ELG.005.095

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

ELIGIBILITY-CHANGE-REASON

Data Element

DE Number

ELG095

System DE Number

ELG.005.095

File Name

File Segment Number

File Segment Name

ELIGIBILITY-DETERMINANTS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value "21" (Other) or "22" (Unknown), then the state should not report the co-occurring value "21" and/or "22" to T-MSIS. If there are multiple co-occurring distinct values between "01" and "19", then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of "01" through "19", CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
Size	X(2)
FLF Start Position	79
FLF Stop Position	80
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Eligibility Change Reason List (VVL) 2. Value must be 2 characters 3. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2146	If the eligibility change reason is populated on a eligibility determinants file, then the eligibility change reason reported must be found in the list of valid values.
RULE-6776	If a segment is an eligibility determinants segment from an ELG file, then the eligibility change reason value reported must be compatible with the specified T-MSIS picture format: X(2).

Measure ID	Measure Name
EL-19-001-1	% of MSIS IDs enrolled any day in the previous month but not any day in the current month, with missing, invalid, unknown, or other ELIGIBILITY-CHANGE-REASON
EL-20-001-1	Eligibility Change Reason

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	ELG.005.095	UPDATE	Definition	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value "21" (Other) or "22" (Unknown), then the state should not report the co-occurring value "21" and/or "22" to T-MSIS. If there are multiple co-occurring distinct values between "01" and "19", then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of "01" through "19", CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
08/09/2023	3.11.0	ELG.005.095	UPDATE	Definition	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.
08/09/2023	3.11.0	ELG.005.095	UPDATE	Definition	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. If for a single termination in eligibility for a single individual, there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.	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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|
01/09/2023	3.2.0	ELG.005.095	UPDATE	Definition	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.	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. If for a single termination in eligibility for a single individual, there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.
03/31/2023	3.5.0	ELG095	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (typically not a reason for termination)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (do not use - typically not a reason for termination)\|
03/31/2023	3.5.0	ELG095	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|No longer in the foster care system - (do not use - typically not a reason for termination)\|
03/10/2023	3.4.0	ELG095	UPDATE	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|01\|Excess income\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|02\|Excess assets\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|No longer in the foster care system\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|15\|Moved to a different state\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|17\|Lack of verifications\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|19\|Suspension due to incarceration\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|20\|Residence in an Institution for Mental Disease (IMD)\|	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|01\|Income Requirement not met - do not use for changes in household composition\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|02\|Asset requirement not met - do not use for changes in household composition\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|03\|Income reduced - (typically not a reason for termination)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|05\|N/A\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|15\|Residency requirement not met (e.g., individual moved to a different state, individual has entered or been discharged from an otherwise unspecified facility or institution)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|17\|Lack of verifications (e.g., unable to successfully verify citizenship status, immigration status, income, or other information from an application; if unverifiable due to non-response, document as "Failure to respond)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|19\|Suspension/termination due to incarceration - use when the state is able to distinguish a more granular reason than just residency requirement not met\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|20\|Disqualification for residence in an Institution for Mental Disease (IMD) - use when the state is able to distinguish a more granular reason than just residency requirement not met\|
03/10/2023	3.4.0	ELG095	ADD	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|23\|Terminated due to Incorrect Granting of Eligibility (e.g., someone is given eligibility in error and then eligibility has to be retracted/terminated)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|24\|Household or family composition criteria not met (e.g., someone was incorrectly included or excluded from the household or family composition) - do not use for changes in income\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|25\|Non-financial program requirements not met (e.g. child support not paid, failure of drug tests, failure to apply for SSN, etc.)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|26\|No longer meets categorical eligibility requirements.\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|27\|End of pregnancy/postpartum coverage period - should only be used if the beneficiary did not obtain coverage through another coverage group like parent/caretaker relative\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|28\|Time limited eligibility expired (e.g., Transitional Medical Assistance (TMA)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|29\|Closed as duplicate\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|30\|Medical/health status or condition or level of care requirements no longer met - for reasons other than no longer being institutionalized or no longer meeting disability requirements (e.g., completed breast and/or cervical cancer treatment, incarcerated individual no longer requires temporary inpatient level of care)\| ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|31\|Change in federal or state law or policy (e.g., a state or federal program is completely discontinued and not replaced by an equivalent or transitional program; unwinding of the Families First Coronavirus Response Act coverage of COVID testing for otherwise uninsured individuals who would have otherwise continued to be eligible if they had been re-determined eligible for at least the same program had the program not been terminated)\|
03/10/2023	3.4.0	ELG095	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.\|	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid.\|
12/03/2021	3.0.0	ELIGIBILITY-CHANGE-REASON	UPDATE	Data Dictionary - Valid Values	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|09\|No longer in need of long-term care services resides\|	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|ELIGIBILITY-CHANGE-REASON\|00010101\|99991231\|09\|No longer in need of long-term care services\|
01/28/2022	3.0.0	ELG095	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. Report this reason when there is a change in the individual's eligibility status.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG095\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. The end date of the segment in which the value is reported must represent the date that the change occurred. The reason for change represents the reason that the segment in which it was reported was closed.\|
06/24/2022	3.0.0	ELG095	UPDATE	Data Dictionary	DE No\|Segment Name\|DE Name\|Definition ELG095\|ELIGIBILITY-DETERMINANTS-ELG00005\|ELIGIBILITY-CHANGE-REASON\|The reason for a change in an individual's eligibility status. Report this reason when there is a change in the individual's eligibility status.	DE No\|Segment Name\|DE Name\|Definition ELG095\|ELIGIBILITY-DETERMINANTS-ELG00005\|ELIGIBILITY-CHANGE-REASON\|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.
10/28/2022	3.0.4	ELG095	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|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.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| ELG095\|ELIGIBILITY-CHANGE-REASON\|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. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21' (Other) or '22' (Unknown), then the state should not report the co-occurring value '21' and/or '22' to T-MSIS. If there are multiple co-occurring distinct values between '01' and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01' through '19', CMS does not currently have a preference for any one value over another.