ES

High Level Category Detailed Category Explanation
Process Change Real Time Outbound Account Transfers SES will send outbound account transfers
synchronously, rather than in a batch job.
Process Change DHS SAVE V37 impacts The FFE integration with DHS SAVE V37
requires changes in the AT payload
mapping.
1
Mapping Change Mapping All Eligibilities/Verifications Legacy only maps the
eligibilities/verifications for which the
applicant is eligible. Because some
verifications/sub-eligibilities are under an
incorrect section of the payload, SES will
always map all CHIP, Medicaid, and
Emergency Medicaid sections to address
these issues in the payload and to
communicate eligibilities/verifications for
applicants who request full
determination.
When same sub-eligibility appears under

CHIP, Medicaid, and Emergency
Medicaid, rather than communicate
duplicative eligibilities, SES will only map
it under the program for which that
applicant is eligible, or under Medicaid if
the applicant is not eligible for any
program.
2
Mapping Change Mapping New Reason Codes Legacy maps the legacy reason codes to
Account Transfer. SES will send the SES
reason codes which include some
changes to the legacy codes as well as
some new codes. The new/different
codes comprise approximately 30% of
the total. Whenever new codes are
added in SES eligibility results, they will
be sent in the payload.
Mapping Change Mapping New Data SES will send data that legacy does not
send.
Mapping Change New Logic to Set Existing Data in Existing SES has corrected logic to set more
Location accurately the values for the data in the
payload.
3
Mapping Change Not Mapping Certain Fields SES does not map data that are obsolete
or originally communicated incorrect
information that cannot be accurately
derived.
End of worksheet
4
High Level Category Examples Impact of Change
Process Change N/A If an application is submitted more than
once in a day or a full determination is
requested after submit, each submitted
app and full determination request will
be sent.
Process Change In this case, the examples are 1. This data will no longer be available for
comprehensive: States in account transfer.
1. When SES starts using DHS SAVE V37 2. States can use DHSComments if
on 3/12, Legacy and SES Account Transfer provided by DHS from Step 2.
will not send any COA,
EligibilityStatmentCodes, and 3. States will need to look for “DHS”
MajorCodes from SES created under VerificationAuthorityName when
applications as the payload only supports identifying DHS verificationMetadata.
DHS SAVE V33 values.
2. Legacy does not send DHSComments.

SES sends DHSComments truncated if
they are longer than 160 Characters.
3. SES maps "DHS" to

VerificationAuthorityName rather than
VerificationAuthorityTDS-FEPS-
AlphaCode to avoid errors when not
sending certain fields.
5
Mapping Change 1. The payload has work quarters under States will receive CHIP, Medicaid, and
CHIP eligibility, instead of Medicaid Emergency Medicaid sections for every
eligibility. referred applicant.
2. The payload has

medicaidLawfulPresence under
Medicaid, CHIP, and Emergency
Medicaid.
6
Mapping Change For Immigration Status, SES may send States will receive approximately 30%
636 (Document Number does not match new/different reason codes. An updated
DHS data) where Legacy would have sent reason code list will be provided in the
189 (DHS data does not match attested detailed spreadsheet.
information).
Mapping Change SES will send tribal income as a separate States will receive new data.
line item with aggregated tribal income.
This aggregated tribal income is a portion
of the total household income (not an
additional income source).
Mapping Change Legacy only maps States will receive some data differently
PersonCaretakerDependentCode = than previously received.
yesNotCovered based on
caretakerRelativeRole, while SES is
mapping
PersonCaretakerDependentCode based
on updated logic to communicate both if
the child is covered and if the person has
a caretaker relative relationship with the
child.
7
Mapping Change Legacy was mapping SES will not send data that was incorrect
InsuranceApplicantLivesWithMinorAgeDe in the legacy payload.
pendentIndicator incorrectly, based on
nonCustodialParentClaimingTaxFilerIndic
ator = 'Y. The payload name and
description are incorrect because it
indicates that the tax claimer lives with
the dependent, when the information
that is needed is that the tax filer does
not live with the dependent. SES is not
mapping as there is no way to derive this
data element based on the SES data
model.
End of worksheet
8
High Level Category Notes
Process Change
Process Change
9
Mapping Change The AT payload has fields for program eligibilities (Medicaid, CHIP,
Emergency Medicaid, etc.) and also for verification (7 Year Limit, 5 Year
Bar, Victims of Trafficking, etc.) The structure separates the payload into
sections based on program eligibilities (Medicaid, CHIP, etc.) with their
corresponding sub-eligibilities underneath.
However, the payload does not consistently have all verifications that
correspond with a particular program underneath the correct program.
For example, Victims of Trafficking only appears under the CHIP section,
but also applies to Medicaid. Although legacy Account Transfer originally
would not send the CHIP section if the applicant is eligible for Medicaid,
SES will now always send all sections, regardless of the person's
eligibilities. In this way, if a person is found eligible for Medicaid with a
Victims of Trafficking Status, the high level sections would read Medicaid
= Y, CHIP = N, and Victims of Trafficking Status = Y under the CHIP
section.
If a sub-eligibility applies to multiple sections and correctly appears in

