CMS Technical Instructions: Beneficiary Demographics

Standardized collection of race, ethnicity, gender, sexual identity, and primary language data in T-MSIS will assist all Medicaid and CHIP beneficiaries in achieving their highest level of health and reduce disparities in quality and access to care. All data elements related to demographic information are required to be reported in T-MSIS for all beneficiaries when possible.

PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 segment:

• ELIGIBLE-FIRST-NAME (ELG020)
• ELIGIBLE-LAST-NAME (ELG021)
• ELIGIBLE-MIDDLE-INIT (ELG022)
• SEX (ELG023)
• DATE-OF-BIRTH (ELG024)
• DATE-OF-DEATH (ELG025)

ELIGIBLE-CONTACT-INFORMATION-ELG00004 segment:

• ELIGIBLE-ADDR-TYPE (ELG065)
• ELIGIBLE-CITY (ELG069)
• ELIGIBLE-STATE (ELG070)
• ELIGIBLE-ZIP-CODE (ELG071)
• ELIGIBLE-COUNTY-CODE (ELG072)
• ELIGIBLE-PHONE-NUM (ELG073)

ETHNICITY-INFORMATION-ELG000015 segment:

• ETHNICITY-CODE (ELG204)

RACE-INFORMATION-ELG000016 segment:

• RACE (ELG213)

Section 4302(b) of the Affordable Care Act required the Department of Health and Human Services to develop data collection standards for five demographic categories – race, ethnicity, sex, primary language, and disability status – and requires any federally conducted or supported health care or public health program, activity, or survey collect and report data on these categories to the extent practicable. Additionally, the Secretary evaluates approaches for collecting and evaluating data on health care disparities in Medicaid and Children’s Health Insurance Program (CHIP).

States are required to report all of the relevant demographic data elements under the PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002, ELIGIBLE-CONTACT-INFORMATION-ELG00004, ETHNICITY-INFORMATION-ELG00015, and RACE-INFORMATION-ELG00016 segments within the Eligible File for all or almost all beneficiaries. This information includes full name, biological sex, date of birth, date of death, address, phone number, race, and ethnicity. The time spans for when all data elements are effective in the segment should also always be reported.

Please refer to the T-MSIS Data Guide for specific coding requirements for each data element.