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TMSIS Dataguide Medicaid.gov
Version 3.28.0

VARIABLE-DEMOGRAPHICS-ELIGIBILITY

File Segment

File Segment Number

ELG00003

File Name

ELG - ELIGIBLE

Last updated

No Updates

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
ELG030 ELG.003.030 RECORD-ID The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). ELG030 Values
ELG031 ELG.003.031 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. ELG031 Values
ELG032 ELG.003.032 RECORD-NUMBER

A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file.

 N/A
ELG033 ELG.003.033 MSIS-IDENTIFICATION-NUM

A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572

 N/A
ELG034 ELG.003.034 MARITAL-STATUS

A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).

Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value.

 ELG034 Values
ELG035 ELG.003.035 MARITAL-STATUS-OTHER-EXPLANATION A free-text field to capture the description of the marital/domestic-relationship status when Marital Status =14 (Other) is selected. N/A
ELG036 ELG.003.036 SSN The eligible individual's social security number. For newborns when value is unknown it is not required. For SSN states, in instances where the social security number is not known and a temporary MSIS Identification Number is used, the MSIS Identification Number field should be populated with the temporary MSIS Identification Number and the SSN field should be space-filled, or blank. When the SSN becomes known, the MSIS Identification Number field should continue to be populated with the temporary MSIS Identification Number and the SSN field should be populated with the newly acquired SSN for at least one monthly submission of the Eligible File so that T-MSIS can associated the temporary MSIS Identification Number and the social security number. N/A
ELG037 ELG.003.037 SSN-VERIFICATION-FLAG A code describing whether the state has verified the social security number (SSN) with the Social Security Administration (SSA). ELG037 Values
ELG038 ELG.003.038 INCOME-CODE

A code indicating the federal poverty level range in which the family income falls.

If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.

A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.

 ELG038 Values
ELG039 ELG.003.039 VETERAN-IND

A flag indicating if a non-citizen is exempt from the 5-year bar on benefits because they are a veteran or an active member of the military, naval or air service.

 ELG039 Values
ELG040 ELG.003.040 CITIZENSHIP-IND

Indicates if the individual is identified as a U.S. Citizen.

 ELG040 Values
ELG041 ELG.003.041 CITIZENSHIP-VERIFICATION-FLAG Indicates the individual is enrolled in Medicaid pending citizenship verification. ELG041 Values
ELG042 ELG.003.042 IMMIGRATION-STATUS The immigration status of the individual. ELG042 Values
ELG043 ELG.003.043 IMMIGRATION-VERIFICATION-FLAG Indicates the individual is enrolled in Medicaid pending immigration verification. ELG043 Values
ELG044 ELG.003.044 IMMIGRATION-STATUS-FIVE-YEAR-BAR-END-DATE The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified alien." N/A
ELG045 ELG.003.045 ENGL-PROF-CODE A code indicating the level of spoken English proficiency by the individual. ELG045 Values
ELG046 ELG.003.046 PRIMARY-LANGUAGE-CODE A code indicating the language that is the individuals' preferred spoken or written language. ELG046 Values
ELG047 ELG.003.047 HOUSEHOLD-SIZE Household Size used in the Medicaid or CHIP eligibility determination process. ELG047 Values
ELG049 ELG.003.049 PREGNANCY-IND

A flag indicating the individual is pregnant at the time of application based on self-attestation.

 ELG049 Values
ELG050 ELG.003.050 MEDICARE-HIC-NUM The Medicare HIC Number (HICN) is an identifier formerly used by SSA and CMS to identify all Medicare beneficiaries. For many beneficiaries, their SSN was a major component of their HICN. To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the Medicare Beneficiary Identifier (MBI) over the course of 2018 and 2019. HICN continue to be used by Medicare for limited administrative purposes after 2019 but starting in 2020 the MBI became the primary identifier for Medicare beneficiaries. HICN consists of two components: SSN & alpha-suffix or (for Railroad IDs) prefix and ID (not always SSN based) N/A
ELG051 ELG.003.051 MEDICARE-BENEFICIARY-IDENTIFIER The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. N/A
ELG054 ELG.003.054 CHIP-CODE A code used to distinguish among Medicaid, Medicaid Expansion CHIP, and Separate CHIP populations. ELG054 Values
ELG057 ELG.003.057 VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE

The first calendar day on which all of the other data elements in the same segment were effective.

 N/A
ELG058 ELG.003.058 VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE

The last calendar day on which all of the other data elements in the same segment were effective.

 N/A
ELG059 ELG.003.059 STATE-NOTATION

A free text field for the submitting state to enter whatever information it chooses.

 N/A
ELG269 ELG.003.269 ELIGIBLE-FEDERAL-POVERTY-LEVEL-PERCENTAGE

This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.

A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group.

 N/A
Definition
A record to capture additional demographic information that is more prone to periodic changes than primary demographics.

File Segment Length
1000