Missing Eligibility Group Codes in 2017 (Brief)

• Eligibility group codes allow T-MSIS Analytic File users to identify the basis on which an individual was deemed eligible for Medicaid or the Children’s Health Insurance Program. This brief identifies states in which (1) the eligibility group code had high rates of missing values in 2017, which suggests that the data were incomplete or (2) codes for certain large mandatory Medicaid eligibility groups were not used, which suggests that states may not be assigning the eligibility group code correctly.
• Although the majority of states (38) had an eligibility group code assigned to more than 95 percent of their beneficiaries, only 13 states had at least one beneficiary in every mandatory eligibility group in which we would expect to see enrollment in all states. When we account for both beneficiaries who were missing an eligibility group code and the use of all expected mandatory eligibility group codes, 37 states fell into the medium or high concern category for the quality of the eligibility group code data.
• When we examined patterns in the use of codes for the large mandatory eligibility groups, we found that all but one state (South Carolina) had enrollment in three groups: (1) parents and other caretaker relatives, (2) infants and children under age 19, and (3) qualified Medicare beneficiaries. We also found that all states except Idaho had enrollment in the pregnant women group. The mandatory eligibility groups in which states were least likely to have enrolled beneficiaries were the two disability groups—working disabled under 1619(b) and disabled adult children. Only 27 states and 32 states, respectively, had beneficiaries in these two groups.

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