EL-3-027-36

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Measure Name	% of MSIS IDs with ELIGIBILITY-GROUP = 12 (Aged, Blind and Disabled Individuals in 209(b) States) if the state is not a 209(b) state
File Type	ELG
Measure ID	EL-3-027-36
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
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-3-027-36	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "12" for states that are not 209(b) states	N/A
11/20/2025	4.0.22	EL-3-027-36	UPDATE	Specification	STEP 1: Measure applies to submitting state1a. If submitting state is NOT expected to report ELIGIBILITY-GROUP value "12" because the state is NOT a 209(b) state, proceed to STEP 2.ELSE1b. If submitting state is expected to report ELIGIBILITY-GROUP value "12" because the state is a 209(b) state, 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 12Of the MSIS IDs that meet the criteria from STEP 3, keep those where ELIGIBILITY-GROUP = "12"STEP 5: Calculate percentageDivide the count of unique MSIS IDs from STEP 4 by the count from STEP 2	N/A
10/07/2025	4.0.19	EL-3-027-36	UPDATE	Grace period expiration date	None	2023-04-30
04/24/2025	4.0.7	EL-3-027-36	ADD	N/A		Created

EL-3-027-36

Key Information

Validation

Measure Priority

Claim Information

Thresholds

Data Elements