GIS 12 MA/019: Individual Categorical Code "84" Children Ages Six through Eighteen from 100% FPL to 133% FPL

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director, Division of Health Reform and Health Insurance Exchange Integration

Subject: Individual Categorical Code "84" Children Ages Six through Eighteen from 100% FPL to 133% FPL

Effective Date: Immediately

Contact Person: Local District Support Unit: Upstate (518)474-8887 NYC (212)417-4500

The purpose of this General Information System (GIS) message is to instruct upstate local departments of social services (LDSS) of the correct coding for children age six through eighteen, with income above 100% of the Federal Poverty Level (FPL) but at or below 133% FPL, who lose Medicaid eligibility but are in their continuous coverage period.

Children who lose Medicaid eligibility and who have a continuous save date (CSD) in WMS are given coverage until the CSD. At the time Medicaid eligibility is lost, their Individual Categorical Code is changed to a continuous-only category code. For the newly expanded group, children age six through eighteen, eligible from 100% FPL to 133% FPL, with Individual Category Code "84", no new continuous-only category code was created. Districts were instructed to continue using Category Code "84" for a period of continuous coverage.

Effective immediately, these children are to be coded "54" when they are in a period of continuous coverage only. The same rules apply to these children, as any child in a continuous-only coverage period. They remain eligible until the date of the CSD unless one of the exceptions applies. For a listing of the applicable exceptions and the codes that will bypass the CSD, see 99 OMM/ADM-3, "Implementation of the Medicaid and Title XXI Provisions of the Balanced Budget Act of 1997."

The department is working on reinstating upstate Individual Category Code "67" for use in the continuous only period for these children. More information will be issued when it is operational.

Please direct any questions to your local district liaison.