multiple sections, then SES will only map those fields for which the
applicant is eligible or default to the Medicaid section if the person is
not eligible for any program. For example, SSN verification appears
under CHIP, Medicaid, and Emergency Medicaid Sections. If the person
is CHIP eligible, the verification will only be mapped under CHIP and not
be mapped under Medicaid or emergency Medicaid. If the person is not
eligible for any program, then the SSN will be mapped under Medicaid
by default.
10
Mapping Change See "Reason Code List" for full list of SES Reason Codes
Mapping Change
Mapping Change
11
Mapping Change
End of worksheet
12
Ref # High Level Category Detailed Category Legacy Behavior
N/A Process Change Real Time Outbound Account Legacy Sends Outbound Account
Transfers Transfers in a Batch Job
7 Mapping Change 1. Mapping All 1. Legacy will only send adult group
Eligibilities/Verifications category Status if the person is
Medicaid Magi eligible
2. New Reason Codes
2. Legacy will send legacy reason
codes for adult group category Status
9 Mapping Change 1. Mapping All 1. Legacy will only send adult group
Eligibilities/Verifications category XX Status if the person is
2. New Reason Codes
codes for adult group category XX
status
13
53 Mapping Change 1. Mapping All 1. Legacy will only send child
Eligibilities/Verifications Category Status if the person is
2. New Reason Codes
codes for child category status
20 Mapping Change Mapping All Eligibilities/Verifications Legacy will only send APTC if the
person is eligible for APTC
21 Mapping Change New Reason Codes Legacy will send legacy APTC reason
codes
14
55 Mapping Change 1. Mapping All 1. Legacy will only send CHIP income
Eligibilities/Verifications status if the person is CHIP eligible
2. New Reason Codes 2. Legacy will send legacy reason
codes for CHIP income status
15
56 Mapping Change 1. Mapping All 1. Legacy will only send Medicaid
Eligibilities/Verifications CHIPRA status if the person is
Medicaid Magi Eligible
2. New Reason Codes
codes for CHIPRA status
16
64 Mapping Change 1. Mapping All 1. Legacy will only send CHIP status if
Eligibilities/Verifications the person is CHIP eligible
codes for CHIP status
17
389 Mapping Change 1. Mapping All 1. Legacy will only send unborn child
Eligibilities/Verifications status if the person is CHIP eligible
codes for unborn child status
18
522.1 Mapping Change 1. Mapping All 1. Legacy will only send CHIP
Eligibilities/Verifications incarceration status if the person is
CHIP eligible
2. New Reason Codes
codes for incarceration status
106 Mapping Change 1. Mapping All 1. Legacy will only send Dependent
Eligibilities/Verifications Child Covered status if the person is
2. New Reason Codes
codes for Dependent Child Covered
status
113 Mapping Change 1. Mapping All 1. Legacy will only send emergency
Eligibilities/Verifications Medicaid if the person is emergency
Medicaid eligible
2. New Reason Codes
codes for emergency Medicaid
19
154 Mapping Change 1. Mapping All 1. Legacy will only send FiveYearBar
Eligibilities/Verifications if the person is Medicaid Magi
Eligible
2. New Reason Codes
codes for FiveYearBar
156 Mapping Change 1. Mapping All 1. Legacy will only send former foster
Eligibilities/Verifications care if the person is Medicaid Magi
Eligible
2. New Reason Codes
codes for former foster care
20
187 Mapping Change 1. Mapping All 1. Legacy will send RPC status under
Eligibilities/Verifications Medicaid Magi or CHIP depending on
the person's eligibility. If the person
2. New Reason Codes is not eligible for either Medicaid or
CHIP, Legacy will not send RPC

codes for RPC
21
Eligibilities/Verifications income status if the person is
2. New Reason Codes
codes for Medicaid income
3. Legacy will only send emergency

