MARYLAND MEDICAL CARE PROGRAM

COVERAGE GROUPS

Version November 2006

- Maryland Medical Care Program Coverage Groups 

- Quick Reference Guide to Medical Care Program

  Coverage Groups and HealthChoice Eligibility    

What is a Maryland Medical Care Program Coverage Group?

A coverage group is a group of people who meet specific criteria to receive Medical Assistance (also known as Medicaid or MA) or other benefits through Maryland’s Medical Care Programs.  Recipients in most coverage groups receive a red and white Medical Care Program card, unless otherwise indicated in this narrative.  There are many ways for people to qualify for medical care benefits (for example, by being a recipient of Supplemental Security Income (SSI) or meeting technical and financial tests for Medical Assistance, Qualified Medicare Beneficiary (QMB), or Pharmacy Assistance).  Sometimes the only difference between coverage groups is a single criterion.  For example, children under 1 year old are in one group, while those between 1 and 6 years old are in another.  Families whose income is within the medically needy income limit are in one group, and those with income exceeding the limit (spenddowns) are in another.  Consequently, there are many different coverage group codes to describe how recipients qualify for benefits. 

How many coverage group codes?

There are 68 coverage group codes in MMIS-II.  Each coverage group is identified by a code--one letter designating the “track,” followed by two numbers (e.g., F01).  Some coverage group codes are assigned to recipients by CARES as part of an eligibility determination.  Other codes originate with the Department of Health and Mental Hygiene (DHMH), to identify recipients enrolled in programs that are not included in CARES.  Generally, users do not need to know all 68 coverage groups, but should be familiar with the tracks (the alpha designation for coverage groups).

A track is a group of related coverage groups.  There are 11 tracks.  The same basic eligibility rules are used for all coverage groups in the same track (as in the families and children “F” track), or all groups within the track share a common characteristic (as in the “E” track, which includes all children covered based on placement in foster care or subsidized adoption).  Knowing the basic requirements for each track enables the user to quickly understand a recipient’s enrollment in a particular coverage group.

  

The most frequently used tracks are for families and children (FAC) (F-track), low income pregnant women and children in the Maryland Children’s Health Program (MCHP) (P-track) and aged, blind, or disabled individuals (ABD) (S-track).  Long term care (LTC) cases have their own tracks, one for ABD individuals (L-track) and another for children and Temporary Cash Assistance (TCA) adults (T-track).

 

Several coverage groups have few, if any, recipients, such as the FAC LTC spend down group (T99).  This is for a child in LTC, who has monthly income so high that it exceeds the LTC facility’s cost of care, and places the child in spenddown.  While this rarely occurs, the group is needed because it is covered under the State Plan. 

 

Some groups are included in this Guide even though they are obsolete or are otherwise no longer used, such as D01 and D03 for the MCHP Premium Employer-Sponsored Insurance groups.  CARES will not allow cases to be enrolled in these groups, and MMIS will not accept current certifications.  However, the codes are maintained because payments and reporting may still be required for prior enrollments.