| A |
Pregnant Woman; income greater than the Family Assist Standard and less than or equal to 133% of FPL |
Yes |
n/a |
| AI |
(Unborn) Pregnant Woman Noncitizen, Inmate, or in State-Operated Facility; income less than or equal to 213% FPL |
Yes |
n/a |
| B |
Pregnant Woman income greater than 133% and less than or equal to 213% of FPL |
Yes |
n/a |
| BI |
Post-Partum Woman Noncitizen, Inmate, or in State-Operated Facility; income less than or equal to 213% FPL |
Yes |
n/a |
| C |
Less than age 1 and Mother Medicaid Eligible; income greater than Family Assist Standard and less than or equal to 147% of FPL |
Yes |
n/a |
| D |
Less than age 1 and Mother Medicaid Eligible; income greater than 147% and less than or equal to 213% of FPL |
Yes |
n/a |
| E |
Less than age 1 and Mother Not Medicaid Eligible; income greater than Family Assist Standard and less than or equal to 147% of FPL |
Yes |
n/a |
| F |
Greater than or equal age 1 and less than age 6; income greater than Family Assist Standard and less than or equal to 147% FPL |
Yes |
n/a |
| FA |
Family Care - adult; income greater than Family Health Spenddown Standard and less than or equal to 49% FPL |
Yes |
n/a |
| FB |
Family Care - adult; income greater than 49% and less than or equal to 90% FPL |
Yes |
n/a |
| FC |
Family Care - adult; income greater than 90% and less than or equal to 138% FPL |
Yes |
n/a |
| FG |
Family Planning - Presumptive; income less than or equal to 213% FPL |
No |
Family Planning Services Only |
| FI |
Family Planning Application Only; income less than or equal to 213% FPL |
No |
Family Planning Services Only |
| FJ |
Family Planning Medical Application; income less than or equal to 213% FPL |
No |
Family Planning Services Only |
| FP |
Illinois Healthy Women (Family Planning Waiver) |
No |
Family Planning Services Only |
| FS |
Veterans Care - spouse of a Veteran |
No |
Long Term Care & Non-Emergency Transportation Not Covered |
| FV |
Veterans Care |
No |
Long Term Care & Non-Emergency Transportation Not Covered |
| FW |
Illinois Healthy Women expansion (Family Planning Waiver) - no TPL |
No |
Family Planning Services Only |
| FX |
Illinois Healthy Women expansion (Family Planning Waiver) - with TPL |
No |
Family Planning Services Only |
| F1 |
CHIPRA 214; age less than 19; Lawfully Permanent Resident (LPR) less than 5 years; income less than or equal to 147% FPL |
Yes |
n/a |
| F2 |
CHIPRA 214; age less than 19; Lawfully Present in US; income less than or equal to 147% FPL |
Yes |
n/a |
| G |
Greater than or equal to age 6; greater than Family Assist Standard and less than or equal to 108% FPL |
Yes |
n/a |
| G5 |
ACA Adult with SSI Recipient; income less than or equal to 138% FPL |
Yes |
n/a |
| G6 |
ACA Adult with income less than or equal to 103% FPL and SSA-Disability Income |
Yes |
n/a |
| G7 |
ACA Adult with income greater than 103% and less than or equal to 138% FPL and SSA-Disability Income |
Yes |
n/a |
| G8 |
ACA Adults (newly eligible) - no SSI or SSA Disability Income; other income less than or equal to 138% FPL |
Yes |
n/a |
| G9 |
ACA Adults - Former Foster Care (newly eligible) greater than or equal to age 19 and less than or equal to age 26 |
Yes |
n/a |
| H |
Greater than or equal to age 6; income greater than 108% and less than or equal to 147% FPL - with no TPL |
Yes |
n/a |
| I |
Greater than or equal to age 6; income greater than 108% and less than or equal to 147% FPL - with TPL |
Yes |
n/a |
| IB |
Infant Born to a Mother who is a Noncitizen, Inmate or Recipient in State-Operated Facility |
