily surrendered within 72 hours of birth pursuant to the Safe Arms for Newborns Act.2CFullNoCounty Childrens Health Initiative Program (CCHIP). Provides county-specific, full-scope medical, dental, mental health and vision benefits to children 18 years of age or younger with a modified adjusted gross income above 266 and up to and including 322 percent of the U.S. Department of Health and Human Services (HHS) poverty guidelines.2EFullNoCraig v. Bonta Blind Pending SB 87 Redetermination. Covers former SSI/SSP recipients who are blind, until the county redetermines their Medi-Cal eligibility.2HFullNoBlind Federal Poverty Level covers blind individuals in the FPL for the Blind Program.2PFullNoApproved Relative Caregiver (ARC) Program. Medi-Cal coverage for foster children and youth age 18 or younger (eligibility ends on the last day of the month of their 18th birthday) participating in the ARC Program who do not qualify for state CalWORKs.2RFullNoARC Program Non-Minor Dependent (NMD). Medi-Cal coverage for foster youth age 18 through 21 years old (eligibility ends on the last day of the month of their 21st birthday) participating in the ARC Program as a NMD who does not qualify for state CalWORKs.2SFullNoARC Program Federal CalWORKs. Medi-Cal coverage for foster children and youth age 18 or younger (eligibility ends on the last day of the month of their 18th birthday) participating in the ARC Program who qualify for federal CalWORKs.2TFullNoARC Program State CalWORKs. Medi-Cal coverage for foster children and youth age 18 or younger (eligibility ends on the last day of the month of their 18th birthday) participating in the ARC Program who qualify for state CalWORKs.
CodeBenefitsSOCProgram/Description2UFullNoARC Program State CalWORKs NMD. Medi-Cal coverage for foster youth age 18 through 21 years old (eligibility ends on the last day of the month of their 21st birthday) participating in the ARC Program as a NMD who qualifies for state CalWORKs.2VFullNoTCVAP. Refugee Medical Assistance (RMA). Covers non-citizen victims of human trafficking, domestic violence and other serious crimes.20FullNoBlind SSI/SSP Cash.23FullY/NBlind LTC.24FullNoBlind MN.26FullNoBlind Pickle Eligibles.27FullYesBlind MN, SOC.28FullNoBlind IHSS.3AFullNoCalWORKs Timed-Out, Safety Net All Other Families.3CFullNoCalWORKs Timed-Out, Safety Net Two-Parent Families.3DFullNoCalWORKs Pending, Medi-Cal Eligible.3EFullNoCalWORKs Legal Immigrant Family Group.3FFullNoCalWORKs Two-Parent Safety Net and Drug/Fleeing Felon Family.3GFullNoCalWORKs Zero Parent Exempt.3HFullNoCalWORKs Zero Parent Mixed.3LFullNoCalWORKs Legal Immigrant Aid to Families.3MFullNoCalWORKs Legal Immigrant Two Parent.3NFullNoAFDC Section 1931(b). Non-CalWORKs.3PFullNoCalWORKs All Families Exempt.3RFullNoCalWORKs Zero Parent Exempt.3TRestricted to pregnancy-related, postpartum and emergency servicesNoInitial Transitional Medi-Cal (TMC). 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.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
CodeBenefitsSOCProgram/Description3UFullNoCalWORKs Legal Immigrant Two Parent Mixed.3VRestricted to pregnancy-related, postpartum and emergency servicesNoAFDC Section 1931(b) Non CalWORKs. Covers those eligible for the Section 1931(b) program who do not have satisfactory immigration status.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.3WFullNoTemporary Assistance for Needy Families (TANF) Timed-Out, Mixed Case.30FullNoCalWORKs All Families.32FullNoTANF Timed-Out.33FullNoCalWORKs Zero Parent.34FullNoAFDC MN.35FullNoCalWORKs Two Parent.36FullNoAid to Disabled Widow(er)s.37FullYesAFDC MN, SOC.38FullNoEdwards v. Kizer.39FullNoInitial TMC (6 months). Provides six months of coverage for those discontinued from CalWORKs or the Section 1931(b) program due to increased earnings or increased hours of employment.4AFullNoOut-of-State AAP. Covers children for whom there is a state-only AAP agreement between any state other than California and adoptive parents.4EFullNoHPE (Title XIX). Covers former foster care children age 26 or younger with no income screening.4FFullNoKinship Guardianship Assistance Payment (Kin-GAP) Cash Assistance. Covers children in the federal program for children in relative placement receiving cash assistance.4GFullNoKin-GAP Cash Assistance. Covers children in the state program for children in relative placement receiving cash assistance.4HFullNoFC children in CalWORKs.4KFullNoEmergency Assistance (EA) FC. Covers juvenile probation cases placed in FC.4LFullNoFC children in Section 1931(b).
CodeBenefitsSOCProgram/Description4MFullNoFormer Foster Youth (FFY).4NFullNoCalWORKs for NMD/FFP Medi-Cal.4SFullNoTitle IV-E Extended for NMD Kin-GAP/FFP Medi-Cal.4TFullNoA federal Title IV-E Kin-GAP that serves former and current foster youth by moving them from FC placements to more permanent placement options through the establishment of a relative guardianship.4UFullNoMedi-Cal coverage for FFY age 18 through 20 years old who were enrolled in a state-sponsored FC program in any state or tribe on their 18th birthday, and not enrolled in Medicaid. Income is exempt. Medi-Cal benefits continue until age 21.4VFullYesTCVAP RMA. Covers non-citizen victims of human trafficking, domestic violence and other serious crimes.4WFullNoState Extended for NMC Kin-GAP/FFP Medi-Cal.40FullNoAFDC-FC. Covers children on whose behalf financial assistance is provided for state only FC placement.42FullNoAFDC-FC. Covers children on whose behalf financial assistance is provided for federal FC placement.43FullNoState Extended FC/FFP Medi-Cal. AFDC-FC State: Covers non-minor dependents (NMDs), age 18 through 21 years old, under AB 12 on whose behalf financial assistance is provided for state-only FC placement.44Restricted to pregnancy-related and postpartum services No213 Percent FPL Pregnant (Income Disregard Program Pregnant). Provides eligible pregnant women of any age with family planning, pregnancy-related services, including services for conditions that may complicate the pregnancy, and postpartum services if family income is at or below 213 percent of the FPL.45FullNoFC. Covers children supported by public funds other than AFDC-FC.46FullNoInterstate Compact on the Placement of Children Child. Covers foster children placed in California from another state. Provides eligibility for CEC if for some reason the child is no longer eligible under FC prior to his/her 18th birthday. Also provides eligibility for the FFY program (aid code 4M) at age 18.47FullNo200 Percent FPL Infant (Income Disregard Program Infant). Provides full Medi-Cal benefits to eligible infants age 0 through 12 months 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 FPL.
CodeBenefitsSOCProgram/Description48Restricted to family planning, pregnancy-related, and postpartum servicesNo213 Percent FPL Pregnant OBRA (Income Disregard Program Pregnant OBRA). Provides eligible pregnant aliens of any age without satisfactory immigration status with family planning, pregnancy-related services, including services for conditions that may complicate the pregnancy, and postpartum services if family income is at or below 213 percent of the FPL.49Full NoTitle IV-E Extended FC/FFP Medi-Cal. AFDC-FC Federal: Covers NMDs age 18 through 21 years old, under AB 12 on whose behalf financial assistance is provided for federal FC placement.5CFullNoMedi-Cal Presumptive Eligibility (PE) (Title XXI), Healthy Families Program (HFP) Transitional Children. Provides no cost, full-scope Medi-Cal coverage with no premium payment for children whose familys income is at or below 150 percent of the FPL during the transition period by the state until the annual eligibility review by the county.5DFullNoMedi-Cal PE (Title XXI), HFP Transitional Children. Provides full-scope Medi-Cal coverage with a premium payment for children whose familys income is above 150 percent up to and including 250 percent of the FPL during the transition period by the state until the annual eligibility review by the county.5EFullNoHFP to the Medi-Cal PE program. Provides immediate, temporary, fee-for-service (FFS), full-scope Medi-Cal benefits to certain children age 19 or younger.5FRestricted to pregnancy-related, postpartum and emergency servicesY/NOBRA Alien Pregnant Woman. Covers eligible pregnant alien women who do not have satisfactory immigration status.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.5JRestricted to pregnancy-related, postpartum and emergency servicesNoSB 87 Pending Disability Program.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.5KFullNoEA FC. Covers child welfare cases placed in EA foster care.
