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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

ELIGIBILITY-GROUP

Data Element

DE Number

ELG087

System DE Number

ELG.005.087

File Name

ELG - ELIGIBLE

File Segment Number

ELG00005

File Segment Name

ELIGIBILITY-DETERMINANTS

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition The eligibility group applicable to the individual based on the eligibility determination process. The valid value list of eligibility groups aligns with those being used in the Medicaid and CHIP Program Data System (MACPro).
Size X(2)
FLF Start Position 57
FLF Stop Position 58
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 2 characters
2. Value must be in Eligibility Group List (VVL)
3. If value is "26", then Dual Eligible Code value must be "06"
4. Conditional
5. Value is mandatory and must be provided when associated Eligibility Determinant Effective Date value is on or after 1 January, 2014.
6. If value is in [72,73,74,75], then associated Restricted Benefits Code value must be in [1,7] and State Plan Option Type must equal "06"
7. If associated CHIP Code value equals "2", then value must be in [07,31,61]
8. If associated CHIP Code value equals "3", then value must be in [61,62,63,64,65,66,67,68]
9. If value is "23", then Dual Eligible Code value must be in [01,02]
10. If value is "25", then Dual Eligible Code value must be in [03,04]
11. If value is "24", then Dual Eligible Code value must be "05"
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name