DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland 21244-1850 
 
Center for Medicaid and State Operations 
 
 
                    SMDL # 03-007 
 
              September 16, 2003 
 
 
 
Dear State Medicaid Directors: 
           
The purpose of this letter is to inform you of changes to the reporting specifications for the 
Medicaid Statistical Information System (MSIS).  These changes are effective with the first 
quarterly tape submittals for Federal fiscal year (FFY) 2005 (the October - December 2004 
quarter).  However because of the intense interest in the new data, we encourage states to include 
these new data fields in the earliest possible quarterly tape submittals.   
 
Effective in FFY 1999, MSIS became the primary Federal reporting medium for general 
Medicaid program information, replacing the hard-copy HCFA-2082 report. Under MSIS, states 
submit quarterly tape extracts of eligibles and claims data from their claims processing and 
administrative systems.  The changes affect only the MSIS eligible tapes and no changes are 
required for the claims tape submittals.  These changes are documented in the attached MSIS 
Data Dictionary replacement pages (also available on our web site at 
http://www.cms.hhs.gov/medicaid/msis). 
 
The changes include updated coding related to race/ethnicity and the participation of eligibles in 
Medicaid waiver programs.  We have added fields to the eligible record to capture indicators for 
each of the major race categories and a Hispanic/Latino ethnicity category.  These multiple fields 
allow us to capture the race/ethnicity for individuals who feel they belong to multiple categories.  
These changes are being made to accommodate the coding of the multiple race/ethnicity 
categories now being captured by many states.  Where states have not opted to capture multiple 
race/ethnicity categories at eligibility intake, the new fields will be coded consistently with the 
current coding.  Refer to OMB Statistical Policy Directive 15, published in the Federal Register 
on October 30, 1997, for clarification on definitions related to race/ethnicity.    
 
In addition to the race/ethnicity changes, we are adding fields to capture the participation of each 
reported individual in Medicaid waiver programs.  More states have implemented these waivers, 
including 1915(b), 1915(c), and 1115 demonstration waiver programs, and we need to establish a 
consistent process for reporting on enrollment in these programs. 
  Page 2  State Medicaid Director 
 
We have made every possible effort to minimize the impact of these changes on your systems 
development staff.  We have worked closely with your staff throughout the 1999 MSIS 
implementation process, and we realize the potential impact of any transition in reporting 
requirements.  For this reason, we have added the new information only as new fields in prior 
filler space.  This means that no existing MSIS tape fields will change.  The new data, 
which we anticipate will be readily available in most systems, will be added to the eligible 
type record in previously unused space, with no change in the total length of the reported 
record.  We believe this will significantly reduce any added burden associated with 
accomplishing these changes and facilitate implementation of the changes for early FY 2004 
quarterly submittals.     
 
Please forward this information, along with the attached modifications to the MSIS data 
dictionary, to the appropriate state staff.  We have an ongoing working relationship with the 
reporting staffs from the states, and look forward to providing any needed information or 
assistance to facilitate these changes. 
 
We very much appreciate your efforts to implement the dramatic improvements in program 
information represented by MSIS.  Please refer any questions or concerns regarding these 
MSIS changes to Roger Buchanan at (410) 786-0780 or rbuchanan@cms.hhs.gov.   
 
              Sincerely, 
 
              /s/ 
 
              Dennis G. Smith 
 
Enclosure (See below) 
 
cc: 
CMS Regional Administrators 
 
CMS Associate Regional Administrators 
  for Medicaid and State Operations 
 
Kathryn Kotula 
Director, Health Policy Unit 
American Public Human Services Association 
 
Joy Wilson 
Director, Health Committee 
National Conference of State Legislatures 
  Page 3  State Medicaid Director 
 
Matt Salo 
Director of Health Legislation 
National Governors Association 
 
Brent Ewig 
Senior Director, Access Policy 
Association of State and Territorial Health Officials 
 
Jim Frogue 
Director, Health and Human Services Task Force 
American Legislative Exchange Council 
  
Trudi Matthews 
Senior Health Policy Analyst 
Council of State Governments 
  Enclosure
 
 
5.4  ELIGIBLE File - Physical Data Record Layout           
 
The following table summarizes the fields in the ELIGIBLE file record in the order in which they physically occur in each record 
(see Section 2, paragraph [e]).  Fields whose values remain fixed for an entire quarter are referred to as "root" fields; fields that 
vary monthly are listed separately for each month. 
 