CodeBenefitsSOCProgram/Description5LFullNoEmergency assistance foster care.
For children, youth and non-minor dependents (NMDs) up to age 21 if they do not meet eligibility requirements for the federal Emergency Assistance Foster Care (EA-TANF) program, aid code 5K.5TRestricted to pregnancy-related, postpartum and emergency servicesNoContinuing TMC. Provides an additional six months of emergency services coverage for those beneficiaries who received six months of initial TMC coverage under aid code 3T.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.5VFullNoTCVAP. Covers non-citizen victims of human trafficking, domestic violence and other serious crimes.5WRestricted to pregnancy-related, postpartum and emergency servicesNo Four-Month Continuing (FMC) Pregnancy and Emergency Services Only. Provides four months of pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services, and 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.50Restricted to CMSP emergency services onlyY/NCounty Medical Services Program (CMSP). OBRA/Out of County Care.53Restricted to LTC and related servicesY/NMI LTC services. Covers eligible persons age 21 through 65 years old who are residing in a Nursing Facility Level A or B with or without SOC. For more information about LTC services, refer to the County Medical Services Program (CMSP) section in this manual.
Note: LTC 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).54FullNoFMC Eligibility. Covers persons discontinued from CalWORKs or Section 1931(b) due to the increased collection of child/spousal support.
CodeBenefitsSOCProgram/Description55Restricted to pregnancy-related, postpartum and emergency servicesNoOBRA Not PRUCOL LTC services. Covers eligible undocumented aliens in LTC who are not PRUCOL. Recipients will remain in this aid code even if they leave LTC. For more information about LTC services, refer to the OBRA and IRCA section in this manual.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.
Note: LTC 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).58Restricted to pregnancy-related, postpartum and emergency servicesY/NOBRA Aliens. Covers eligible aliens who do not have satisfactory immigration status.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.59FullNoContinuing TMC (6 months). Provides an additional six months of TMC for beneficiaries who had six months of initial TMC coverage under aid code 39.6AFullNoDisabled Adult Child(ren) (DAC) Blind.6CFullNoDAC Disabled.6EFullNoCraig v. Bonta Disabled Pending SB 87 redetermination. Covers former SSI/SSP recipients who are disabled, until the county redetermines their Medi-Cal eligibility.6GFullNo250 Percent Working Disabled Program.6HFullNoDisabled FPL. Covers the disabled in the A&D FPL program.6JFullNoSB 87 Pending Disability. Covers with no SOC beneficiaries age 21 through 65 years old who have lost their non-disability linkage to Medi-Cal and are claiming disability.6NFullNoFormer SSI No Longer Disabled in SSI Appeals Status.6PFullNoPersonal Responsibility and Work Opportunity Reconciliation Act/ No Longer Disabled Children.6RFullYesSB 87 Pending Disability (SOC). Covers with an SOC those age 21 through 65 years old who have lost their non-disability linkage to Medi-Cal and are claiming disability.
CodeBenefitsSOCProgram/Description6URestricted to pregnancy-related, postpartum and emergency servicesNoRestricted FPL Disabled. Covers the disabled in the A&D FPL program who do not have satisfactory immigration status.
Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services.6VFullNoDepartment of Developmental Services (DDS) Waivers (No SOC).6WFullYesDDS Waivers (SOC).6XFullNoMedi-Cal In-Home Operations (IHO) Waiver (No SOC).6YFullYesMedi-Cal IHO Waiver (SOC).60FullNoDisabled SSI/SSP Cash.63FullY/NDisabled LTC.64FullNoDisabled MN.65FullY/NKatrina-Covers eligible evacuees of Hurricane Katrina.66FullNoDisabled Pickle Eligibles.67FullYesDisabled MN, SOC.68FullNoDisabled IHSS.69Restricted to emergency servicesNo200 Percent Infant OBRA. Provides emergency services only for eligible infants without satisfactory immigration status who are age 0 through 12 months old or beyond 1 year when inpatient status, which began before 1st birthday, continues and family income is at or below 200 percent of the FPL.7AFull No100 Percent Child. Provides full benefits to otherwise eligible children, age 6 through 18 years old or beyond 19 when inpatient status began before the 19th birthday and family income is at or below 100 percent of the FPL.7CRestricted to pregnancy-related, postpartum and emergency servicesNo100 Percent OBRA Child. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services to otherwise eligible children, without satisfactory immigration status who are age 6 through 18 years old or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the FPL.7FValid for pregnancy verification office visit NoPE Pregnancy Verification. This option allows the Qualified Provider (QP) to make a determination of PE for outpatient prenatal care services based on preliminary income information. 7F is valid for pregnancy test, initial visit, and services associated with the initial visit. Persons placed in 7F have pregnancy test results that are negative. . HCPCS codes U0001 and U0002 are benefits. CPT code 87635 is a benefit.
CodeBenefitsSOCProgram/Description7GValid only for specific ambulatory prenatal care servicesNoPE Ambulatory Prenatal Care. This option allows the QP to make a determination of PE for outpatient prenatal care services based on preliminary income information. 7G is valid for specific Ambulatory Prenatal Care Services. Persons placed in 7G have self-attested to the pregnancy or have a pregnancy test result that is positive. QP issues a paper Immediate Needs Card.7HValid only for TB-related outpatient servicesNoTuberculosis (TB) Program. Covers eligible individuals who are TB-infected for TB-related outpatient services only.7JFullNoCEC. Provides full-scope benefits to children age 19 or younger who would otherwise lose their no SOC Medi-Cal.7KRestricted to pregnancy-related, postpartum and emergency servicesNoCEC. Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services with no SOC to children without satisfactory immigration status who are age 19 old who would otherwise lose their no SOC Medi-Cal.7MValid for Minor Consent servicesY/NMinor Consent Program. Covers eligible minors age 12 through 21 years old. Limited to services related to Sexually Transmitted Diseases (STDs), sexual assault, drug and alcohol abuse, and family planning. Paper Immediate Needs Card issued.7NValid for Minor Consent services, limited to pregnancy-related and postpartum servicesNoMinor Consent Program. Covers eligible pregnant minors age 21 or younger. Limited to pregnancy-related services, including services for conditions that may complicate the pregnancy and postpartum services. Paper Immediate Needs Card issued.7PValid for Minor Consent servicesY/NMinor Consent Program. Covers eligible minors age 12 through 21 years old. Limited to services related to STDs, sexual assault, drug and alcohol abuse, family planning, and outpatient mental health treatment. Paper Immediate Needs Card issued.7RValid for Minor Consent servicesY/NMinor Consent Program. Covers eligible minors age 12 or younger. Limited to services related to family planning and sexual assault. Paper Immediate Needs Card issued.7SFullNoExpress Lane Enrollment (ELE) (Title XIX). CalFresh (CF) parents from age 19 through 65 years old who are neither blind nor disabled. Full-scope, no cost Medi-Cal coverage.7TFullNoELE National School Lunch Program (NSLP).
CodeBenefitsSOCProgram/Description7UFullNoELE (Title XIX). CF adults from age 19 through 65 years old who are citizens or lawfully present, and neither blind nor disabled. Full-scope, no cost Medi-Cal coverage.7VFullYesTCVAP. Covers non-citizen victims of human trafficking, domestic violence and other serious crimes.7WFullNoELE (Title XIX). CF children age 19 or younger who are neither blind nor disabled. Full-scope, no cost Medi-Cal coverage.7XFullNoOne-Month Medi-Cal to HF Bridge.71Restricted to dialysis and supplemental dialysis-related servicesY/NMedi-Cal Dialysis Only Program/Medi-Cal Dialysis Supplement Program. Covers eligible persons of any age who are eligible only for dialysis and related services.72FullNo133 Percent Program. Provides full Medi-Cal benefits to eligible children age 1 through 5 years old or beyond 6 when inpatient status, which began before 6th birthday, continues and family income is at or below 133 percent of the FPL.73Restricted to parenteral hyper-alimentation and related expensesY/NTotal Parenteral Nutrition. Covers eligible persons of any age who are eligible for parenteral hyperalimentation and related services and persons of any age who are eligible under the MN or MI programs.74Restricted to emergency servicesNo133 Percent Program (OBRA). Provides emergency services only for eligible children without satisfactory immigration status who are age 1 through 5 years old or beyond 6 when inpatient status, which began before 6th birthday, continues and family income is at or below 133 percent of the FPL.76Restricted to 60-day postpartum servicesNo60-Day Postpartum Program. Provides Medi-Cal at no SOC to women who, while pregnant, were eligible for, applied for, and received Medi-Cal benefits. They may continue to be eligible for all postpartum services and family planning. This coverage begins on the last day of pregnancy and ends the last day of the month in which the 60th day occurs.77Limited to organ transplant anti-rejection medication onlyNoOrgan transplants: Anti-rejection medications program.8EFullNoAccelerated Enrollment. Provides immediate, temporary, FFS, full-scope Medi-Cal benefits for children age 19 or younger.
CodeBenefitsSOCProgram/Description8FCMSP acute inpatient services only Y/NCMSP Companion Aid Code. Used in conjunction with Medi-Cal aid code 53. Aid Code 8F will appear as a special aid code and will entitle the eligible client to acute inpatient services only while residing in a Nursing Facility Level A or B. For more information about LTC services, refer to the County Medical Services Program (CMSP) section in this manual.8GFullNoSeverely Impaired Working Individual.8HFamily PlanningN/AFamily Planning, Access, Care and Treatment (Family PACT). Comprehensive family planning services for low income residents of California with no other source of health care coverage. Health Access Plan card issued.8LFullNoAccelerated Enrollment. Provides immediate, temporary, fee-for-service, full-scope Medi-Cal benefits for adults age 19 or older.8NRestricted to emergency servicesNo133 Percent Excess Property Child Emergency Services Only. Provides emergency services only for eligible children without satisfactory immigration status who are age 1 through 5 years old or beyond 6 when inpatient status, which began before 6th birthday, continues, and family income is at or below 133 percent of the FPL.8PFullNo133 Percent Excess Property Child. Provides full-scope Medi-Cal benefits to eligible children age 1 through 5 years old or beyond 6 when inpatient status, which began before 6th birthday, continues, and family income is at or below 133 percent of the FPL.8RFull No100 Percent Excess Property Child. Provides full-scope benefits to otherwise eligible children, age 6 through 18 years old or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the FPL.8TRestricted to pregnancy-related, postpartum and emergency servicesNo100 Percent Excess Property Child Provides pregnancy-related services, including services for conditions that may complicate the pregnancy, postpartum services and emergency services to otherwise eligible children without satisfactory immigration status who are age 6 through 18 years old or beyond 19 when inpatient status begins before the 19th birthday and family income is at or below 100 percent of the FPL.8UFullNoChild Health and Disability Prevention (CHDP) Gateway Deemed Infant. Provides full-scope, no SOC Medi-Cal benefits for infants born to mothers who were enrolled in Medi-Cal with no SOC in the month of the infants birth.
CodeBenefitsSOCProgram/Description8VFullYesCHDP Gateway Deemed Infant SOC. Provides full-scope Medi-Cal benefits with a SOC for infants born to mothers who were enrolled in Medi-Cal with a SOC in the month of the infants birth and SOC was met.8WFullNoCHDP Gateway Medi-Cal. Provides for the pre-enrollment of children into the Medi-Cal program who are screened as probable for Medi-Cal eligibility, including children with unsatisfactory immigration status. Provides temporary full-scope Medi-Cal benefits with no SOC.8XFullNoCHDP Gateway Title XXI Medi-Cal PE, Targeted Low-Income FPL for Children (Medicaid-Childrens Health Insurance Program Title XXI). Provides for the pre-enrollment of children into the Medi-Cal program who are screened as probable for Medi-Cal eligibility, including children with unsatisfactory immigration status. Provides temporary full-scope Medi-Cal benefits with no SOC.80Restricted to Medicare expensesNoQualified Medicare Beneficiary. Provides payment of Medicare Part A premium and Part A and B coinsurance and deductibles for eligible low income aged, blind or disabled individuals.81FullY/NMI Adults Aid Paid Pending.82FullNoMI Child. Covers MI individuals age 21 or younger 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 to be eligible under aid code 82 until age 22 if they have filed for a State hearing.83FullYesMI Child SOC. Covers MI individuals age 21 or younger who meet the eligibility requirements of MI.84CMSP services only (no Medi-Cal)NoMI Adult. Covers MI adults age 21 through 64 years old who meet the eligibility requirements of MI.
