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CMS MACBIS T-MSIS Reporting Reminder: Medicaid Expansion Population in the T-MSIS Eligible file -- ELIGIBILITY-GROUP Valid Values 72-75

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 01, 2020

CMS MACBIS T-MSIS Reporting Reminder: Medicaid Expansion Population in the T-MSIS Eligible file -- ELIGIBILITY-GROUP Valid Values 72-75

Reporting Reminder History

Date Description of Change
2/4/2019 Original reporting reminder issued
9/1/2020 Added clarifying language on state’s reporting to the MBES and around the categorization of ELIGIBILITY-GROUP valid values “74” and “75” as “Mandatory Coverage”

Topic Description

This reporting reminder provides background information and direction for states in reporting the ELIGIBILITY-GROUP (ELG087) data element for the Medicaid Expansion population in the T-MSIS Eligible file (ELIGIBILITY-GROUP valid values “72” through “75”)[1].

Impacted Data Elements

  • ELIGIBILITY-GROUP (ELG087)

Reporting Reminder

  • States should assign T-MSIS eligibility groups for their Medicaid expansion population using the T-MSIS Eligible file data element ELIGIBILITY-GROUP (ELG087) consistent with how they are assigned for the purposes of state’s reporting to the MBES.
  • States should seek additional specific guidance via the State Data Quality Technical Assistance (DQ TA) team regarding specific requirements for reporting. However, some general background to inform the usage of T-MSIS Eligibility Groups 72-75 follows from Appendix F of the T-MSIS version 2.3 Data Dictionary:
72 - Adult Group Individuals at or below 133% FPL Age 19 through 64 newly eligible for all states
73 - Adult Group Individuals at or below 133% FPL Age 19 through 64 NOT newly eligible for non 1905z(3) states
74 - Adult Group Individuals at or below 133% FPL Age 19 through 64 NOT newly eligible parent/ caretaker-relative(s) in 1905z(3) states
75 - Adult Group Individuals at or below 133% FPL Age 19 through 64 NOT newly eligible non-parent/ caretaker-relative(s) in 1905z(3) states

[1] ACA Medicaid expansion for childless adults (represented in T-MSIS by ELIGIBILITY-GROUP valid values "72" through "75") are still technically characterized as mandatory eligibility groups by Subsection 1902(a)(10)(A)(i) of the Social Security Act (SSA) despite the U.S. Supreme Court ruling (National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012)) which ruled that states could not be required to offer such coverage. Therefore, some states may not report any of the Medicaid expansion groups to T-MSIS if these groups are not applicable to a particular state.

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