 
  ELIGIBLE RECORD SUMMARY 
DEFAULT 
- POSITION -  ERROR 
FIELD NAME          COBOL PICTURE  START     END    TOLERANCE 
 
ROOT FIELDS 
 
MSIS-IDENTIFICATION-NUMBER  X(20)  01  20  0.1% 
DATE-OF-BIRTH  9(8)  21  28  0.1% 
DATE-OF-DEATH  9(8)  29  36  5.0% 
SEX-CODE  X(1)  37  37  2.0% 
RACE-ETHNICITY-CODE  9(1)  38  38  2.0% 
SOCIAL-SECURITY-NUMBER  9(9)  39  47  2.0% 
COUNTY-CODE  9(3)  48  50  5.0% 
ZIP-CODE  9(5)  51  55  5.0% 
TYPE-OF-RECORD  9(1)  56  56  2.0% 
FEDERAL-FISCAL-YEAR-QUARTER  9(5)  57  61  0.1% 
DUAL-ELIGIBLE-FLAG  9(2)  62  63  2.0% 
HIC-NUMBER  X(12)  64  75  5.0% 
MSIS-CASE-NUMBER  X(12)  76  87  0.1% 
RACE-CODE-1  9(1)  88  88  5.0% 
RACE-CODE-2  9(1)  89  89  5.0% 
RACE-CODE-3  9(1)  90  90  5.0% 
RACE-CODE-4  9(1)  91  91  5.0% 
RACE-CODE-5  9(1)  92  92  5.0% 
ETHNICITY-CODE  9(1)  93  93  5.0% 
FILLER                                                                            X(9)    94  102   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002  22        ELIGIBLE RECORD SUMMARY 
 
DEFAULT 
- POSITION -  ERROR 
FIELD NAME          COBOL PICTURE  START     END    TOLERANCE 
 
MONTHLY FIELDS 
 
MONTH 1: 
 
DAYS-OF-ELIGIBILITY  S9(2)  103  104  2.0% 
ELIGIBILITY-GROUP  X(6)  105  110  2.0% 
MAINTENANCE-ASSISTANCE-STATUS  X(1)  111  111  0.1% 
BASIS-OF-ELIGIBILITY  X(1)  112  112  0.1% 
HEALTH-INSURANCE  9(1)  113  113  5.0% 
TANF-CASH-FLAG  9(1)  114  114  2.0% 
RESTRICTED-BENEFITS-FLAG  9(1)  115  115  5.0% 
PLAN-TYPE-1  9(2)  116  117  5.0% 
PLAN-ID-1  X(12)  118  129  5.0% 
PLAN-TYPE-2  9(2)  130  131  5.0% 
PLAN-ID-2  X(12)  132  143  5.0% 
PLAN-TYPE-3  9(2)  144  145  5.0% 
PLAN-ID-3  X(12)  146  157  5.0% 
PLAN-TYPE-4  9(2)  158  159  5.0% 
PLAN-ID-4  X(12)  160  171  5.0% 
CHIP-CODE  X(1)  172  172  5.0% 
INCOME-CODE  X(2)  173  174  5.0% 
WAIVER-TYPE-1  X(1)  175  175  5.0% 
WAIVER-ID-1  X(2)  176  177  5.0% 
WAIVER-TYPE-2  X(1)  178  178  5.0% 
WAIVER-ID-2  X(2)  179  180  5.0% 
WAIVER-TYPE-3  X(1)  181  181  5.0% 
WAIVER-ID-3  X(2)  182  183  5.0% 
FILLER  X(10)  184  193 
 
 
MONTH 2: 
 
DAYS-OF-ELIGIBILITY  S9(2)  194  195  2.0% 
ELIGIBILITY-GROUP  X(6)  196  201  2.0% 
MAINTENANCE-ASSISTANCE-STATUS  X(1)  202  202  0.1% 
BASIS-OF-ELIGIBILITY  X(1)  203  203  0.1% 
HEALTH-INSURANCE  9(1)  204  204  5.0% 
TANF-CASH-FLAG  9(1)  205  205  2.0% 
RESTRICTED-BENEFITS-FLAG  9(1)  206  206  5.0% 
PLAN-TYPE-1  9(2)  207  208  5.0% 
PLAN-ID-1  X(12)  209  220  5.0% 
PLAN-TYPE-2  9(2)  221  222  5.0% 
PLAN-ID-2  X(12)  223  234  5.0% 
PLAN-TYPE-3  9(2)  235  236  5.0% 
PLAN-ID-3  X(12)  237  248  5.0% 
PLAN-TYPE-4  9(2)  249  250  5.0% 
PLAN-ID-4  X(12)  251  262  5.0% 
CHIP-CODE  X(1)  263  263  5.0% 
INCOME-CODE  X(2)  264  265  5.0% 
WAIVER-TYPE-1  X(1)  266  266  5.0% 
WAIVER-ID-1  X(2)  267  268  5.0% 
WAIVER-TYPE-2  X(1)  269  269  5.0% 
WAIVER-ID-2  X(2)  270  271  5.0% 
WAIVER-TYPE-3  X(1)  272  272  5.0% 
WAIVER-ID-3  X(2)  273  274  5.0% 
FILLER  X(10)  275  284 
 
