EL-3-022-27

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Measure Name	# of distinct mandatory eligibility group values populated for children, pregnant women, caretakers, and foster children (ELIGIBILITY-GROUP = 01, 05, 06, 07, 08 or 09)
File Type	ELG
Measure ID	EL-3-022-27
Measure Type	Count
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	6
Maximum	6
TA Minimun	6
TA Maximum	6
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

DD Data Element	ELIGIBILITY-GROUP
DD Data Element Number	ELG087

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-022-27	UPDATE	Annotation	Count the number of mandatory eligibility groups for children, pregnant women, caretakers and foster children with at least one MSIS ID with a primary eligibility group indicator associated with it	N/A
11/20/2025	4.0.22	EL-3-022-27	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: Eligibility determinants on the last day of DQ report monthUsing the MSIS IDs that meet the criteria from STEP 1, 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 3: Frequency of mandatory eligibility groupsOf the MSIS IDs that meet the criteria from STEP 2, count the number of unique MSIS IDs where ELIGIBILITY-GROUP is equal to each of the following values: 01, 05, 06, 07, 08, 09STEP 4: Count of categoriesOf the 6 mandatory eligibility group categories referenced in STEP 3, count the number of categories with at least one MSIS ID	N/A
04/24/2025	4.0.7	EL-3-022-27	ADD	N/A		Created

EL-3-022-27

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements