DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
Centers for Medicaid and State Operations 
 
         SHO #06-006     
 
October 17, 2006               
 
Dear State Childrens Health Insurance Program Director: 
 
As you are aware, the State Childrens Health Insurance Program (SCHIP) regulations (42 CFR 457.740) require States to 
report statistical enrollment data for all individuals enrolled in programs that receive Title XXI funds.  The purpose of this 
letter is to remind States of the importance of the timely submission of enrollment data for children in SCHIP State plans, 
as well as children and adults with Title XXI funding covered in Section 1115 demonstrations.  This letter also highlights 
the process for States to adhere to this requirement.    
States are required to submit quarterly and annual enrollment data into the Internet-based SCHIP Statistical Enrollment 
Data System (SEDS) which is accessed via our website at http://63.148.94.170/mbescbes\.  States complete different types 
of enrollment forms in SEDS depending upon whether children are covered through a separate SCHIP or a Medicaid 
expansion program.  States with separate child health programs must submit data on the CMS-21E Form and States with 
SCHIP Medicaid expansion programs must submit data on the CMS-64.21E Form. 
In addition to enrollment data provided for children covered in the SCHIP State plan, States with approved Section 1115 
SCHIP demonstrations must submit enrollment data on a timely basis into SEDS by the type of demonstration population 
(i.e., pregnant women, parents, childless adults) on the CMS-21 Waiver Form.  States with an approved Employee 
Sponsored Insurance (ESI) program under the SCHIP State plan must also complete the CMS-21E1 Informational Form 
and States with an approved 1115 demonstration ESI component must complete the CMS-21 Waiver Informational Form. 
States are required to submit data into SEDS within 30 days after the end of a quarter and year on a Federal Fiscal Year 
(FFY) basis.  Data is due as follows:  
  Quarter 1 - January 30;  
  Quarter 2 - April 30;  
  Quarter 3 - July 30; and  
  Quarter 4 - October 30.   
For example, the FFY 2006 fourth quarter enrollment data and 2006 annual enrollment data are both due on October 30, 
2006.   
All forms collect the following information for each quarter of the Federal Fiscal Year: 
1.  Unduplicated number of ever enrolled during quarter; 
2.  Unduplicated number of new enrollees during quarter; 
3.  Unduplicated number of disenrollees during quarter; 
4.  Number of member months enrollment during quarter; 
5.  Average number of months enrolled during quarter; 
6.  Number enrolled on last day of the quarter (point-in-time); and 
7.  Unduplicated number enrolled during the Federal Fiscal Year (fourth quarter only). 
Should you have any questions regarding the submission of enrollment data into SEDS for populations covered through 
Title XXI funds, please contact Ms. Kathleen Farrell, Director, Division of State Childrens Health Insurance, Family and 
Childrens Health Programs Group at (410) 786-1236.    
            Sincerely,  
/s/        
            Dennis G. Smith  
            Director  Enclosure 
cc:   
CMS Regional Administrators 
CMS Associate Regional Administrators for Medicaid and State Operations 
Martha Roherty, Director, Health Policy Unit, American Public Human Services Association 
Joy Wilson, Director, Health Committee, National Conference of State Legislature 
Matt Salo, Director of Health Legislation, National Governors Association 
Jacalyn Bryan Carden, Director of Policy and Programs, Association of State and Territorial Health Officials 
Christie Raniszewski Herrera, Director, Health and Human Services Task Force, American Legislative Exchange Council 
Lynne Flynn, Director for Health Policy, Council of State Governments