Reporting Individuals Who Receive Medicaid Coverage for COVID-19 Testing in the T-MSIS Eligible File

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Greetings from the MACBIS T-MSIS Coding Information Team!

CMS has issued guidance on state reporting requirements for Transformed Medicaid Statistical Information (T-MSIS) enrollment data for uninsured individuals who receive limited Medicaid coverage for COVID-19 testing. Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA) added Section 1902(a)(10)(A)(ii)(XXIII) to the Social Security Act (the Act),[1] which permits states to temporarily cover uninsured individuals through an optional Medicaid eligibility group for the limited purpose of COVID-19 testing during any portion of the public health emergency period beginning March 18, 2020.

States adopting the new optional Medicaid eligibility group for the provision of COVID-19 testing and testing-related services must accurately report this information in the T-MSIS Eligible file. There are two data elements in the Eligible file that should be reported to document a beneficiary’s enrollment in Medicaid as defined by Section 1902(a)(10)(A)(ii)(XXIII) of the Social Security Act: ELIGIBILITY-GROUP (ELG087) and RESTRICTED-BENEFITS-CODE (ELG097). Information about proposed changes to the valid values for these data elements in the T-MSIS Data Dictionary can be found in the guidance on the T-MSIS Coding Blog. For additional information, states are encouraged to review the COVID-19 FAQs published by the Centers for Medicare and Medicaid Services.[2] 

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If you would like for CMS to provide guidance regarding a particular T-MSIS topic, please send your request to MACBISData@cms.hhs.gov.