 
 
July 2002  23   
  ELIGIBLE RECORD SUMMARY 
 
DEFAULT 
- POSITION -  ERROR 
FIELD NAME          COBOL PICTURE  START     END    TOLERANCE 
 
 
MONTH 3: 
 
DAYS-OF-ELIGIBILITY  S9(2)  285  286  2.0% 
ELIGIBILITY-GROUP  X(6)  287  292  2.0% 
MAINTENANCE-ASSISTANCE-STATUS  X(1)  293  293  0.1% 
BASIS-OF-ELIGIBILITY  X(1)  294  294  0.1% 
HEALTH-INSURANCE  9(1)  295  295  5.0% 
TANF-CASH-FLAG  9(1)  296  296  2.0% 
RESTRICTED-BENEFITS-FLAG  9(1)  297  297  5.0% 
PLAN-TYPE-1  9(2)  298  299  5.0% 
PLAN-ID-1  X(12)  300  311  5.0% 
PLAN-TYPE-2  9(2)  312  313  5.0% 
PLAN-ID-2  X(12)  314  325  5.0% 
PLAN-TYPE-3  9(2)  326  327  5.0% 
PLAN-ID-3  X(12)  328  339  5.0% 
PLAN-TYPE-4  9(2)  340  341  5.0% 
PLAN-ID-4  X(12)  342  353  5.0% 
CHIP-CODE  X(1)  354  354  5.0% 
INCOME-CODE  X(2)  355  356  5.0% 
WAIVER-TYPE-1  X(1)  357  357  5.0% 
WAIVER-ID-1  X(2)  358  359  5.0% 
WAIVER-TYPE-2  X(1)  360  360  5.0% 
WAIVER-ID-2  X(2)  361  362  5.0% 
WAIVER-TYPE-3  X(1)  363  363  5.0% 
WAIVER-ID-3  X(2)  364  365  5.0% 
FILLER     X(10)  366  375 
 
 
The  error tolerance describes, for each field, the maximum allowable percentage of records submitted that may have missing, 
unknown, or invalid codes.  Error rates in excess of the error tolerance level for any field will cause the entire file to be 
rejected. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002  23.1  5.5 ELIGIBLE File - Logical Data Record Layout 
 
The following table summarizes the fields in the ELIGIBLE file record in the order in which fields are processed by the 
validation program (see Section 2.0. paragraph [e]).    NOTE: Monthly fields are edited collectively in month order.  
(ex.  DAYS-OF-ELIGIBILITY Month 1, DAYS-OF-ELIGIBILITY Month 2, DAYS-OF-ELIGIBILITY Month 3) 
 
     FIELD-TYPE 
MSIS-IDENTIFICATION-NUMBER   (Root) 
DATE-OF-BIRTH         (Root) 
DATE-OF-DEATH        (Root) 
SEX-CODE           (Root) 
RACE-ETHNICITY-CODE      (Root)   
RACE-CODE-1          (Root) 
RACE-CODE-2          (Root) 
RACE-CODE-3          (Root) 
RACE-CODE-4          (Root) 
RACE-CODE-5          (Root) 
ETHNICITY-CODE        (Root) 
SOCIAL-SECURITY-NUMBER    (Root) 
COUNTY-CODE         (Root)           
ZIP-CODE           (Root) 
TYPE-OF-RECORD        (Root) 
FEDERAL-FISCAL-YEAR-QUARTER  (Root) 
DUAL-ELIGIBILITY-FLAG      (Root) 
HIC-NUMBER          (Root) 
MSIS-CASE-NUMBER       (Root) 
DAYS-OF-ELIGIBILITY       (Monthly) 
ELIGIBILITY-GROUP        (Monthly) 
MAINTENANCE-ASSISTANCE-STATUS (Monthly) 
BASIS-OF-ELIGIBILITY      (Monthly) 
TANF-CASH-FLAG        (Monthly) 
RESTRICTED-BENEFITS-FLAG    (Monthly) 
PLAN-TYPE-1          (Monthly) 
PLAN-ID-1           (Monthly) 
PLAN-TYPE-2          (Monthly) 
PLAN-ID-2           (Monthly) 
PLAN-TYPE-3          (Monthly) 
PLAN-ID-3           (Monthly) 
PLAN-TYPE-4          (Monthly) 
PLAN-ID-4           (Monthly) 
HEALTH-INSURANCE       (Monthly) 
CHIP-CODE          (Monthly) 
INCOME-CODE          (Monthly)   
WAIVER-TYPE-1         (Monthly) 
WAIVER-ID-1          (Monthly) 
WAIVER-TYPE-2         (Monthly) 
WAIVER-ID-2          (Monthly) 
WAIVER-TYPE-3         (Monthly) 
WAIVER-ID-3          (Monthly) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002                24   
  ELIGIBLE FILE 
 