Medicaid income status if the person
is emergency Medicaid Eligible

codes for emergency Medicaid
income
22
245 Mapping Change 1. Mapping All 1. Legacy will send Medicaid
Eligibilities/Verifications residency status under Medicaid
Magi, CHIP, or emergency Medicaid
2. New Reason Codes depending on the person's eligibility.
If the person is not eligible for either
Medicaid Magi, CHIP, or Emergency
Medicaid, Legacy will not send
Medicaid Residency Status

codes for Medicaid residency
23
Eligibilities/Verifications status if the person is Medicaid Magi
Eligible
2. New Reason Codes
codes for Medicaid status
97 Mapping Change New logic to set existing data in Legacy sends expenseCategoryText
existing location along with Student Loan & Alimony.
24
271 Mapping Change 1. Mapping All 1. Legacy will only send
Eligibilities/Verifications optionalTargetedLowIncomeChildCat
egoryStatus status if the person is
2. New Reason Codes Medicaid Magi Eligible

codes for
optionalTargetedLowIncomeChildCat
egoryStatus
102 Mapping Change Mapping New Data Legacy did not map Tribal income as
a separate line item.

Eligibilities/Verifications parentCaretakerStatus status if the
person is Medicaid Magi Eligible
2. New Reason Codes
codes for parentCaretakerStatus
25
107 Mapping Change 1. New logic to set existing data in 1. Legacy maps Title 2 Income
existing location verificationMetadata as an
immigration
2. Not Sending Certain Fields verificationCategoryType
3. DHS SAVE V37 impacts 2. Legacy maps the FFE

citizenshipLawfulPresence event as
4. DHS SAVE V37 impacts verification metadata
3. Legacy maps "DHS" to

VerificationAuthorityTDS-FEPS-
AlphaCode. A change is in progress
to send under
VerificationAuthorityName to avoid
errors when not sending MajorCode
or EligibilityStatementCode
4. Legacy does not map

DHScomments
26
Eligibilities/Verifications traffickingVictimStatus if the person
is CHIP Eligible
2. New Reason Codes
codes for traffickingVictimStatus

Eligibilities/Verifications sevenYearLimitStatus if the person is
2. New Reason Codes
codes for sevenYearLimitStatus
27
604 Mapping Change 1. Mapping All Legacy only sends annualIncome
Eligibilities/Verifications verification when annual income is
used for medicaidIncome verification
2. New Reason Codes and the person is Medicaid eligible
632 Mapping Change Mapping All Eligibilities/Verifications Legacy will only send
MedicaidResidency correct state
indicator if the person is Medicaid
Magi Eligible
233 Mapping Change Not Sending Legacy sends in FFE policy

Information
28
233.1 Mapping Change Not Sending Legacy sends in FFE policy
Information
149 Mapping Change New logic to set existing data in Legacy randomly generates person
existing location S:ID
29
Eligibilities/Verifications TitleIIWorkQuarters Status if the
person is CHIP Eligible (Noting that
2. New Reason Codes Work Quarters only apply to
Medicaid)

codes for TitleIIWorkQuarters Status
385 Mapping Change New logic to set existing data in Legacy is mapping
existing location typeAdjustAttestedAnnualMedicaidH
ouseholdIncomeAmt as a current
income line item with frequency of
annual
30
412 Mapping Change New logic to set existing data in Legacy only maps yesNotCovered
existing location based caretakerRelativeRole
association.
524 Mapping Change Not Sending Legacy mapped