Yes |
n/a |
| IF |
DOC inmate; not otherwise eligible |
No |
Limited Inpatient & Outpatient Hospital Services |
| M |
Family Assist - income less than or equal to Family Assist Standard |
Yes |
n/a |
| MA |
Transitional Medicaid - match |
Yes |
n/a |
| MB |
Family Support Community |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MC |
Family Support Residential |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MD |
DCFS child - extended medical eligibility - match |
Yes |
n/a |
| ME |
Children's mental health (extension) - screening, assessment and support services |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MF |
Specialized Family Support |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MH |
Children's mental health (initial authorization) - screening, assessment and support services |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MJ |
LTC Provisional Eligibility - Title 19 |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MK |
LTC Provisional Eligibility - Unmatchable |
Yes |
n/a |
| ML |
Mobile Crisis |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MM |
MPE - match - Medical Presumptive Eligibility - Pregnant Woman |
No |
Inpatient Services Not Covered |
| MP |
MPE - no match - Medical Presumptive Eligibility - Undocumented Pregnant Woman |
No |
Inpatient Services Not Covered |
| MQ |
Temporary Medical Assistance - no match |
Yes |
Long Term Care Not Covered |
| MR |
DHS Mental Health conversion-DHS Social Services (Service Package B) |
No, Limited Medical Benefits |
additional information in the Provider Handbook |
| MX |
COVID Screening - with TPL |
No |
COVID Testing Only |
| MY |
COVID Screening - without TPL meets citizenship requirements |
No |
COVID Testing Only |
| MZ |
COVID Screening - without TPL does not meet citizen requirements |
No |
COVID Testing Only |
| NC |
Otherwise Ineligible; Non-citizen eligible for renal services, kidney transplant, and immunosuppressive drugs only |
No |
Renal Dialysis Services Only |
| ND |
Non-citizen; court-ordered medical coverage |
Yes |
Non-Emergency Transportation Services Not Covered |
| NE |
Non-citizen eligible for emergency services |
Yes |
Non-Emergency Transportation Services Not Covered |
| NI |
Health Coverage for Immigrant Adults; age equal to or greater than 42 and less than or equal to 64; income less than or equal to 138% FPL; not eligible for federal match |
Yes |
n/a |
| PA |
Presumptive eligibility children; income greater than 147% and less than or equal to 209% FPL; the days prior to registration |
Yes |
n/a |
| PB |
Presumptive eligibility children; income less than or equal to 147% FPL; the days prior to registration |
Yes |
n/a |
| PH |
Presumptive eligibility children; income greater than 147% FPL and less than or equal to 209% of FPL |
Yes |
n/a |
| PL |
Presumptive eligibility children; income less than or equal to 147% FPL |
Yes |
n/a |
| PM |
Adult Presumptive Eligibility - MAGI Adults only - income less than 138% FPL |
Yes |
n/a |
| PN |
Adult Presumptive Eligibility - AABD Adults |
Yes |
n/a |
| RY |
All Kids Share; age less than 19; lawfully present in US; income greater than 147% and less than or equal to 157% FPL; with TPL |
Yes |
n/a |
| RZ |
All Kids Premium 1; age less than 19; lawfully present in US; income greater than 157% and less than or equal to 209% FPL; with TPL |
Yes |
n/a |
| S |
All Kids Share; age less than 19; income greater than 147% and less than or equal to 157% FPL; no TPL |
Yes |
n/a |
| SL |
All Kids Share; age less than 19; income greater than 147% and less than or equal to 157% FPL; with TPL |
Yes |
n/a |
| TA |
Child in Foster Care |
Yes |
n/a |
| TB |
Child in Foster Care |
Yes |
n/a |
| TC |
Child in KinGap (Guardianship) |
Yes |
n/a |
| TD |
Child in KinGap (Guardianship) |
Yes |
n/a |
| TE |
Adoption Assistance |
Yes |
n/a |
| TF |
Foster Care Continuous Eligibility without legal |
Yes |
n/a |
| TG |
Foster Care Continuous Eligibility with legal |
Yes |
n/a |
| TT |
Victims of Trafficking, Torture or Other Serious Crimes |
Yes |
n/a |
| TV |
Aslyees and Torture Victims |
Yes |
n/a |
| XJ |
DCFS; Group 09; adoption assistance; out-of-state placement, eligible for Medicaid in other state. |
Yes |
n/a |
| XU |
DCFS; Group 30; Department of Corrections (not DCFS) |
Yes |
n/a |
| XV |
DCFS; Group 31; child of ward |
Yes |
n/a |
| YA |
MCHIP- Former Share; age less than 19; income greater than 147% FPL and less than or equal to 157% FPL; no TPL |
Yes |
n/a |
| YB |
MCHIP - Share; age less than 19; LPR < 5 yrs; income greater than 147% FPL and less than or equal to 157% FPL; no TPL |
Yes |
n/a |
| YC |
Former Share; age less than 19; income greater than 147% FPL and less than or equal to 157% FPL; undocumented |
Yes |
n/a |
| YD |
MCHIP - Former Premium Level 1; age less than 19; income greater than 157% FPL and less than or equal to 209% FPL; no TPL |
Yes |
n/a |
| YE |
MCHIP - Former Premium Level 1; age less than 19; LPR less than 5 yrs; income greater than 157% FPL and less than or equal to 209% FPL; no TPL |
Yes |
n/a |
| YF |
Former Premium Level 1; age less than 19; income less than 157% FPL and less than or equal to 209% FPL; undocumented |
Yes |
n/a |
| YG |
MCHIP - Former Premium Level 2; age less than 19; income greater than 209% FPL and less than or equal to 318% FPL; no TPL |
Yes |
n/a |
| YH |
MCHIP - Former Premium Level 2; age less than 19; LPR less than 5 yrs - income greater than 209% FPL and less than or equal to 318% FPL; no TPL |
Yes |
n/a |
| YI |
Former Premium Level 2; age less than 19; income greater than 209% FPL and less than or equal to 318% FPL; undocumented |
Yes |
n/a |
| ZX |
All Kids Premium Level 2; age less than 19; income greater than 209% and less than or equal to 318% FPL; no TPL |
Yes |
Non-Emergency Transportation Services and Over-the-Counter Medication Not Covered |
| ZY |
All Kids Premium Level 2; age less than 19; income greater than 209% and less than or equal to 318% FPL; with TPL |
Yes |
Non-Emergency Transportation Services and Over-the-Counter Medication Not Covered |
| Z8 |
All Kids Premium Level 1; age less than 19; income greater than 157% and less than or equal to 209% FPL; with TPL |
Yes |
n/a |
| Z9 |
All Kids Premium Level 1; age less than 19; income greater than 157% and less than or equal to 209% FPL; no TPL |
Yes |
n/a |
| 1A |
All Kids Assist; less than age 19; income less than or equal to 147% FPL; undocumented |
Yes |
n/a |
| 2A |
All Kids Share; less than age 19; income greater than 147% and less than or equal to 157% FPL; undocumented |
Yes |
n/a |
| 3B |
All Kids Premium Level 1; less than age 19; income greater than 157% and less than or equal to 209% FPL; undocumented |
Yes |
n/a |
| 3K |
CHIPRA 214; less than age 19; legal permanent residents less than 5 years; income greater than 147% and less than or equal to 157% FPL; no TPL |
Yes |
n/a |
| 3L |
CHIPRA 214; less than age 19; lawfully present in US; income greater than 147% less than or equal to 157% FPL; no TPL |
Yes |
n/a |
| 3M |
CHIPRA 214; less than age 19; legal permanent residents less than 5 years; income greater than 157% and less than or equal to 209% FPL; no TPL |