Data Element Name: RACE-CODE-1 
 
Definition:  Root Field - A code indicating if the eligible has indicated a race of White. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles race demographics includes a race of White.  This determination is independent of 
indications of other races.  That is, for RACE-CODE-1 through RACE-CODE-5, any combination of race codes is possible.  If 
there is no available race information for the eligible, code all five RACE-CODE(s) as 0, and the race for the eligible will be 
deemed to be unknown.  
 
 
Valid Values  Code Definition 
   
  0  Non-White or Race Unknown 
  1  White 
 
 
Error Condition                  Resulting Error Code 
 
  1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
  2.  Value not equal to 0 OR 1  - Reset to 0...................................................................................203 
 
  3.  Relational Field in Error................................................................................................999 
 
  4.  Value = 0 and Race/Ethnicity Code = 1..................................................................................550 
 
  5.   Value = 1 and Race/Ethnicity Code is not equal to 1 or 7 or 8...............................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.1   
  ELIGIBLE FILE 
 
Data Element Name: RACE-CODE-2 
 
Definition:  Root Field - A code indicating if the eligible has indicated a race of Black or African-American. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles race demographics includes a race of Black or African-American.  This determination 
is independent of indications of other races.  That is, for RACE-CODE-1 through RACE-CODE-5, any combination of race 
codes is possible.  If there is no available race information for the eligible, code all five RACE-CODE(s) as 0, and the race for 
the eligible will be deemed to be unknown.  
 
 
Valid Values  Code Definition 
  
  0  Non-Black or African American or Race Unknown 
  1  Black or African American 
 
 
Error Condition                  Resulting Error Code 
 
  1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
  2.  Value not equal to (0 OR 1)  - Reset to 0  ...............................................................................203 
 
  3.  Relational Field in Error................................................................................................999 
 
  4.  Value = 0 and Race/Ethnicity Code = 2..................................................................................550 
 
  5.   Value = 1 and Race/Ethnicity Code is not equal to 2 or 7 or 8...............................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.2    ELIGIBLE FILE 
 
Data Element Name: RACE-CODE-3 
 
Definition:  Root Field - A code indicating if the eligible has indicated a race of American Indian or Alaska Native. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles race demographics includes a race of American Indian or Alaska Native.  This 
determination is independent of indications of other races.  That is, for RACE-CODE-1 through RACE-CODE-5, any 
combination of race codes is possible.  If there is no available race information for the eligible, code all five RACE-CODE(s) as 
0, and the race for the eligible will be deemed to be unknown.  
 
 
Valid Values  Code Definition 
  
  0  Non-American Indian or Alaska Native or Race Unknown 
  1  American Indian or Alaska Native 
 
 
Error Condition                  Resulting Error Code 
 
  1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
  2.  Value not equal to 0 OR 1  - Reset to 0...................................................................................203 
 
  3.  Relational Field in Error................................................................................................999 
 
  4.  Value = 0 and Race/Ethnicity Code = 3..................................................................................550 
 
  5.   Value = 1 and Race/Ethnicity Code is not equal to 3 or 7 or 8...............................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.3 
    ELIGIBLE FILE 
 
Data Element Name: RACE-CODE-4 
 
Definition:  Root Field - A code indicating if the eligible has indicated a race of Asian. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles race demographics includes a race of Asian.  This determination is independent of 
indications of other races.  That is, for RACE-CODE-1 through RACE-CODE-5, any combination of race codes is possible.  If 
there is no available race information for the eligible, code all five RACE-CODE(s) as 0, and the race for the eligible will be 
deemed to be unknown.  
 
