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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

ELG - ELIGIBLE

File

View Changelog
File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
ELG00001 FILE-HEADER-RECORD-ELIGIBILITY A record segment containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
ELG00002 PRIMARY-DEMOGRAPHICS-ELIGIBILITY A record segment to capture basic demographic information about the individual.
ELG00003 VARIABLE-DEMOGRAPHICS-ELIGIBILITY A record segment to capture additional demographic information that is more prone to periodic changes than primary demographics.
ELG00004 ELIGIBLE-CONTACT-INFORMATION A record segment to capture addresses and phone numbers of the individual.
ELG00005 ELIGIBILITY-DETERMINANTS A record segment to capture factors that influence an individual’s eligibility for basic Medicaid/CHIP, as well as the various waivers and demonstrations.
ELG00006 HEALTH-HOME-SPA-PARTICIPATION-INFORMATION A record segment to capture the eligible person's participation in the state's health home initiative.
ELG00007 HEALTH-HOME-SPA-PROVIDERS A record segment to capture the identity of the health home entity in which the eligible person is enrolled, as well as the identity of the provider with primary responsibility for coordinating the delivery of health home services.
ELG00008 HEALTH-HOME-CHRONIC-CONDITIONS A record segment to capture an eligible person's chronic conditions that qualified him/her for participation in the health home initiative.
ELG00009 LOCK-IN-INFORMATION A record segment to capture the provider, or providers, to whom the eligible person is restricted, as well as the time periods during which the lock-in provisions are in force.
ELG00010 MFP-INFORMATION A record segment to capture information about an eligible person's participation in the Money Follows the Person demonstration program.
ELG00011 STATE-PLAN-OPTION-PARTICIPATION A record segment to capture the identity of the State Plan Options in which an eligible person is enrolled.
ELG00012 WAIVER-PARTICIPATION A record segment to capture the identity of the waivers in which an eligible person is enrolled.
ELG00013 LTSS-PARTICIPATION A record segment to capture the level of care an eligible person receives at various points in time while in a long-term care facility.
ELG00014 MANAGED-CARE-PARTICIPATION A record segment to capture information about an eligible person's enrollment in a managed care plan.
ELG00015 ETHNICITY-INFORMATION A record segment to capture information about an eligible person's ethnicity.
ELG00016 RACE-INFORMATION A record segment to capture information about an eligible person's race.
ELG00017 DISABILITY-INFORMATION A record segment to capture information about an eligible person's disabilities.
ELG00018 1115A-DEMONSTRATION-INFORMATION A record segment to capture an eligible person's 1115A participation.
ELG00020 HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME A record segment to capture an eligible person's chronic conditions for which an eligible person is receiving home and community-based care.
ELG00021 ENROLLMENT-TIME-SPAN-SEGMENT A record segment to capture the eligible person's type of enrollment and time spans of enrollment.
ELG00022 ELG-IDENTIFIERS A record segment to capture the identifiers assigned to a beneficiary by various entities.
Definition
Enhanced information about beneficiary enrollment and eligibility including person level demographic and eligibility data.

Overview

Eligible File – Eligible Person Record Segment Relationships

Eligible File – Eligible Person Record Segment Relationships

Description

Each eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty­­-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:

SUBMITTING-STATE

MSIS-IDENTIFICATION-NUM

The exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:

SUBMITTING-STATE

MSIS-IDENTIFICATION-NUM

HEALTH-HOME-SPA-ID

HEALTH-HOME-ENTITY-NAME