Yes |
n/a |
| 3N |
CHIPRA 214; less than age 19; lawfully present in US; income greater than 157% and less than or equal to 209% FPL; no TPL |
Yes |
n/a |
| 3P |
CHIPRA 214; less than age 19; legal permanent residents less than 5 years; income greater than 209% less than or equal to 318% FPL; no TPL |
Yes |
Non-Emergency Transportation Services and Over-the-Counter Medication Not Covered |
| 3Q |
CHIPRA 214; less than age 19; lawfully present in US; income greater than 209% and less than or equal to 318%; no TPL |
Yes |
Non-Emergency Transportation Services and Over-the-Counter Medication Not Covered |
| 3R |
All Kids Premium Level 2; less than age 19; income greater than 209% and less than or equal to 318% FPL; undocumented |
Yes |
Non-Emergency Transportation Services and Over-the-Counter Medication Not Covered |
| 4 |
All Kids Prior Coverage; less than age 19; income greater than 147% and less than or equal to 318% FPL |
Yes |
n/a |
| 4B |
All Kids Prior Coverage; less than age 19; income greater than 147% and less than or equal to 209% FPL; undocumented |
Yes |
n/a |
| 6 |
AABD expansion income greater than Family Health Spenddown Standard and less than or equal to 100% FPL |
Yes |
n/a |
| 6I |
Health Benefits for Immigrant Seniors; age equal to or greater than 65; income less than or equal to 100% FPL; not eligible for federal match programs due to Immigration status |
Yes |
Long Term Care Not Covered |
| 6S |
Child with SSI income; age less than 19; income greater than 147% FPL and less than or equal to 318% FPL |
Yes |
n/a |
| 7 |
AABD Spenddown; income over 100% FPL |
Yes, if Spenddown is Met |
n/a |
| 7I |
Health Benefits for Immigrant Seniors with Spenddown; age equal to or greater than 65; income over 100% FPL; not eligible for federal match programs due to Immigration status |
Yes, if Spenddown is Met |
Long Term Care Not Covered |
| 8 |
Health Benefits for Workers with Disabilities; age equal to 16 and less than or equal to 64; income greater than 100% and less than or equal to 200% FPL |
Yes |
n/a |
| 8A |
Health Benefits for Workers with Disabilities; age equal to 16 and less than or equal to 64; income greater than 200% and less than or equal to 350% FPL |
Yes |
n/a |
| 9 |
Breast and Cervical Cancer; less than or equal to 200% FPL |
Yes |
n/a |
| 9A |
Breast and Cervical Cancer; expansion income greater than 200% and less than or equal to 250% FPL |
Yes |
n/a |
| 9B |
Breast and Cervical Cancer expansion; income greater than 250% and less than or equal to 400% FPL |
Yes |
n/a |
| 9C |
Breast and Cervical Cancer expansion; income greater than 400% FPL |
Yes |
n/a |
| n/a |
Blank MangP codes are valid codes but when combined with QMB Codes have different meanings. |
n/a |
n/a |
| n/a |
Blank MangP Code with QMB STAT= DUAL |
Yes |
Medicare Pays First, HFS pays Part A & B, copays and deductibles |
| n/a |
Blank MangP Code with QMB STAT = MDSL and Spenddown Code 1 or 3 |
Yes |
HFS Medical Services if Spenddown is Met, payment for Part B |
| n/a |
Blank MangP Code with QMB STAT = QI-1 and Spenddown Code 1 or 3 |
Yes |
HFS Medical Services if Spenddown is Met, payment for Part B |
| n/a |
Blank MangP Code with QMB STAT = QI-1 and NO Spenddown Code |
QI-1 Only |
No HFS Medical Services, payment for Part B |
| n/a |
Blank MangP Code with QMB STAT = SLIB |
SLIB Only |
No HFS Medical Services, payment for Part B |
| n/a |
Blank MangP Code with QMB STAT= YES |
QMB Only |
No HFS Medical Services, payment for Part A & B copays and deductibles |
