EL-3-013-18

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Measure Name	% of Medicaid MSIS IDs with a CHIP Eligibility Group
File Type	ELG
Measure ID	EL-3-013-18
Measure Type	Non-Claims Percentage
Content area	ELG

Validation Type	Inferential

Measure Priority	High
Focus Area	N/A
Category	Beneficiary eligibility

Claim Type	N/A
Adjustment Type	N/A
Crossover Type	N/A

Minimum	0
Maximum	0.01
TA Minimun	0
TA Maximum	0.01
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	ELIGIBILITY-GROUP • CHIP-CODE • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG087 • ELG054 • ELG033

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-013-18	UPDATE	Annotation	Calculate the percentage of unique MSIS IDs classified as Medicaid with an eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-013-18	UPDATE	Specification	STEP 1: Enrolled on the last day of DQ report monthDefine the eligible population from segment ENROLLMENT-TIME-SPAN-ELG00021 by keeping active records that satisfy the following criteria:1. ENROLLMENT-EFF-DATE <= last day of the DQ report month 2. ENROLLMENT-END-DATE >= last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Variable demographics on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, join to segment VARIABLE-DEMOGRAPHIC-ELG00003 by keeping records that satisfy the following criteria:1a. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE <= last day of the DQ report month2a. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE >= last day of the DQ report month OR missingOR1b. VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE is missing2b. VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE is missingSTEP 3: Medicaid enrolleesOf the MSIS IDs that meet the criteria from STEP 2, further refine the population by keeping records that satisfy the following criteria:1. CHIP-CODE="1"STEP 4: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 3, join to segment ELIGIBILITY-DETERMINANTS-ELG00005 by keeping records that satisfy the following criteria:1. PRIMARY-ELIGIBILITY-GROUP-IND = 12a. ELIGIBILITY-DETERMINANT-EFF-DATE <= last day of the DQ report month3a. ELIGIBILITY-DETERMINANT-END-DATE >= last day of the DQ report month OR missingOR2b. ELIGIBILITY-DETERMINANT-EFF-DATE is missing3b. ELIGIBILITY-DETERMINANT-END-DATE is missingSTEP 5: CHIP eligibility groupOf the MSIS IDs that meet the criteria from STEP 3, keep the MSIS IDs that satisfy the following criteria:1. ELIGIBILITY-GROUP = ("61", "62", "63, "64", "65", "66", "67", or "68")STEP 6: PercentageDivide the count of unique MSIS IDs from STEP 5 by the count in STEP 3	N/A
04/24/2025	4.0.7	EL-3-013-18	ADD	N/A		Created

EL-3-013-18

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements