Updated research request forms and data security approval required beginning 4/24/23
SAS Name
RSTRCTD_BNFTS_CD_05
A flag that indicates the scope of Medicaid or Children’s Health Insurance Program (CHIP) benefits to which a beneficiary is entitled, in the month. There are separate variables for each of the 12 months during the year.
| Code | Code value |
|---|---|
| 0 | Individual is not eligible for Medicaid or Children’s Health Insurance Program (CHIP) during the month. |
| 1 | Individual is eligible for Medicaid or CHIP and entitled to the full scope of Medicaid or CHIP benefits. |
| 2 | Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but only entitled to restricted benefits based on alien status. |
| 3 | Individual is eligible for Medicaid but only entitled to restricted benefits based on Medicare dual-eligibility status (e.g., Qualified Medicare Beneficiary [QMB], Specified Low-Income Medicare Beneficiary [SLMB], Qualified Disabled Working Individual [QDWI], Qualifying individuals [QI]). |
| 4 | Individual is eligible for Medicaid or CHIP but only entitled to restricted benefits for pregnancy-related services. |
| 5 | Individual is eligible for Medicaid or Medicaid-Expansion CHIP but, for reasons other than alien, dual-eligibility or pregnancy-related status, is only entitled to restricted benefits (e.g., restricted benefits based upon substance abuse, medically needy or other criteria). |
| 6 | Individual is eligible for Medicaid or Medicaid-Expansion CHIP but only entitled to restricted benefits for family planning services. |
| 7 | Individual is eligible for Medicaid and entitled to Medicaid benefits under an alternative package of benchmark-equivalent coverage, as enacted by the Deficit Reduction Act of 2005. |
| A | Individual is eligible for Medicaid and entitled to benefits under the Psychiatric Residential Treatment Facilities Demonstration Grant Program (PRTF), as enacted by the Deficit Reduction Act of 2005. PRTF grants assist States to help provide community alternatives to psychiatric resident treatment facilities for children. |
| B | Individual is eligible for Medicaid and entitled to Medicaid benefits using a Health Opportunity Account (HOA) |
| C | Individual is eligible for separate CHIP dental coverage (supplemental dental wraparound benefit to employer-sponsored insurance) |
| D | Individual is eligible for Medicaid and entitled to benefits under a “Money Follows the Person” (MFP) rebalancing demonstration, as enacted by the Deficit Reduction Act of 2005, to allow States to develop community based long-term care opportunities. |
| E | Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but for reasons other than alien, dual-eligibility, or pregnancy-related status, is only entitled to restricted benefits (e.g., restricted benefits based on substance abuse, medically needy, or other criteria) that do not meet the standard for Minimum Essential Coverage |
| F | Individual is eligible for Medicaid but is only entitled to restricted benefits for medical assistance for COVID-19 diagnostic products and any visit described as a COVID–19 testing-related service for which payment may be made under the State plan during any portion of the public health emergency period, beginning March 18, 2020. |
| Null/missing | source value is missing or unknown |
SOURCE: T-MSIS Annual Demographic and Eligibility TAF