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DHS AID CODES

 

 

The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Eligibility Verification System (EVS). Providers must submit an inquiry to the EVS to verify a recipient’s eligibility for services. The eligibility response returns a message indicating whether or not 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, an aid code is not returned, since the recipient is not considered eligible until the Share of Cost 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 systems and for other non-Medi-Cal programs that need to verify eligibility through EVS.

 

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, Permanently Residing in the U.S. Under Color of Law (PRUCOL) aliens, and certain amnesty aliens.

 

Code

Benefits

SOC

Program/Description

0A

Full

No

Refugee Cash Assistance (RCA).  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.

0C

HF services only (no Medi-Cal)

No

Access for Infants and Mothers (AIM) – Infants enrolled in Healthy Families (HF).  Infants from a family with an income of 200 to 300 percent of the federal poverty level, born to a mother enrolled in AIM.  The infant's enrollment in the HF program is based on their mother's participation in AIM.

0M

Full

No

0N

Full

No

BCCTP – AE.  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.

0P

Full

No

=

Code

Benefits

SOC

Program/Description

0R

Restricted Services

No

BCCTP – High Cost Other Health Coverage (OHC).  State-funded.  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.  Breast cancer-related services covered for 18 months.  Cervical cancer-related services covered for 24 months.

0T

Restricted Services

No

0U

Restricted Services

No

BCCTP – Undocumented Aliens.  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.  Does not cover individuals with creditable insurance.  State-funded cancer treatment services are
18-months (breast) and 24-months (cervical).

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 patient’s day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).

0V

Restricted Services

No


Code

Benefits

SOC

Program/Description

01

Full

No

Refugee Cash Assistance (RAC).  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.

02

Full

Y/N

Refugee Medical Assistance/Entrant Medical Assistance.  Covers eligible refugees and entrants who are not eligible for Medi-Cal or Healthy Families and do not qualify for or want cash assistance.

03

Full

No

Adoption 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 placement without such assistance.

04

Full

No

Adoption Assistance Program/Aid for Adoption of Children (AAP/AAC).  Covers children receiving cash grants under the state-only AAP/AAC program.

06

Full

No

Adoption Assistance Program (AAP) Child.  Covers children receiving federal AAP cash subsidies from out of state.  Provides eligibility for Continued Eligibility for Children (CEC) if for some reason the child is no longer eligible under AAP prior to his/her eighteenth birthday.

08

Full

No

Entrant 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.

1E

Full

No

Craig v. Bonta Aged Pending SB 87 Redetermination.  Covers former Supplemental Security Income/State Supplementary Payment recipients who are aged, until the county redetermines their Medi-Cal eligibility.

1H

Full

No

Federal Poverty Level – Aged (FPL-Aged).  Covers the aged in the Aged and Disabled FPL program.

1U

Restricted to pregnancy and emergency services

No

1X

Full

No

1Y

Full

Yes

 

Code

Benefits

SOC

Program/Description

10

Full

No

Aid to the Aged  – SSI/SSP.

13

Full

Y/N

Aid to the Aged – Long Term Care (LTC).  Covers persons 65 years of age or older who are medically needy and in LTC status.

14

Full

No

Aid to the Aged – Medically Needy. 

16

Full

No

Aid to the Aged – Pickle Eligibles. 

17

Full

Yes

Aid to the Aged – Medically Needy, SOC. 

18

Full

No

Aid to the Aged – In Home Support Services (IHSS).

2A

Full

No

Abandoned Baby Program.  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.

2E

Full

No

Craig v. Bonta Blind – Pending SB 87 redetermination.  Covers former Supplemental Security Income/State Supplementary Payment recipients who are blind, until the county redetermines their Medi-Cal eligibility.

20

Full

No

23

Y/N

Blind – Long Term Care (LTC).

24

Full

No

Blind – Medically Needy. 

26

Full

No

Blind – Pickle Eligibles. 

27

Full

Yes

Blind – Medically Needy, SOC. 

28

Full

No

 

 

 

 

 

 

Code

Benefits

SOC

Program/Description

3A

Full

No

California Work Opportunity and Responsibility to Kids (CalWORKs), Timed-Out, Safety Net – All Other Families. 

3C

Full

No

CalWORKS Timed-Out, Safety Net – Two-Parent Families.

3D

Full

No

CalWORKS – Pending, Medi-Cal Eligible. 

3E

Full

No

CalWORKS – Legal Immigrant – Family Group. 

Full

No

CalWORKS – Zero Parent Exempt.

3H

Full

No

CalWORKS – Zero Parent Mixed.

3L

Full

No

CalWORKs – Legal Immigrant – Aid to families.

3M

Full

No

CalWORKs – Legal Immigrant – Two Parent. 

3N

Full

No

Aid to Families with Dependent Children (AFDC) – 1931(b)
Non-CalWORKS.

Full

No

CalWORKS – All Families – Exempt.

3R

Full

No

CalWORKS – Zero Parent – Exempt.

3T

Restricted to pregnancy and emergency services

No

Initial 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.

3U

Full

No

CalWORKs – Legal Immigrant – Two Parent Mixed.

3V

Restricted to pregnancy and emergency services

No

AFDC – 1931(b) Non CalWORKS.  Covers those eligible for the Section 1931(b) program who do not have satisfactory immigration status. 

3W

Full

No

Temporary Assistance to Needy Families (TANF) Timed-Out, Mixed Case.


Code

Benefits

SOC

Program/Description

30

Full

No

CalWORKS – All Families.

32

Full

No

TANF Timed out. 

33

Full

No

CalWORKS – Zero Parent.

34

Full

No

AFDC – Medically Needy. 

35

Full

No

CalWORKS – Two Parent.

36

Full

No

Aid to Disabled Widow(er)s 

37

Full

Yes

AFDC – Medically Needy SOC. 

38

Full

No

Edwards v. Kizer.

39

Full

No

Initial Transitional Medi-Cal (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.

4A

Full

No

Out-of-State Adoption Assistance Program (AAP).  Covers children for whom there is a state-only AAP agreement between any state other than California and adoptive parents.

4F

No

Kinship Guardianship Assistance Payment (Kin-GAP) Cash Assistance.  Covers children in the federal program for children in relative placement receiving cash assistance.

4G

Full

No

Kin-GAP Cash Assistance.  Covers children in the state program for children in relative placement receiving cash assistance.

4K

Full

No

4M

Full

No

Former Foster Care Children (FFCC).

40

Full

No

42

Full

No

AFDC-Foster Care.  Covers children on whose behalf financial assistance is provided for federal foster care placement.

44

Restricted to pregnancy-related services

No

200 Percent FPL Pregnant (Income Disregard Program – Pregnant).  Provides eligible pregnant women of any age with family planning,

pregnancy-related and postpartum services if family income is at or below 200 percent of the federal poverty level.

 

Code

Benefits

SOC

Program/Description

45

Full

No

Foster Care.  Covers children supported by public funds other than AFDC-FC.

Full

No

Interstate Compact on the Placement of Children (ICPC) 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 foster care prior to his/her eighteenth birthday.  Also provides eligibility for the Former Foster Care Children (FFCC) program (aid code 4M) at age 18.

47

Full

No

200 Percent FPL Infant (Income Disregard Program – Infant).  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.

48

Restricted to pregnancy-related services

5F

Restricted to pregnancy and emergency services

Y/N

5K

Full

No

Emergency Assistance (EA) Foster Care.  Covers child welfare cases placed in EA foster care.

5T

Restricted to pregnancy and emergency services

No

Continuing 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.

5W

Restricted to pregnancy and emergency services

No

Four-Month Continuing Pregnancy and Emergency Services Only.  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.

 

Code

Benefits

SOC

Program/Description

50

Restricted to CMSP emergency services only

53

Restricted to LTC and related services

Y/N

Medically Indigent – Long Term Care (LTC) 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.  For more information about LTC services, refer to the County Medical Services Program (CMSP) 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 patient’s day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).

54

Full

No

55

Restricted to pregnancy and emergency services

No

OBRA Not PRUCOL – Long Term Care (LTC) services.  Covers eligible undocumented aliens in LTC who are not PRUCOL.  Recipients 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.