 
Valid Values  Code Definition 
   
  0  Non-Asian or Race Unknown 
  1  Asian 
 
 
Error Condition                  Resulting Error Code 
 
  1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
  2.  Value not equal to 0 OR 1  - Reset to 0...................................................................................203 
       
    3.  Relational Field in Error................................................................................................999 
 
  4.  Value = 0 and Race/Ethnicity Code = 4..................................................................................550 
 
  5.   Value = 1 and Race/Ethnicity Code is not equal to 4 or 7 or 8...............................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.4 
       ELIGIBLE FILE 
 
Data Element Name: RACE-CODE-5 
 
Definition:  Root Field - A code indicating if the eligible has indicated a race of Native Hawaiian or other Pacific Islander. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles race demographics includes a race of Native Hawaiian or other Pacific Islander.  This 
determination is independent of indications of other races.  That is, for RACE-CODE-1 through RACE-CODE-5, any 
combination of race codes is possible.  If there is no available race information for the eligible, code all five RACE-CODE(s) as 
0, and the race for the eligible will be deemed to be unknown.  
 
 
Valid Values  Code Definition 
   
  0  Non-Native Hawaiian or Other Pacific Islander or Race Unknown 
  1  Native Hawaiian or Other Pacific Islander 
 
 
Error Condition                  Resulting Error Code 
 
  1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
  2.  Value not equal to 0 OR 1  - Reset to 0...................................................................................203 
 
  3.  Relational Field in Error................................................................................................999 
 
  4.  Value = 0 and Race/Ethnicity Code = 6..................................................................................550 
 
  5.   Value = 1 and Race/Ethnicity Code is not equal to 6 or 7 or 8...............................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.5 
       ELIGIBLE FILE 
 
Data Element Name: ETHNICITY-CODE 
 
Definition:  Root Field - A code indicating if the eligible has indicated an ethnicity of Hispanic or Latino. 
 
 
Field Description: 
 
COBOL Error      Example 
PICTURE  Tolerance  Value   
 
9(1)    5.0%    1 
 
 
Coding Requirements: 
 
Use this code to indicate if the eligibles demographics include an ethnicity of Hispanic or Latino.  This determination is 
independent of indication of RACE-CODE (1-5).  
 
Valid Values  Code Definition 
 
  0  Not Hispanic or Latino 
  1  Hispanic or Latino 
9  Ethnicity Unknown 
   
 
 
Error Condition                  Resulting Error Code 
 
 1.  Value is Non-Numeric - Reset to 0  ........................................................................................812 
 
 2.  Value is 9...............................................................................................................................301 
 
 3.  Value not equal to 0 or 1or 9 ...................................................................................................203 
 
 4.  Relational Field in Error................................................................................................999 
 
 5.  Value = 0 and Race/Ethnicity Code = 5 OR 7 .........................................................................550 
 
 6.   Value = 1 and Race/Ethnicity Code is not equal to 5 OR 7...................................................551 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
July 2002          44.6  ELIGIBLE FILE 
 
 
Data Element Names: WAIVER-ID-1 
WAIVER-ID-2 
WAIVER-ID-3 
 
Definition: Monthly Fields - Fields for specifying up to three waiver programs under which the eligible individual is covered 
during the month.  These Ids must be assigned by the State, using alpha or numeric codes, to uniquely identify 
each specific waiver program(s) under which the individual is covered.  The categories of waiver programs include 
1915(b), 1915(c), combined (b)/(c) programs, and 1115 demonstrations.  Individuals are to be associated with a 
specific waiver only if they are enrolled in a waiver program.  
 
    In order to support more detailed analysis of the waiver data, States must submit a hard-copy baseline crosswalk 
showing the MSIS WAIVER-ID number, and the associated approved full waiver ID number and name.  Updates to 
this crosswalk must be submitted when waivers are added or ID numbers are changed.  
 
 
 
 
Field Description: 
 
COBOL  Error  Example 
PICTURE  Tolerance  Value   
 
X(2)  5.0%  C1   
 
 
Coding Requirements: 
 
Please fill in the monthly WAIVER-ID fields in sequence (e.g., if an individual is enrolled in two waivers, only the first and 
second set of monthly fields should be used8 fill the WAIVER-ID-3 field.  If only enrolled in one waiver, code WAIVER-
ID-1 and 8-fill WAIVER-ID-2 and WAIVER-ID-3). 
 
