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TMSIS Dataguide Medicaid.gov
Version 3.36.0

ELG - ELIGIBLE

File

View Changelog
File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
ELG00001 FILE-HEADER-RECORD-ELIGIBILITY A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
ELG00002 PRIMARY-DEMOGRAPHICS-ELIGIBILITY A record to capture basic demographic information about the individual.
ELG00003 VARIABLE-DEMOGRAPHICS-ELIGIBILITY A record to capture additional demographic information that is more prone to periodic changes than primary demographics.
ELG00004 ELIGIBLE-CONTACT-INFORMATION A record to capture addresses and phone numbers of the individual.
ELG00005 ELIGIBILITY-DETERMINANTS A record to capture factors that influence an individual's eligibility for basic Medicaid/CHIP, as well as the various waivers and demonstrations.
ELG00006 HEALTH-HOME-SPA-PARTICIPATION-INFORMATION A record to capture the eligible person's participation in the state's health home initiative.
ELG00007 HEALTH-HOME-SPA-PROVIDERS A record to capture the identity of the health home entity in which the eligible person is enrolled, as well as the identity of the provider with primary responsibility for coordinating the delivery of health home services.
ELG00008 HEALTH-HOME-CHRONIC-CONDITIONS A record to capture an eligible person's chronic conditions that qualified him/her for participation in the health home initiative.
ELG00009 LOCK-IN-INFORMATION A record to capture the provider, or providers, to whom the eligible person is restricted, as well as the time periods during which the lock-in provisions are in force.
ELG00010 MFP-INFORMATION A record to capture information about an eligible person's participation in the Money Follows the Person demonstration program.
ELG00011 STATE-PLAN-OPTION-PARTICIPATION A record to capture the identity of the State Plan Options in which an eligible person is enrolled.
ELG00012 WAIVER-PARTICIPATION A record to capture the identity of the waivers in which an eligible person is enrolled.
ELG00013 LTSS-PARTICIPATION A record to capture the level of care an eligible person receives at various points in time while in a long-term care facility.
ELG00014 MANAGED-CARE-PARTICIPATION A record to capture information about an eligible person's enrollment in a managed care plan.
ELG00015 ETHNICITY-INFORMATION A record to capture information about an eligible person's ethnicity.
ELG00016 RACE-INFORMATION A record to capture information about an eligible person's race.
ELG00017 DISABILITY-INFORMATION A record to capture information about an eligible person's disabilities.
ELG00018 1115A-DEMONSTRATION-INFORMATION A record to capture an eligible person's 1115A participation.
ELG00020 HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME A record to capture an eligible person's chronic conditions for which an eligible person is receiving home and community-based care.
ELG00021 ENROLLMENT-TIME-SPAN-SEGMENT A record to capture the eligible person's type of enrollment and time spans of enrollment.
ELG00022 ELG-IDENTIFIERS A record to capture the identifiers assigned to a beneficiary by various entities.
Definition
Enhanced information about beneficiary enrollment and eligibility including person level demographic and eligibility data.

Overview

Diagram 5: Eligible File – Eligible Person Record Segment Relationships

elg_overview

Description of Diagram 5:

Each eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:

1. SUBMITTING-STATE
2. MSIS-IDENTIFICATION-NUM

The exception (the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment) is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:

1. SUBMITTING-STATE
2. MSIS-IDENTIFICATION-NUM
3. HEALTH-HOME-SPA-ID
4. HEALTH-HOME-ENTITY-NAME