Appendix D - Eligibility Cancel Reason Codes
The Eligibility Cancel Reason Codes are organized in numerical order by Code.
| Code | Eligibility Cancel Reason |
| 001 | Death |
| 002 | Loss of Virginia residence |
| 003 | No Longer Meets Nonfinancial Requirements |
| 004 | Recipient Requested Cancellation |
| 005 | Medicaid — No Longer Meets Resource Requirements FAMIS — Failure to Complete Renewal |
| 006 | Agency unable to locate |
| 007 | No Longer Meets Income Requirements |
| 008 | Case or Enrollee Added In Error or temporary cancellation to allow adding other coverage |
| 009 | Foster care/adoption child Age 21; Refugee ‘UM’; Age 21 In Foster Care; LIFC child (System Generated) |
| 010 | Automatic Cancellation for Spend Down Eligibility (Used prior to 07-01-03 MMIS conversation) (System Generated) |
| 011 | Automatic Cancellation for Retro-active Eligibility (System Generated) |
| 012 | Agency correspondence returned or Medicaid card returned |
| 013 | 18 Years of Age, Not in School (System Generated) |
| 014 | Cancellation due to fraud conviction |
| 015 | Cancellation due to appeal decision top of page |
| 016 | Child’s Reaching age 19 (AC 092 or 098) (System Generated) |
| 017 | Pregnant Women Exceeding 11 Months Enrollment Period (AC 091 and 097) (System Generated) |
| 018 | Child Reached Age 1 (AC 093 or 099) (System Generated) |
| 019 | Automatic Cancellation for Closed Coverage (Used prior to 07-01-03 MMIS conversation) (System Generated) |
| 020 | Automatic Cancellation for Alien Eligibility-Emergency Services (System Generated) |
| 021 | Refugee in AC 078 reached eligibility limitation (System Generated) |
| 022 | Child reaching age 6 (System Generated) |
| 023 | Automatic cancellation — Medicare not on file for QMB, SLMB, QDWI, QI (System Generated) |
| 024 | Cancellation of QMB, SLMB or QI limited coverage to enroll in full Medicaid coverage or to add greater limited benefit coverage |
| 025 | LIFC - failure to provide earning report timely in 12-month extension (System Generated) |
| 026 | LIFC — end of 12-month extension (System Generated) |
| 027 | QI end of year automatic cancellation (System Generated) |
| 028 | Ineligible due to institutional status (FAMIS) |
| 029 | Eligible for state employee health coverage (FAMIS) |
| 030 | Failure to assign rights or pursue 3rd party payments (FAMIS) |
| 031 | Enrolled with creditable coverage in another health plan (FAMIS) |
| 032 | Reserved top of page |
| 033 | BCCPTA/TPL overlap |
| 034 | Automatic cancellation — BCCPTA/TPL overlap (System Generated) |
| 035 | BCCPTA — No longer meets certification requirements |
| 036 | FP Waiver — 24 month limit (System Generated) |
| 037 | FP Waiver — Age 57 (System Generated) |
| 040 | End of TDO period |
| 041 | Court decision |
| 042 | Child eligible in another assistance program with no break in coverage — Medicaid to FAMIS or FAMIS to Medicaid |
| 043 | Reserved |
| 044 | Reserved |
| 045 | Reserved |
| 046 | Reserved |
| 047 | Reserved |
| 049 | Reserved |
| 050 | Reserved |
| 080 | One day eligibility for an assessment |
| 086 | SLH Foster child reached age 21, computed and entered by the system |
| 087 | End of SLH 180 day coverage period, computed and entered by the system (System Generated) |
| 088 | End of SLH 180 days, entered at time of enrollment, not system calculated |
| 099 | System generated cancel for change of aid category |
| P01 | Cancelled QI2 paid during first yearly financial run (No longer used-QI 2 group ended 12-31-02) |
| P02 | Cancelled QI2 paid during second yearly financial run (No longer used-QI 2 group ended 12-31-02) |
.................................................................................................................................................
|
|
| © 2003
VCU-VISSTA. All rights reserved. Last Modified:November 23, 2004 Send comments to VISSTA Media Lab |
Virginia
Institute for Social Services Training Activities 104 North Linden Street, P.O. Box 842027 Richmond, VA 23284-2027 804.828.0178 FAX: 804.828.1207 |