Enter the coded WAIVER-ID number assigned by the State, and reported in the hard-copy crosswalk documentation. 
 
If individual is not eligible for Medicaid during the month, 0-fill all three fields. 
 
If individual is not enrolled in waiver during the month, 8-fill all three fields.   
 
 
Error Condition  Resulting Error Code 
 
1.      Value is SPACE FILLED............................................................................................................................................... 303 
 
2.   Relational Field in Error............................................................................................................................999 
 
3.  Value is <> 00" AND DAYS-OF-ELIGIBILITY = +00 AND CHIP CODE<>3"................................................................502 
 
4.  Value is = 00" AND DAYS-OF-ELIGIBILITY NOT = +00................................................................................................502 
 
4.  Value is <> 88" AND corresponding WAIVER-TYPE = 0 or 8........................................................................................538 
 
6.  Value is = 88" AND corresponding WAIVER-TYPE = 1 THROUGH 5 OR 9..................................................................538 
 
7.  Value is > 00"  in any month later than the month that...................................................................................................504 
included DATE-OF-DEATH. 
 
8.     Value appears more than once in monthly array AND VALUE<>88" OR SPACE Filled .............................................532 
 
 
 
 
 
July 2002          50.1  ELIGIBLE FILE 
 
Data Element Names: WAIVER-TYPE-1 
WAIVER-TYPE-2 
WAIVER-TYPE-3 
 
Definition: Monthly Fields - Codes for specifying up to three waiver types under which the eligible individual is 
    covered during the month. 
 
Field Description: 
 
COBOL  Error  Example 
PICTURE  Tolerance  Value   
 
X(1)  5.0%  3     
 
Coding Requirements: 
 
Please fill in the monthly WAIVER-TYPE fields in sequence (e.g., if an individual is enrolled in two waivers, only the first 
and second set of monthly fields should be used; if only enrolled in one waiver, code WAIVER-TYPE-1 and 8-fill 
WAIVER-TYPE-2 through WAIVER-TYPE-3). 
 
Values must correspond to associated WAIVER-ID-NUMBER. 
 
Valid Values  Code Definition 
 
0    Individual was not eligible for Medicaid this month 
1    The associated Waiver-ID-Number is for an 1115 waiver this month.  May also be called a research, 
experimental, demonstration or pilot waiver or refer to consumer-directed care or expanded eligibility.  
May cover entire State or just a geographic entity or specific population. 
2    The associated Waiver-ID-Number is for a 1915(b) waiver this month.  May also be called managed 
care, freedom-of-choice, statewideness, selective contracting, comparability, or program waiver. 
3    The associated Waiver-ID-Number is for a 1915(c) waiver this month.  May also be called Home and 
Community Based Care, HCBS, HCB, and will often mention specific populations such as MR/DD, 
aged, disabled/physically disabled, aged/disabled, AIDS/ARC, mental health, TBI/head injury, special 
care children/technology dependent children. 
4    The  associated  Waiver-ID-Number  is  a  combined  1915(b)(c)  waiver  this  month.    Includes  both 
managed  care  and  alternatives  to  institutional  long  term  care  such  as:    case  management; 
homemaker/home health aid; personal care services; adult day health; habilitation; respite. 
    5    The associated Waiver-ID-Number is for a HIFA (Health Insurance and Flexibility and Accountability) 
waiver this month.  May also be called demonstration waiver or refer to the eligibility expansion, and 
will be a new  waiver on or after August 2001. 
6  The associated Waiver-ID-Number is for Pharmacy waiver coverage this month.  Includes waivers 
under 1115 demonstration authority which are primarily intended to increase coverage or expand 
eligibility for pharmacy benefits. 
7  The associated Waiver-ID-Number is for another type of waiver. 
8  Not applicable, individual is eligible for Medicaid, but is NOT enrolled in a waiver this month. 
9    The associated Waiver-ID-Number is for an unknown type of waiver. 
 
Error Condition                                                                                                                                                 Resulting Error 
Code 
1.  Value is Non-Numeric  Reset to 9..............................................................................................................812 
 
2.  Value is 9-filled................................................................................................................................................................301 
 
3.  Value is not valid.............................................................................................................................................................203 
 
4.  Relational Field in Error...................................................................................................................................................999 
 
5.  Value is <> 0 AND DAYS-OF-ELIGIBILITY= +00 AND CHIP-CODE <>3".....................................................................502 
 
6.  Value = 0 AND DAYS-OF-ELIGIBILITY <> +00..............................................................................................................502 
 
 
 
July 2002          50.2