CodeBenefitsSOCProgram/Description85CMSP services only (no Medi-Cal)YesMI Adult. Covers MI adults age 21 through 65 years old who meet the eligibility requirements of MI.86FullNoMI Confirmed Pregnancy. Covers individuals age 21 or older, with confirmed pregnancy, who meet the eligibility requirements of MI.87FullYesMI Confirmed Pregnancy SOC. Covers individuals age 21 or older, with confirmed pregnancy, who meet the eligibility requirements of MI but are not eligible for 185 percent/200 percent or the MN programs.88CMSP services only (no Medi-Cal)NoMI Adult Disability Pending. Covers MI adults age 21 through 65 years old who meet the eligibility requirements of MI and have a pending Medi-Cal disability application.89CMSP services only (no Medi-Cal)YesMI Adult Disability Pending SOC. Covers MI adults age 21 through 65 years old who meet the eligibility requirements of MI and have a pending Medi-Cal disability application.9AEWC only (no Medi-Cal)NoEvery Woman Counts (EWC) recipient identifier. EWC offers benefits to uninsured and underinsured women whose household income is at or below 200 percent of the FPL. EWC offers reimbursement for screening, diagnostic and case management services.
Note: EWC and Medi-Cal are separate programs; however, EWC relies on the Medi-Cal billing process (with few exceptions).9DCCS-only (no Medi-Cal)NoCalifornia Childrens Services (CCS)-only. Children who meet CCS eligibility requirements, but are not Medi-Cal recipients. Assigned only to CCS enrollees of specified CCS 1115 Waiver Demonstration Projects.9HHF services only (no Medi-Cal)NoHF Child. Provides a comprehensive health insurance plan for uninsured children from age 1 through 19 years old whose familys income is at or below 200 percent of the FPL. HF covers medical, dental and vision services to enrolled children.9JGHPPNoGenetically Handicapped Persons Program (GHPP)-eligible. Eligible for GHPP benefits and case management.9KCCSNoCCS-eligible. Eligible for all CCS benefits (such as diagnosis, treatment, therapy and case management).9MCCS MTP onlyNoEligible for CCS Medical Therapy Program (MTP) services only.
CodeBenefitsSOCProgram/Description9NCCS Case ManagementNoEligible for CCS only if concurrently eligible for full-scope, no SOC Medi-Cal. CCS authorization required.9RCCSNoCCS-eligible HF child. A child in this program is enrolled in a HF plan and is eligible for all CCS benefits (such as diagnosis, treatment, therapy and case management). The childs county of residence has no cost sharing for the childs CCS services.9UCCSNoCCS-eligible HF child. A child in this program is enrolled in a HF plan and is eligible for all CCS benefits (such as diagnosis, treatment, therapy and case management). The childs county of residence has county cost sharing for the childs CCS services.9VPFC/PPCWNoCCS-eligible Partners for Children/Pediatric Palliative Care Waiver (PFC/PPCW) program participant. A child assigned this aid code has met the requirements for, and is enrolled in the PFC/PPCW program. Loss of Medi-Cal eligibility will result in the discontinuance of state-funded services and waiver benefits.9WPFC/PPCWNoCCS-eligible PFC/PPCW program participant. A child assigned this aid code has met the requirements for, and is enrolled in both CCS and the PFC/PPCW program. Loss of Medi-Cal eligibility will result in the discontinuance of waiver benefits and reassignment to an appropriate non-waiver based CCS aid code for the child by the responsible CCS county program.
Special Share of Cost These indicators, which appear on a recipients SOC Case Summary
(SOC) Case Indicators: Form, are used to identify the following:
IE Ineligible: A person who is IE for Medi-Cal benefits in the case. An IE person may only use medical expenses to meet the 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 to use medical expenses to 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 RR.
For more information, refer to the Share of Cost (SOC) section of the Part 1 manual.
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RP pgs. 5-6 (11.06.00)
RP pgs. 1-2, 7-8 (02.06.01)
RP pgs. 9-10 (03.06.01)
RP pgs. 1-2, 13-14 new (04.05.01)
RP pgs. 1-2 (09.10.01)
RP pgs. 7-8 (10.04.01)
RP pgs. 5-14, 15-17 new (11.06.01)
RP pgs. 1-6 (01.04.02)
RP pgs. 5-6, 11-12 (03.07.02)
RP pgs. 11-12 (07.08.02)
RP pgs. 5-8, 15-16 (11.07.02)
RP pgs. 1, 2 (02.2003) MTP, section renamed from 200-25 to aid codes
RP pgs. 1-2 (04.04.03)
RP pgs. 1-4, 9-10 (05.14.03)
RP pgs. 15-16 (06.05.03)
RP pgs. 1-2, 15-16 (07.08.03)
RP pgs. 1-2, 15-16 (08.06.03)
RP pgs. 9-10 (02.05.04)
RP pgs. 7-8, 13-14 (03.03.04)
MW pgs. 15-16 (05.06.04)
LB pgs. 1-4, 9-10 (06.04.04)
LB pgs. 1-4 (08.05.04)
LB pgs. 1-2 (12.06.04)
LB pg. 4 (07.05.05) correct Code 3E
LB pgs. 1-4, 9-10 (07.07.05)
LB pgs. 1-13 (05.04.06)
LB pgs. 1-6 (08.04.06)
LB pgs. 7-10 (09.07.06)
BB pgs. 1-15 (11.03.06)
LB pgs. 1-4 (07.06.07)
LB pgs. all (09.13.07) no content change, properties reformat
MT pg. 15 (10.09.07)
LB pgs. 1-19 (05.06.08)
LB pgs. 3-4, 11-12 (06.05.08)
JT pgs. 11, 19 (08.28.08) corrections
JT pgs. 7-12, 15-16 (12.04.08)
JT pgs. 7-8 (07.03.09)
JT pg. 10 (12.06.10)
JT pgs. 10, 16-17 (01.07.11)
JT pgs. 7-19, 20 new (03.06.12)
JT pg. 19 (11.12.12)
JT pgs. 5, 12, 18 (12.07.12)
JT pgs. 5-11, 19 (06.07.13)
AdS pgs. 5, 9 (08.14.13)
JT pgs. 5-20, 21-23 new (12.09.13)
JT pg. 20 (01.07.14) expedited correction
JT pgs. 19, 20 (02.05.14)
JT pgs. 5, 6, 15, 19 (03.07.14)
JT pgs. 19, 20 (04.02.14)
JT pgs. 6, 7, 22, 23 (05.07.14)
JT pgs. 5-8 (06.06.14)
JT pg. 5 (07.03.14)
JT pgs. 22, 23 (09.04.14)
JT pg. 14 (09.02.15)
JT pgs. 12-18 (10.07.15)
MiR pgs. 1-23, 24-27 new (07.08.16)
AA pgs. 7-27, 28, 29 new (08.11.16)
MiR pgs. 7-11 (10.11.16)
MiR pgs. 12-13 (11.09.16)
BB pgs. 6-29, 30 new (01.12.17)
JT pgs. 6-30, 31-33 new (03.15.17)
MiR pg. 29 (07.06.17)
CS pgs. 30-33, 34 new (09.08.17)
KW pgs. 9-34, 35, 36 new (12.11.17)
KW pg. 10 (01.10.18)
HC pgs. 18, 19 (02.08.18)
HC pgs. 9-35, 36 deleted (06.08.18)
JG pgs. 2, 3, 5, 7-15, 17-33 (01.14.19)
SE pg. 26 (02.12.19)
HC pg. 14 (06.10.19)
HC pg. 5 (07.12.19)
AL pgs. 10, 21, 32 (09.12.19)
AQ pgs. 16, 28 (05.13.20) Normal.dotm Cruze, Hannah 4 Microsoft Office Word @ @ kk)@ Fk)@ β) # , T
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