ELG.005.095

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TMSIS Dataguide

Medicaid.gov

Version:

ELIGIBILITY-TERMINATION-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-TERMIMNATION-REASON value '21'; (Unknown) '22'; (Other), 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	77
FLF Stop Position	78
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Eligibility Termination Reason List (VVL) 3. Situational 4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.

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-TERMINATION-REASON
EL-20-001-1	Eligibility Termination 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
11/07/2025	4.0.21	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) '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-TERMIMNATION-REASON value '21'; (Unknown) '22'; (Other), 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.
07/17/2025	4.0.14	ELG.005.095	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Situational4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.
02/27/2025	4.0.3	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated.
12/19/2024	4.0.1	ELG.005.095	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Eligibility Change Reason List (VVL)3. Conditional	1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional
09/16/2024	4.0.0	ELG.005.095	UPDATE	File segment	None	48
09/16/2024	4.0.0	ELG.005.095	ADD	N/A		Created
10/09/2026	4.0.38	ELIGIBILITY-TERMINATION-REASON (ELG.005.095)	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-TERMINATION-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)	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-TERMINATION-REASON\|00010101\|20270630\|17\|Do not use after 06/30/2027 - 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)
10/09/2026	4.0.38	ELIGIBILITY-TERMINATION-REASON (ELG.005.095)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-TERMINATION-REASON\|00010101\|99991231\|32\|Beneficiary income could not be verified (if unable to verify due to non-response, report with "failure to respond" using valid value '13')
10/09/2026	4.0.38	ELIGIBILITY-TERMINATION-REASON (ELG.005.095)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-TERMINATION-REASON\|00010101\|99991231\|33\|The individual's iImmigration status or citizenship status could not be verified - or - the individual's immigration status is verified and their status is not satisfactory for full benefits (i.e., IMMIGRATION-STATUS does not equal 2 [CHIPRA 214] or 4 [eligible noncitizen]) If unable to verify due to non-response, report with "failure to respond" using valid value '13'
10/09/2026	4.0.38	ELIGIBILITY-TERMINATION-REASON (ELG.005.095)	Add	Data Dictionary - Valid Values	N/A	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION ELIGIBILITY-TERMINATION-REASON\|00010101\|99991231\|36\|Unable to verify other information from a beneficiary's case file (if unable to verify due to non-response, report with "failure to respond" using valid value '13')