MATP ELIGIBILITY Quick Reference Guide - PA.Gov

1 MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services. Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator A 00 SSI Aged Y. A 44 SSI Aged State Supplement Only Y. A 45 SSI Aged Title XIX Nursing Fac N. A 46 SSI Aged Essential/Mandatory Y. A 60 SSI Aged Indv Receiv Dom Care Sup Y. A 62 SSI Aged Indv Receiv PCBH Supplemnt Y. A 64 SSI Aged (FLAC IS B) Y. ACX 00 Act 150 N. B 00 State Blind Pension (SBP) Y. B 80 State Blind Pension (SBP) Y. C 00 TANF Y. C 04 TANF ELA Y. C 06 TANF/TIMEOUT Y. C 07 TANF/Contingency Y. C 08 Extended TANF Y. C 09 Extended TANF-DV Y. C 47 1 Month TANF Diversion N. C 48 2 Month TANF Diversion N. C 49 3 Month TANF Diversion N. C 53 TANF Work Support Phase II Y. C 56 TANF WS Component Y. C 57 TANF WS Phase II-Extended-Continued Y. C 58 TANF WS Phase II-Extended Y. C 59 TANF WS Phase II - DV Y.

2 C 71 Trans Cash Assistance - EMC Y. C 72 Trans Cash Assistance - Non-EMC Y. D 02 GA RFP/RCA (Refugee Cash Assist) Y. D 05 Repatriated National Y. E 00 Emergency Assistance (Federal Fund) N. EIX 00 Early Intervention N. Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 1 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services. Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator J 00 SSI Disabled Y. J 31 SSI Disabled Federal Foster Care Y. J 32 SSI Disabled - Federal Adoption Assistance Y. J 33 SSI Disabled State Foster Care Y. J 35 SSI Adoption Foster Care Othr State Y. J 36 Out of State Adoption Assistance Y. J 37 NMP SPLC Y. J 44 SSI Disabled State Splmnt Only Y. J 45 SSI Disabled Title XIX Nursing Fac N.

3 J 46 SSI Disabled Essential/Mandatory Y. J 60 SSI Disabled Indv Rec Dom Care Sup Y. J 62 SSI Disabled Indv Rec PCBH Sup Y. J 64 SSI Disabled (FLAC IS B) Y. LTC 00 Medicaid Long Term Care Application N. M 00 SSI Blind Y. M 44 SSI Blind State Splmnt Only Y. M 45 SSI Blind Title XIX Nursing Fac N. M 46 SSI Blind Essential/Mandatory Y. M 60 SSI Blind Indv Receiv Dom Care Sup Y. M 62 SSI Blind Indv Receiv PCBH Sup Y. M 64 SSI Blind (FLAC IS B) Y. MAF 00 Select Plan for Women N. MAW 00 Medicaid Waiver Application N. MG 00 Modified Adjusted Gross Income (MAGI) Y. MG 17 Hospital Based Presumptive ELIGIBILITY Y. MG 18 MAGI NMP SMA Income Inelig Y. MG 19 MAGI (Newly Eligible) Y. MG 27 MAGI (Below TANF NMP Limit) Y. MG 38 SCI Inmate N. MG 39 County Inmate N. MG 71 TMA MAGI Y. Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 2 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services.

4 Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator MG 90 Enhanced FMAP Y. MG 91 Newly Eligible - MA Y. MG 92 Former MNO - MA Y. MHX 00 Mental Health N. MRX 00 OMR Base N. PA 00 NMP Aged Y. PA 01 NMP Aged Refugee Y. PA 21 NMP Aged spend - down (Monthly Auth) Y. PA 22 NMP Aged spend - down (Ongoing Auth) Y. PA 66 Specif Low Inc. Med. Benefit Buy-In Y. PA 80 With Buyin Y. PA 81 Aged Disabled Adult Child w/Buy-In Y. PA 84 Aged Pickle Indv Y. PA 85 Aged Disable Emp Indv Y. PA 86 Aged QDWI Indv N. PAN 00 Aged Long Term Care (NMP) N. PAN 66 Aged Long Term Care w/Buyin (NMP) N. PAN 80 Aged Long Term Care w/Buyin (NMP) N. PAW 00 Aged Waiver Program (NMP) Y. PAW 66 Aged Waiver Program w/Buyin (NMP) Y. PAW 80 Aged Waiver Program w/Buyin (NMP) Y. PAW 81 Special SSI Waiver - AGED - DAC Y. PAW 84 Special SSI Waiver - AGED - PICKLE Y. PAW 85 Special SSI Waiver-AGED-Disab Emp Y. PC 00 NMP TANF Y. PC 02 NMP TANF Refugee (RMA) Y. PC 03 NMP TANF Rep Unaccompanied Minor Y.

5 Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 3 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services. Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator PC 30 Release from YDC Y. PC 31 NMP TANF Federal Foster Care Y. PC 32 NMP TANF Fed Adoption Assistance Y. PC 33 NMP TANF State Foster Care Y. PC 34 NMP TANF State Adoption Assistance Y. PC 35 Adoption ASST-FSTR Care Other State Y. PC 36 Out of State Adoption Assistance Y. PC 37 Subsidized Permanent Leqal Custodianship (SPLC) Y. PC 38 SCI Inmate N. PC 39 County Inmate N. PC 40 TANF Related Medical Assistance NMP Y. PCN 31 Federal Foster care Long Term Care N. PCN 32 Federal Adoption Asst Long Term Car N. PCN 33 State Foster care Long Term Care N.

6 PCN 34 State Adoption Asst Long Term Care N. PCN 35 Out of State Foster care Long Term N. PCN 36 Out of State Adopt Asst Long Term C N. PCN 37 Subsidized PLC Long Term Care N. PCW 00 Medicaid for Special Groups NMP Waiver Program Y. PCW 02 Special Groups Waiver Programs Y. PD 00 NMP GA Chronically Needy Y. PD 02 NMP GA Chronically Needy Refugee Y. PD 21 NMP GA Chron Need spend - down (Mnth) Y. PD 22 NMP GA Chron Need spend - down (Ongo) Y. PD 38 SCI Inmates N. PD 39 County Inmates N. PG 00 Elderly Med Cost Sharing Healthy Horizons N. PH 00 Healthy Horizons Y. PH 20 Breast & Cervical Cancer Y. PH 38 SSA Disabled SCI Inmates N. PH 39 SSA Disabled County Inmates N. PH 80 Cat. Needy Healthy Horiz w/Buyin Y. PH 95 H. Horiz Child Spec Needs Y. PH 97 SSI Pending/Child/Special Needs Y. Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 4 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services.

7 Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator PI 00 Medically Improved MAWD Y. PI 66 Med Improved MAWD Elig for SLMB Y. PI 80 Med Improved MAWD Elig Med Buy-In Y. PJ 00 NMP Disabled Y. PJ 21 NMP Disabled spend - down (Monthly) Y. PJ 22 NMP Disabled spend - down (Ongoing) Y. PJ 66 Specif Low Inc. Med. Benefit Buy-In Y. PJ 80 With Buyin Y. PJ 81 Disabled Adult Child w/Buy-In Y. PJ 83 Disabled Widow(er) Y. PJ 84 Disabled Pickle Indv Y. PJ 85 Disabled Disable Emp Indv Y. PJ 86 Disabled QDWI Indv N. PJN 00 Disabled Long Term Care (NMP) N. PJN 66 Disabled Long Term Care w/Buyin NMP N. PJN 80 Disabled Long Term Care w/Buyin NMP N. PJW 00 Disabled Waiver Program (NMP) Y. PJW 66 Disabled Waiver Program w/Buyin NMP Y. PJW 80 Disabled Waiver Program w/Buyin NMP Y. PJW 81 Special SSI Waiver - Disabled - DAC Y. PJW 83 Special SSI Waiver - Disabled widow Y. PJW 84 Special SSI Waiver-DISABLED-PICKLE Y. PJW 85 Special SSI Waiver-DISAB-Disab Emp Y.

8 PM 00 NMP Blind Y. PM 01 NMP Blind Refugee Y. PM 21 NMP Blind spend - down (Ongoing Mnth) Y. PM 22 NMP Blind spend - down (Ongoing Auth) Y. PM 66 Specif Low Inc. Med. Benefit Buy-In Y. PM 80 With Buy-In Y. PM 81 Blind Disabled Adult Child w/Buy-In Y. PM 84 Blind Pickle Indv Y. PM 85 Blind Disable Emp Indv Y. PM 86 Blind QDWI Indv N. PMN 00 Blind Long Term Care (NMP) N. PMN 66 Blind Long Term Care w/Buyin NMP N. PMN 80 Blind Long Term Care w/Buyin NMP N. Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 5 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services. Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator PMW 00 Blind Waiver Program (NMP) Y. PMW 66 Blind Waiver Program w/Buyin NMP Y.

9 PMW 80 Blind Waiver Program w/Buyin NMP Y. PMW 81 Special SSI Waiver - Blind - DAC Y. PMW 84 Special SSI Waiver-BLIND-PICKLE Y. PMW 85 Special SSI Waiver-BLIND-Disab Emp Y. PS 17 NMP SMA Presumptive ELIGIBILITY Y. PSF 14 Family Planning Services Program N. PSF 15 Family Planning Services Program N. PVN 00 VA Facility Long Term Care N. PVN 66 VA Long Term Care w/Buyin (NMP) N. PVN 80 VA Long Term Care w/Buyin (NMP) N. PW 00 MAWD Y. PW 66 MAWD Elig for SLMB Y. PW 80 MAWD Elig for Medicare Buy-In Y. SC 00 Family Works N. SC 82 Family Works-Preliminary Screening N. TA 00 MNO Aged Y. TA 22 SSI MNO Aged spend down Y. TA 65 Spec Low Inc Med Benef. Pt B Buyin N. TA 66 Specif Low Inc Med Benef. Buyin/MNO Y. TA 67 Qual. Individual (QI-1) Buy-In Only N. TA 80 With Buy-In Y. TAN 00 Aged Long Term Care (MNO) N. TAN 66 Aged Long Term Care w/Buyin (MNO) N. TAN 80 Aged Long Term Care w/Buyin (MNO) N. TAW 00 Aged Waiver Program (MNO) Y. TAW 66 Aged Waiver Program w/Buyin (MNO) Y. TAW 80 Aged Waiver Program w/Buyin (MNO) Y.

10 TC 00 MNO TANF Y. TC 22 TANF MNO Abs/Inc spend down Y. TD 00 MNO GA Chronically Needy Y. TD 22 GA MNO spend down Y. Last Revised: 06/01/2016 Both the ELIGIBILITY Verification System (EVS) and this Chart should PA-DHS\OMAP\BMCO\MATP be used simultaneously when determining MATP Eligibilty. 6 of 7. MATP ELIGIBILITY . Quick Reference Guide If the consumer's eligibilty shows two categories, as long as one of the codes is showing eligible; then the consumer is eligible for MATP Services. Category of Program Valid MATP. Assistance Status Code Recipient Program Status Description Indicator TJ 00 MNO Disabled Y. TJ 01 MNO Disabled Refugee Y. TJ 22 SSI MNO Disab spend down Y. TJ 65 Spec Low Inc Med Benef. Pt B Buyin N. TJ 66 Specif Low Inc Med Benef. Buyin MNO Y. TJ 67 Qual. Individual (QI-1) Buy-In Only N. TJ 80 With Buy-In Y. TJN 00 Disabled Long Term Care (MNO) N. TJN 66 Disabled Long Term Care w/Buyin MNO N. TJN 80 Disabled Long Term Care w/Buyin MNO N. TJW 00 Disabled Waiver Program (MNO) Y.