EL-3-033-42

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TMSIS Dataguide

Medicaid.gov

Version:

EL-3-033-42

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs with ELIGIBILITY-GROUP = 11 (Individuals Receiving SSI) without full benefits
File Type	ELG
Measure ID	EL-3-033-42
Measure Type	Non-Claims Percentage
Content area	ELG

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	N/A
Category	Beneficiary eligibility

Claim Information

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

Thresholds

Minimum	0
Maximum	0.05
TA Minimun	0
TA Maximum	0.05
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	ELIGIBILITY-GROUP • MSIS-IDENTIFICATION-NUM • RESTRICTED-BENEFITS-CODE
DD Data Element Number	ELG087 • ELG082 • ELG097

Annotation	N/A
Specification	N/A

Published Date	Data Guide Version	DQM	Action	Field	Before	After
11/20/2025	4.0.22	EL-3-033-42	UPDATE	Annotation	Calculate the percentage of MSIS IDs with an ELIGIBILITY-GROUP value of "11" that are not receiving full benefits	N/A
11/20/2025	4.0.22	EL-3-033-42	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: ELIGIBILITY-GROUP = "11"Of the MSIS IDs that meet criteria from STEP 2, further refine the population by keeping records with ELIGIBILITY-GROUP = "11"STEP 4: Enrollees without full benefitsOf the MSIS ID's that meet the criteria from STEP 3, further refine the population by keeping records that satisfy the following criteria:1. RESTRICTED-BENEFITS-CODE is not ("1", "4", "5" "7", "A", "B", "D") OR2. RESTRICTED-BENEFITS-CODE is missingSTEP: 5: Calculate percentage for measureDIVIDE the count of MSIS IDs from STEP 4 by the count of MSIS IDs from STEP 3	N/A
10/07/2025	4.0.19	EL-3-033-42	UPDATE	Grace period expiration date	None	2025-08-28
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-3-033-42	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-3-033-42	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Ta min		0
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Ta max		0.05
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Threshold minimum	TBD	0
05/27/2025	4.0.9	EL-3-033-42	UPDATE	Threshold maximum	TBD	0.05
04/24/2025	4.0.7	EL-3-033-42	ADD	N/A		Created