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 patient’s day-to-day plan of care in the LTC facility (for example, pharmacy, support surfaces and therapies).

58

Restricted to pregnancy and emergency services

Y/N

59

Full

No

Continuing TMC (6 months).  Provides an additional six months of TMC for beneficiaries who had six months of initial TMC coverage under aid code 39.


Code

Benefits

SOC

Program/Description

6A

Full

No

Disabled Adult Child(ren) (DAC) Blind.

6C

Full

No

Disabled Adult Child(ren) (DAC) Disabled.

Full

No

6G

Full

No

6H

Full

No

Disabled – FPL.  Covers the disabled in the Aged and Disabled Federal Poverty Level program.

Full

No

SB 87 Pending Disability.  Covers with no SOC beneficiaries ages 21 to 65 who have lost their non-disability linkage to Medi-Cal and are claiming disability.

6N

Full

No

Former SSI No Longer Disabled in SSI Appeals Status.

6P

Full

No

PRWORA/No Longer Disabled Children. 

6R

Full

Yes

SB 87 Pending Disability (SOC).  Covers with an SOC those ages 21 to 65 who have lost their non-disability linkage to Medi-Cal and are claiming disability.

6U

Restricted to pregnancy and emergency  services

No

Restricted Federal Poverty Level – Disabled.  Covers the disabled in the Aged and Disabled FPL program who do not have satisfactory immigration status.

6V

Full

No

Department of Developmental Services (DDS) Waivers (No SOC). 

6W

Full

Yes

DDS Waivers (SOC). 

6X

Full

No

Medi-Cal In-Home Operations (IHO) Waiver (No SOC). 

6Y

Full

Yes

Medi-Cal In-Home Operations (IHO) Waiver (SOC).


Code

Benefits

SOC

Program/Description

60

Full

No

63

Full

Y/N

Disabled – Long Term Care (LTC)

64

Full

No

Disabled – Medically Needy.

65

Full

Y/N

Katrina-Covers eligible evacuees of Hurricane Katrina.

66

Full

No

Disabled – Pickle Eligibles.

67

Full

Yes

Disabled – Medically Needy SOC.

68

Full

No

69

Restricted to emergency services

No

7A

Full

No

100 Percent Child.  Provides full benefits to otherwise eligible children, ages 6 to 19 or beyond 19 when inpatient status began before the 19th birthday and family income is at or below 100 percent of the federal poverty level.

7C

Restricted to pregnancy and emergency services

No

100 Percent OBRA Child.  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.

7F

Valid for pregnancy verification office visit

No

Presumptive Eligibility (PE) – Pregnancy Verification.  This option allows the Qualified Provider 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.

 

Code

Benefits

SOC

Program/Description

7G

Valid only for ambulatory prenatal care services

No

7H

Valid only for TB-related outpatient services

No

7J

Full

No

Continuous Eligibility for Children (CEC).  Provides full-scope benefits to children up to 19 years of age who would otherwise lose their no Share of Cost Medi-Cal.

7K

Restricted to pregnancy and emergency services

No

7M

Valid for Minor Consent services

Y/N

Minor Consent Program.  Covers eligible minors at least 12 years of age and under the age of 21.  Limited to services related to Sexually Transmitted Diseases, sexual assault, drug and alcohol abuse, and family planning.  Paper Medi-Cal ID Card issued.

7N

Valid for Minor Consent services

No

Valid for Minor Consent services

Y/N

7R

Valid for Minor Consent services

Y/N

7T

Full

No

Express Enrollment – National School Lunch Program (NSLP).

7X

Full

No

One-Month Medi-Cal to Healthy FamiliesBridge. 

 

Code

Benefits

SOC

Program/Description

71

Restricted to dialysis and supplemental dialysis-related services

Y/N

72

Full

No

133 Percent Program.  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. 

73

Restricted to parenteral hyperali-mentation-related expenses

Y/N

Total Parenteral Nutrition (TPN).  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 Medically Needy or Medically Indigent Programs.

74

Restricted to emergency services

No

133 Percent Program (OBRA).  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.

76

Restricted to 60-day postpartum services

No

60-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.

8E

Full

No

8F

 

CMSP acute inpatient services only

Y/N

8G

Full

No

Severely Impaired Working Individual (SIWI). 

8H

Family Planning

N/A

8N

Restricted to emergency services

No

133 Percent Excess Property Child – Emergency Services Only.  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.

 

Code

Benefits

SOC

Program/Description

8P

Full

No

8R

Full

No

8T

Restricted to pregnancy and emergency services

No

100 Percent Excess Property Child – Pregnancy and Emergency Services Only.  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.

8U

Full

No

CHDP TriZetto (formerly Gateway) Deemed Infant.  Provides full-scope, no Share of Cost (SOC) Medi-Cal benefits for infants born to mothers who were enrolled in Medi-Cal with no SOC in the month of the infant’s birth.

8V

Full

Yes

8W

Full

No

CHDP TriZetto (formerly Gateway) Medi-Cal.  Provides for the pre-enrollment of children into the Medi-Cal program who are screened as probable for Medi-Cal eligibility.  Provides temporary full-scope Medi-Cal benefits with no SOC. 

8X

Full

No

CHDP TriZetto (formerly Gateway) Healthy Families.  Provides for the pre-enrollment of children into the Medi-Cal program who are screened as probable for Healthy Families eligibility.  Provides temporary full-scope Medi-Cal benefits with no SOC. 

CHDP services only

No

CHDP.  Covers CHDP eligible children who are also eligible for Medi-Cal emergency, pregnancy-related and Long Term Care (LTC) services.

80

Restricted to Medicare expenses

No

Qualified Medicare Beneficiary (QMB).  Provides payment of Medicare Part A premium and Part A and B coinsurance and deductibles for eligible low income aged, blind or disabled individuals.

81

Full

Y/N

82

Full

No

MI – Child.  Covers medically indigent persons under 21 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.

 

Code

Benefits

SOC

Program/Description

83

Full

Yes

84

CMSP services only (no Medi-Cal)

No

MI – Adult.  Covers medically indigent adults aged 21 and over but under 65 years that meet the eligibility requirements of medically indigent.

85

CMSP services only (no Medi-Cal)

Yes

MI – Adult.  Covers medically indigent adults aged 21 and over but under 65 years, which meet the eligibility requirements of medically indigent.

86

Full

No

MI – Confirmed Pregnancy.  Covers persons aged 21 years or older, with confirmed pregnancy, which meet the eligibility requirements of medically indigent. 

87

Full

Yes

MI – Confirmed Pregnancy SOC.  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.

88

CMSP services only (no Medi-Cal)

No

MI – Adult – Disability Pending.  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.

89

CMSP services only (no Medi-Cal)

Yes

MI – Adult – Disability Pending SOC.  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.

9A

Cancer Detection Programs:  Every Woman Counts only

No

The Cancer Detection Programs:  Every Woman Counts recipient identifier.  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.  Cancer Detection Programs:  Every Woman Counts offers reimbursement for screening, diagnostic and case management services.

 

9H

HF services only (no

Medi-Cal)

No

Healthy Families Child.  Provides a comprehensive health insurance plan for uninsured children from 1 to 19 years of age whose family’s income is at or below 200 percent of the Federal poverty level.  HF covers medical, dental and vision services to enrolled children.

 

Code

Benefits

SOC

Program/Description

9J

GHPP

No

9K

CCS

No

CCS-eligible.  Eligible for all CCS benefits (i.e., diagnosis, treatment, therapy and case management).

9M

CCS Medical Therapy Program only

No

Eligible for CCS Medical Therapy Program services only.

9N

CCS Case Management

No

Eligible for CCS only if concurrently eligible for full-scope, no SOC Medi-Cal.  CCS authorization required.

9R

CCS

No

CCS-eligible Healthy Families child.  A child in this program is enrolled in a Healthy Families plan and is eligible for all CCS benefits
(i.e., diagnosis, treatment, therapy and case management).

 

 

Special Share of Cost (SOC) Case Indicators:  These indicators, which appear on a recipient’s SOC Case Summary Form, are used to identify the following:

 

IE – Ineligible:  A person who is ineligible 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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