Technical Instructions History
|
Date |
Description of Change |
|
01/31/2022 |
Original Reporting Reminder Issued |
|
09/08/2022 |
Updated the definition of ELIGIBILITY-CHANGE-REASON to align with upcoming T-MSIS Data Dictionary updates[1] |
Topic Description
Complete and consistent state reporting of an individual’s eligibility status, including any changes, will be a critical component of CMS monitoring states’ transitions back to normal eligibility and enrollment operations in Medicaid and the Children’s Health Insurance Program (CHIP) after the end of the Public Health Emergency. This reporting reminder notes expectations for state reporting of ELIGIBILITY-CHANGE-REASON (ELG095) in the ELIGIBILITY-DETERMINANTS-ELG00005 segment of the T-MSIS Eligible File as well as an update to the definition of this data element.
Impacted Data Elements
- ELIGIBILITY-CHANGE-REASON (ELG095)
Reporting Reminder
ELIGIBILITY-CHANGE-REASON, which is on the ELIGIBILITY-DETERMINANTS-ELG00005 segment, should be populated when a change to an individual’s eligibility status results in a complete loss/termination of coverage. Using a default such as value ‘21’ (Unknown) or ‘22’ (Other) for all circumstances is not valid. Information about changes to an individual’s eligibility status should be identified using a state’s eligibility determination system. For example, if an individual qualified for Medicaid via Modified Adjusted Gross Income (MAGI) and now has excess income that no longer qualifies that individual for Medicaid, a value of ‘01’ (Excess income) should be reported in the ELIGIBILITY-CHANGE-REASON data element field on the individual’s last ELIGIBILITY-DETERMINANTS-ELG00005 segment containing the eligibility group that the beneficiary is no longer eligible for beyond the end date of the segment.
To clarify this reporting, CMS will update the T-MSIS Data Dictionary to include the following definition for ELIGIBILITY-CHANGE-REASON (ELG095)[1] : The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed.