EL-6-040-40

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TMSIS Dataguide

Medicaid.gov

Version:

EL-6-040-40

Data Quality Measure

Last updated

Key Information

Measure Name	% of MSIS IDs enrolled in the past year with at least one gap in enrollment over that time
File Type	ELG
Measure ID	EL-6-040-40
Measure Type	Non-Claims Percentage
Content area	ELG
Grace Period Expiration	07/30/2026

Validation

Validation Type	Inferential

Measure Priority

Measure Priority	High
Focus Area	Enrollment monitoring
Category	Beneficiary eligibility

Claim Information

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

Thresholds

Minimum	0.001
Maximum	0.1
TA Minimun	0.001
TA Maximum	0.1
Longitudinal Threshold	N/A
For TA (for including in compliance training)	TA- Inferential
For TA (Longitudinal)	No

Data Elements

DD Data Element	ENROLLMENT-TYPE • MSIS-IDENTIFICATION-NUM • ENROLLMENT-END-DATE • ENROLLMENT-EFF-DATE
DD Data Element Number	ELG252 • ELG251 • ELG254 • ELG253

Annotation

Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period

Specification

STEP 1: Enrolled at any time within the past 12 months

Define 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 >= 12 months prior to last day of the DQ report month OR missing

3. MSIS-IDENTIFICATION-NUM is not missing

STEP 2: Enrollment Type is Medicaid or CHIP

Using the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with:

1. ENROLLMENT-TYPE = "1" or "2"

STEP 3: Non-duplicate enrollment spans

Duplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE

STEP 4: Sort records chronologically for each MSIS ID

For each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE

STEP 5: Maximum enrollment end date thus far

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combination

STEP 6: Total record count by MSIS ID

For each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATE

STEP 7: Previous enrollment end date

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combination

STEP 8: Enrollment span start

For each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:

1a. Tot_Rec = 1 for the MSIS ID

OR

1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date

ELSE

Set Enrollment_Span_Start = "0"

STEP 9: Total count of noncontiguous enrollment spans

For each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"

STEP 10: Count of MSIS IDs with one or more enrollment gaps

For each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 1.

STEP 11: Calculate percentage for measure

Divide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2

Published Date	Data Guide Version	DQM	Action	Field	Before	After
01/30/2026	4.0.26	EL-6-040-40	UPDATE	Specification	STEP 1: Enrolled at any time within the past 12 monthsDefine 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 >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Enrollment status by monthUsing the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where:1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missingELSESet Enrollment_Status = "0"STEP 4: Identify enrollment gapsFor each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where:1. Enrollment_Status = "0" for the month2. There is any prior month within the 12 month period with Enrollment_Status = "1"3. There is any subsequent month within the 12 month period with Enrollment_Status = "1"ELSESet Enrollment_Gap = "0"STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest monthFor the months identified in STEP 4 where Enrollment_Gap = "1", if the preceding month in the 12 month period also has Enrollment_Gap = "1", set Enrollment_Gap for the month = "0" STEP 6: Total count of enrollment gaps across 12 month periodFor each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1"STEP 7: Count of MSIS IDs with an enrollment gapFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0STEP 8: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2	STEP 1: Enrolled at any time within the past 12 monthsDefine 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 >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Non-duplicate enrollment spansDuplicate records are dropped if the following three data elements are the same: MSIS-IDENTIFICATION-NUM, ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATESTEP 4: Sort records chronologically for each MSIS IDFor each MSIS ID identified in STEP 2, sort records chronologically by ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 5: Maximum enrollment end date thus farFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Max_End_Date_Thus_Far = the maximum value for ENROLLMENT-END-DATE for that combinationSTEP 6: Total record count by MSIS IDFor each MSIS ID identified in STEP 2, set Tot_Rec = Count of unique combinations of ENROLLMENT-EFF-DATE and ENROLLMENT-END-DATESTEP 7: Previous enrollment end dateFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Prev_Enrollment_End_Date = the ENROLLMENT-END-DATE value immediately prior to the ENROLLMENT-END-DATE value for that combinationSTEP 8: Enrollment span startFor each combination of ENROLLMENT-EFF-DATE, and ENROLLMENT-END-DATE for a given MSIS ID, set Enrollment_Span_Start = "1" as follows:1a. Tot_Rec = 1 for the MSIS IDOR1b. ENROLLMENT-EFF-DATE is greater than Prev_Enrollment_End_Date ELSESet Enrollment_Span_Start = "0"STEP 9: Total count of noncontiguous enrollment spansFor each MSIS ID that meets the criteria from STEP 2, set Tot_Enrollment_Span = Count of rows where Enrollment_Span_Start = "1"STEP 10: Count of MSIS IDs with one or more enrollment gapsFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Tot_Enrollment_Span is greater than 1.STEP 11: Calculate percentage for measureDivide the count of MSIS IDs from STEP 10 by the count of MSIS IDs from STEP 2
01/30/2026	4.0.26	EL-6-040-40	UPDATE	Grace period expiration date	2025-08-28	2026-07-30
11/21/2025	4.0.22	EL-6-040-40	UPDATE	Annotation	N/A	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period
11/21/2025	4.0.22	EL-6-040-40	UPDATE	Specification	N/A	STEP 1: Enrolled at any time within the past 12 monthsDefine 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 >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Enrollment status by monthUsing the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where:1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missingELSESet Enrollment_Status = "0"STEP 4: Identify enrollment gapsFor each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where:1. Enrollment_Status = "0" for the month2. There is any prior month within the 12 month period with Enrollment_Status = "1"3. There is any subsequent month within the 12 month period with Enrollment_Status = "1"ELSESet Enrollment_Gap = "0"STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest monthFor the months identified in STEP 4 where Enrollment_Gap = "1", if the preceding month in the 12 month period also has Enrollment_Gap = "1", set Enrollment_Gap for the month = "0" STEP 6: Total count of enrollment gaps across 12 month periodFor each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1"STEP 7: Count of MSIS IDs with an enrollment gapFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0STEP 8: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2
11/20/2025	4.0.22	EL-6-040-40	UPDATE	Annotation	Calculate the percentage of MSIS IDs enrolled in the past 12 months with at least one gap in enrollment during that time period	N/A
11/20/2025	4.0.22	EL-6-040-40	UPDATE	Specification	STEP 1: Enrolled at any time within the past 12 monthsDefine 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 >= 12 months prior to last day of the DQ report month OR missing3. MSIS-IDENTIFICATION-NUM is not missingSTEP 2: Enrollment Type is Medicaid or CHIPUsing the MSIS IDs that meet the criteria from STEP 1, further refine the population by keeping records with: 1. ENROLLMENT-TYPE = "1" or "2"STEP 3: Enrollment status by monthUsing the MSIS IDs that meet the criteria from STEP 2, for each month within the 12 month period identified in STEP 1, set Enrollment_Status = "1" where:1. ENROLLMENT-EFF-DATE <= first day of the month 2. ENROLLMENT-END-DATE >= last day of the month OR missingELSESet Enrollment_Status = "0"STEP 4: Identify enrollment gapsFor each month within the 12 month period identified in STEP 1, set Enrollment_Gap = "1" where:1. Enrollment_Status = "0" for the month2. There is any prior month within the 12 month period with Enrollment_Status = "1"3. There is any subsequent month within the 12 month period with Enrollment_Status = "1"ELSESet Enrollment_Gap = "0"STEP 5: Address multi-month enrollment gaps by keeping the enrollment gap status only for the earliest monthFor the months identified in STEP 4 where Enrollment_Gap = "1", if the preceding month in the 12 month period also has Enrollment_Gap = "1", set Enrollment_Gap for the month = "0" STEP 6: Total count of enrollment gaps across 12 month periodFor each MSIS ID that meets the criteria from STEP 2, set Gap_Total = Count of months where Enrollment_Gap = "1"STEP 7: Count of MSIS IDs with an enrollment gapFor each MSIS ID that meets the criteria from STEP 2, further refine the population by keeping records where Gap_Total is greater than 0STEP 8: Calculate percentage for measureDivide the count of MSIS IDs from STEP 6 by the count of MSIS IDs from STEP 2	N/A
10/07/2025	4.0.19	EL-6-040-40	UPDATE	Grace period expiration date	None	2025-08-28
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Priority	N/A	High
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Category	N/A	Beneficiary eligibility
05/27/2025	4.0.9	EL-6-040-40	UPDATE	For ta comprehensive	No	TA- Inferential
05/27/2025	4.0.9	EL-6-040-40	UPDATE	For ta inferential	No	Yes
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Ta min		0.001
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Ta max		0.1
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Threshold minimum	TBD	0.001
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Threshold maximum	TBD	0.1
05/27/2025	4.0.9	EL-6-040-40	UPDATE	Focus area	N/A	Enrollment monitoring
04/24/2025	4.0.7	EL-6-040-40	ADD	N/A		Created