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| Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
|---|---|---|---|---|---|
| BENEFIT-TYPE | 001 | Inpatient Hospital Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 002 | Outpatient Hospital Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 003 | Rural health clinic services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 004 | FQHC services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 005 | Other Laboratory and X-Ray Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 006 | Nursing Facility Services for 21 and over,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 007 | EPSDT,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 008 | Family Planning Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 009 | Mandatory tobacco cessation counseling for pregnant women under 1905(a)(4)(D),Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 010 | Physicians' Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 011 | Medical and Surgical Services Furnished by a Dentist,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 012 | Nurse-midwife services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 013 | Certified pediatric or family nurse practitioners' services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 014 | Free Standing Birth Center Services,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 015 | Home Health Services - Intermittent or part-time nursing services provided by a home health agency,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 016 | Home Health Services - Home Health Aide Services Provided by a Home Health Agency,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 017 | Home Health Services - Medical supplies, equipment, and appliances suitable for use in the home,Mandatory Benefits for Categorically Needy (Mandatory and Options for Coverage) Individuals and Optional Benefits for Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 018 | Medical care and any type of remedial care recognized under State law - Podiatrists' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 019 | Medical care and any type of remedial care recognized under State law - Optometrists' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 020 | Medical care and any type of remedial care recognized under State law - Chiropractors' Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 021 | Medical care and any type of remedial care recognized under State law - Other Practitioners' Services within scope of practice as defined by State law,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 022 | Home Health Services - Physical therapy; occupational therapy; speech pathology; audiology provided by a home health agency,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 023 | Private Duty Nursing,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 024 | Clinic Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 025 | Dental Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 026 | Physical Therapy and Related Services - Physical Therapy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 027 | Physical Therapy and Related Services - Occupational Therapy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 028 | Physical Therapy and Related Services - Services for individuals with speech, hearing and language disorders,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 029 | Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prescribed Drugs,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 030 | Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Dentures,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 031 | Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prosthetic Devices,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 032 | Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Eyeglasses,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 033 | Other diagnostic, screening, preventive, and rehabilitative services - Diagnostic Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 034 | Other diagnostic, screening, preventive, and rehabilitative services - Screening Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 035 | Other diagnostic, screening, preventive, and rehabilitative services - Preventive Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 036 | Other diagnostic, screening, preventive, and rehabilitative services - Rehabilitative Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 037 | Services for individuals over age 65 in IMDs - Inpatient hospital services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 038 | Services for individuals over age 65 in IMDs - Nursing facility services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 039 | Intermediate Care Facility Services for individuals with intellectual disabilities or persons with related conditions,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 040 | Inpatient psychiatric facility services for under 21,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 041 | Hospice Care,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 042 | Case Management Services and TB related services - Case management services as defined in the State Plan in accordance with section 1905(a)(19) or 1915(g),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 043 | Case Management Services and TB related services - Special TB related services under section 1902(z)(2),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 044 | Respiratory care services under 1902(e)9)(A) through (C),Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 045 | Personal care services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 046 | Primary care case management services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 047 | Special sickle-cell anemia-related services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 048 | Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Transportation,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 049 | Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Services provided in religious non-medical health care facilities,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 050 | Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Nursing facility services for patients under 21,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 051 | Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Emergency hospital services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 052 | Any other medical care and any other type of remedial care recognized under State law, specified by the Secretary - Critical Access Hospitals,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 053 | Extended services for pregnant women - Additional Services for any other medical conditions that may complicate pregnancy,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 054 | Community First Choice,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 055 | Health Home Services,Optional Benefits for Categorically Needy (Mandatory and Options for Coverage) and Medically Needy Individuals | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 056 | Limited Pregnancy-Related Services for Pregnant Women with Income Above the Applicable Income Limit,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 057 | Ambulatory prenatal care for pregnant women furnished during a presumptive eligibility period,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 058 | Benefits for Families Receiving Transitional Medical Assistance,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 059 | Standards for Coverage of Transplant Services,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 060 | School-Based Services Payment Methodologies,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 061 | Indian Health Services and Tribal Health Facilities,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 062 | Methods and Standards to Assure High Quality Care,Special Benefit Provisions | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 063 | Medicare Premium Payments,Coordination of Medicaid with Medicare and Other Insurance | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 064 | Medicare Coinsurance and Deductibles,Coordination of Medicaid with Medicare and Other Insurance | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 065 | Other Medical Insurance Premium Payments,Coordination of Medicaid with Medicare and Other Insurance | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 066 | Programs for Distribution of Pediatric Vaccines,Special Benefit Programs | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 067 | Laboratory and x-ray services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 068 | Home Health Services - Home health aide services provided by a home health agency,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 069 | Private duty nursing services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 070 | Physical Therapy and Related Services - Audiology services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 071 | Extended services for pregnant women - Additional Pregnancy-related and postpartum services for a 60-day period after the pregnancy ends and any remaining days in the month in which the 60th day falls.,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 072 | Home and Community Care for Functionally Disabled Elderly individuals as defined and described in the State Plan,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 073 | Emergency services for certain legalized aliens and undocumented aliens, Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 074 | Licensed or Otherwise State-Approved Free-Standing Birthing Center and other ambulatory services that are offered by a freestanding birth center,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 075 | Homemaker,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 076 | Home Health Aide,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 077 | Adult Day Health services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 078 | Habilitation,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 079 | Habilitation: Residential Habilitation,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 080 | Habilitation: Supported Employment,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 081 | Habilitation: Education (non IDEA available),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 082 | Habilitation: Day Habilitation,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 083 | Habilitation: Pre-Vocational,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 084 | Habilitation: Other Habilitative Services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 085 | Respite,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 086 | Day Treatment (mental health service),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 087 | Psychosocial rehabilitation,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 088 | Environmental Modifications (Home Accessibility Adaptations),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 089 | Vehicle Modifications,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 090 | Non-Medical Transportation,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 091 | Special Medical Equipment (minor assistive Devices),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 092 | Home Delivered meals,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 093 | Assistive Technology (i.e., communication devices),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 094 | Personal Emergency Response (PERS),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 095 | Nursing Services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 096 | Community Transition Services,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 097 | Adult Foster Care,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 098 | Day Supports (non-habilitative),Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 099 | Supported Employment,Home and Community-Based Services | 01/01/0001 | 12/31/9999 | |
| BENEFIT-TYPE | 100 | Supported Living Arrangements,Home and Community-Based Services | 01/01/0001 | 12/31/9999 |
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