EL-3-019

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Measure Name	% of MSIS IDs with ELIGIBILITY-GROUP = 73, 74, or 75 (adult group - not newly eligible) if the state did not report MBES enrollment for this group
File Type	ELG
Measure ID	EL-3-019_1-34
Measure Type	Non-Claims Percentage
Content area	ELG

Validation Type	Inferential

Measure Priority	High
Focus Area	Enrollment monitoring
Category	Beneficiary eligibility

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

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

DD Data Element	ELIGIBILITY-GROUP • SUBMITTING-STATE • MSIS-IDENTIFICATION-NUM
DD Data Element Number	ELG087 • ELG080 • ELG082

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-019_1-34	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "73", "74", or "75" for states NOT expected to report these values according to public MBES enrollment data on Medicaid.gov	N/A
11/20/2025	4.0.22	EL-3-019_1-34	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are NO enrollees in any "Not Newly Eligible" category in the MBES enrollment data, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "73", "74", or "75" because there are enrollees in any "Not Newly Eligible" category in the public MBES enrollment data on Medicaid.gov, the final measure statistic will be displayed as "N/A".STEP 2: 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 3: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 2, 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 4: MSIS IDs with eligibility group 73, 74, or 75Of the MSIS IDs that meet the criteria from STEP 3, count the number of unique MSIS IDs where ELIGIBILITY-GROUP = "73", "74", or "75"STEP 5: Calculate percentageDivide the count from STEP 4 by the count from STEP 2	N/A
10/07/2025	4.0.19	EL-3-019_1-34	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-019_1-34	ADD	N/A		Created

EL-3-019_1-34

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements