Scope of Medicaid or CHIP Benefits - November

SAS Name
RSTRCTD_BNFTS_CD_11

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.

Comments

SOURCE: T-MSIS Annual Demographic and Eligibility TAF

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.
Null/missing source value is missing or unknown