Fillable Printable Risk Poolto Eligibility Category To Rate Code
Fillable Printable Risk Poolto Eligibility Category To Rate Code
Risk Poolto Eligibility Category To Rate Code
Rate Codes to be included in main Risk Groups
Updated 10/8/14
Authorized by 1115 Waiver
Reporting Risk
Group
TANF <1 TANF 1-13
TANF 14-44
Male
TANF 14-44
Female
TANF 45 +
SSI with
Medicare
SSI w/o
Medicare
Adults Less Than or Equal to
106% of the FPL
(Formerly known as AHCCCS
Care or TXIX Waiver NON-
MED)
SOBRA
Family
Planning
Extension
Program
SOBRA
Pregnant
Women
State Only
Transplants
Main Risk Group
TACI/
KIDI
TACS/KIDC MALE/KIDM FMAL/KIDF ADLT SSIW SSIN ACMA SFPS
ADLT,
FMAL
TRAN
Rate Codes 1001 1002 100B 1004 100D 1005 100E 1008 100H 2100 210Z 2110 3904 390D 3504 350D 3704 370D 5500 5005 1000 100Z 3100
to be included 1011 1003 100C 1006 100F 1007 100G 1009 100J 2120 212Z 2210 3905 390E 3505 350E 3705 370E 5510 5007 1010 101Z 310Z
in Main Risk 1021 1012 101B 1014 101D 1015 101E 1018 101H 2200 220Z 2310 3906 390F 3506 350F 3706 370F 5520 5008 1020 102Z 3200
Group/Reporting 1101 1013 101C 1016 101F 1017 101G 1019 101J 2220 222Z 2410 3907 390G 3507 350G 3707 370G 5015 2100 210Z 320Z
Risk Group 1111 1022 102B 1024 102D 1025 102E 1028 102H 2300 230Z 2510 3908 390H 3508 350H 3708 370H 5017 2110 211Z
1121 1023 102C 1026 102F 1027 102G 1029 102J 2320 232Z 2610 3909 390J 3509 350J 3709 370J 5018 2120 212Z
4301 1102 110B 1104 110D 1105 110E 1108 110H 2400 240Z 8610 3914 391D 3514 351D 3714 371D 5025 2200 220Z
4311 1103 110C 1106 110F 1107 110G 1109 110J 2420 242Z 8710 3915 391E 3515 351E 3715 371E 5027 2210 221Z
4321 1112 111B 1114 111D 1115 111E 1118 111H 2500 250Z 211Z 3916 391F 3516 351F 3716 371F 5028 2220 222Z
100A 1113 111C 1116 111F 1117 111G 1119 111J 2520 252Z 221Z 3917 391G 3517 351G 3717 371G 500E 2300 230Z
101A 1122 112B 1124 112D 1125 112E 1128 112H 2600 260Z 231Z 3918 391H 3518 351H 3718 371H 500G 2310 231Z
102A 1123 112C 1126 112F 1127 112G 1129 112J 2620 262Z 241Z 3919 391J 3519 351J 3719 371J 500H 2320 232Z
110A 4302 430B 4304 430D 4305 430E 4518 451H 8600 860Z 251Z 3924 392D 3524 352D 3724 372D 501E 2410 241Z
111A 4303 430C 4314 431D 4315 431E 4519 451J 8620 862Z 261Z 3925 392E 3525 352E 3725 372E 501G 2510 251Z
112A 4312 431B 4324 432D 4325 432E 4618 461H 8700 870Z 861Z 3926 392F 3526 352F 3726 372F 501H 2610 261Z
430A 4313 431C 4404 440D 4515 451E 4619 461J 8720 872Z 871Z 3927 392G 3527 352G 3727 372G 502E 2400 240Z
431A 4322 432B 4414 441D 4517 451G 3928 392H 3528 352H 3728 372H 502G 2420 242Z
432A 4323 432C 4424 442D 4615 461E 3929 392J
3529 352J 3729 372J
502H 2500 250Z
4401 5003 500C 6014 4617 461G 2520 252Z
440A 5013 501C 4405 440E 2600 262Z
4411 5023 502C 4415 441E 2620 260Z
441A 4402 440B 4425 442E 8600 860Z
4421 4403 440C 6015 8610 861Z
442A 4412 441B 8700 870Z
6011 4413 441C 8710 871Z
4422 442B 8720 872Z
4423 442C
6012
6013
Delivery 9910 9960 9920 9921 9939 9935 9937 9950
Supplement 9911 9944 9922 9923
9945 9946
Rural Hospital 9810 9812 9813 9814 9815 9816 9817 9818 9819 9820 9822 9821 9839 9835 9837
Supplement 9811 9844 9846 9887 9823
9845
Funding
Kids Care Title XXI
State Only
Transplants
State Only
Child Expansion
Title XIX
Notes:
Rate Code Format:
1.
Coverage for HIFA Parents was discontinued 10/1/2009 #### Prospective # = numeric
2.
Child expansion covers 6-18 year olds only. The TANF < 1 codes were setup as a precaution ###X PPC X= Alphanumeric
ALTCS
Adults Greater
Than 106% of
the FPL
(Formerly Newly
Eligible Adults)
NEAD
s:\fin\reference\Collapse Risk Group_updated forCYE15 11:57 AM 10/8/2014
