California Medicaid Eligibility Groups by Medi-Cal Aid Code
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This dataset identifies California’s eligibility groups by aid code. California uses aid codes to account for eligibility group populations and the eligibility requirements, scope of benefits, services, costs, claims, encounter data, and managed care arrangements related to those populations. Aid codes in this dataset are mapped to the Transformed Medicaid Statistical Information System (T-MSIS) eligibility group descriptions and codes. California uses this mapping to submit claims data, enrollee encounter data, and supporting information to the Centers for Medicare & Medicaid Services (CMS), as required by Section 4735 of the Balanced Budget Act of 1997 and Section 6504 of the Affordable Care Act for the purpose of program integrity, program oversight, and administration. This dataset includes aid codes that do not have Medi-Cal benefits or have benefits and are not federal programs. Some aid codes may appear to be identical but possess distinct benefits or grouping factors. An aid code may appear more than once if multiple populations are represented in one aid code and can be identified and mapped to distinct T-MSIS groups.
Applications Submitted for Insurance Affordability Programs With the Help of an Assister
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This dataset provides the total number of Insurance Affordability Programs (IAPs) applications submitted with the help of an assister. This data is from the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS). IAPs are comprised of Medi-Cal and subsidized Qualified Health Plans (QHPs) offered through Covered California. Assisters are affiliated with Covered California and may include agents, Service Center Representatives, Certified Enrollment Counselors, County Eligibility Workers, and Plan-Based Enrollers. This dataset is part of public reporting requirements set forth in the California Welfare and Institutions Code 14102.5(5).
California Medicaid Eligibility Groups by Medi-Cal Aid Code
공공데이터포털
This dataset identifies California’s eligibility groups by aid code. California uses aid codes to account for eligibility group populations and the eligibility requirements, scope of benefits, services, costs, claims, encounter data, and managed care arrangements related to those populations. Aid codes in this dataset are mapped to the Transformed Medicaid Statistical Information System (T-MSIS) eligibility group descriptions and codes. California uses this mapping to submit claims data, enrollee encounter data, and supporting information to the Centers for Medicare & Medicaid Services (CMS), as required by Section 4735 of the Balanced Budget Act of 1997 and Section 6504 of the Affordable Care Act for the purpose of program integrity, program oversight, and administration. This dataset includes aid codes that do not have Medi-Cal benefits or have benefits and are not federal programs. Some aid codes may appear to be identical but possess distinct benefits or grouping factors. An aid code may appear more than once if multiple populations are represented in one aid code and can be identified and mapped to distinct T-MSIS groups.
Applications Received For Insurance Affordability Programs Through Other Eligibility Pathways
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The number of Insurance Affordability Programs (IAPs) applications received through other eligibility pathways. Other eligibility pathways include applications transferred through transition from Advanced Premium Tax Credits (APTC) to Medi-Cal, as well as applications submitted through Hospital Presumptive Eligibility (HPE), through Express Lane, or the Medi-Cal Access Program (MCAP) during a reporting period. APTC to Medi-Cal batch data is reported by CalHEERS and MEDS and consists of individuals who are no longer eligible for APTC but are eligible for Medi-Cal. Another eligibility pathway is Express Lane Eligibility (ELE), which is a program that waives the need for a Medi-Cal eligibility determination for 12 months if the individual is enrolled in CalFresh. Hospital Presumptive Eligibility (HPE) applications are submitted through qualified HPE Providers. ELE and HPE data are reported by DHCS and commencing with this report, MCAP applications are reported by MAXIMUS Inc. This dataset is part of public reporting requirements of set forth in the California Welfare and Institutions Code 14102.5.