InsuranceApplicantLivesWithMinorA
geDependentIndicator
31
240 Mapping Change 1. Mapping All 1. Legacy will send Medicaid lawful
Eligibilities/Verifications presence status under Medicaid
MAGI, CHIP, or emergency Medicaid
2. New Reason Codes depending on the person's eligibility.
If the person is not eligible for either
Medicaid Magi, CHIP, or Emergency
Medicaid, Legacy will not send
Medicaid lawful presence Status

codes for Medicaid lawful presence
32
296 Mapping Change 1. Mapping All 1. Legacy will only send pregnancy
Eligibilities/Verifications category Status if the person is CHIP
Eligible
2. New Reason Codes
codes for pregnancy category
562 Mapping Change New logic to set existing data in Legacy maps qhp effective date for
existing location all eligibility start dates
33
Eligibilities/Verifications chipStateHealthBenefitStatus if the
person is CHIP Eligible
2. New Reason Codes
codes for
chipStateHealthBenefitStatus

Eligibilities/Verifications chipWaitingPeriodStatus if the
person is CHIP Eligible
2. New Reason Codes
codes for chipWaitingPeriodStatus
34
335 Mapping Change 1. Mapping All 1. Legacy will send SSN Status under
Eligibilities/Verifications Medicaid Magi, CHIP, or emergency
Medicaid depending on the person's
2. New Reason Codes eligibility. If the person is not eligible
for either Medicaid Magi, CHIP, or
Emergency Medicaid, Legacy will not
send SSN Status

codes for SSN Status
84.1 Mapping Change DHS SAVE V37 impacts Legacy will send COA codes until V37
is toggled on, then it will no longer
send COA codes
35
137.1 Mapping Change DHS SAVE V37 impacts Legacy will send
EligibilityStatmentCodes until V37 is
toggled on, then it will no longer
send EligibilityStatmentCode
262.1 Mapping Change DHS SAVE V37 impacts Legacy will send MajorCodes until
V37 is toggled on, then it will no
longer send MajorCodes
124 Mapping Change New logic to set existing data in Legacy maps EmployerAddress as
existing location primary applicant's home address.
537 Mapping Change Mapping New Data Legacy does not send current income
amount returned from equifax
730 Mapping Change New logic to set existing data in 1. Legacy sets the
existing location LawfulPresenceStatusEligibility/Eligib
ilityIndicator (Attestation) as True if
EITHER the
lawfulPresenceStatusIndicator or the
citizenshipStatusIndicator is True.
2. Legacy duplicates
LawfulPresenceStatusEligibility/Eligib
ilityIndicator - one field for the
attestation (not linked to the
verification metatdata) and one field
for the hub verification (linked to the
verification metadata)
36
180 Mapping Change New logic to set existing data in 1. Legacy only uses numeric I94
existing location Numbers, but will be updating to
also send alphanumeric and numeric
I94 numbers
End of worksheet
37
Ref # SES Behavior Payload Name
N/A SES will send outbound account transfers synchronously, in real N/A
time
7 1. SES will send adultGroupCategoryStatus regardless of eligibility MedicaidMAGIAdultGroupCategoryEli
gibilityBasis/StatusIndicator
2. SES Will send SES reason codes
MedicaidMAGIAdultGroupCategoryEli
gibilityBasis/EligibilityBasisStatusCode
MedicaidMAGIAdultGroupCategoryEli
gibilityBasis/EligibilityBasisIneligibility
ReasonText
9 1. SES will send adultGroupXXCategoryStatus regardless of MedicaidMAGIAdultGroupXXCategory

eligibility EligibilityBasis/StatusIndicator
2. SES Will send SES reason codes for adultGroupXXCategoryStatus MedicaidMAGIAdultGroupXXCategory

EligibilityBasis/EligibilityBasisStatusCo
de
MedicaidMAGIAdultGroupXXCategory
EligibilityBasis/EligibilityBasisIneligibili
tyReasonText
38
53 1. SES will send child category status regardless of eligibility MedicaidMAGIChildCategoryEligibility
Basis/hix-core:StatusIndicator
2. SES will send SES reason codes for child category status
MedicaidMAGIChildCategoryEligibility
Basis/hix-ee:EligibilityBasisStatusCode
MedicaidMAGIChildCategoryEligibility
Basis/hix-
ee:EligibilityBasisIneligibilityReasonTe
xt
20 SES will send APTC status regardless of eligibility APTCEligibility/hix-

ee:EligibilityIndicator
21 SES Will Send SES APTC reason codes APTCEligibility/hix-

ee:EligibilityReasonText
39
55 1. SES will send CHIP income status regardless of eligibility CHIPIncomeEligibilityBasis/hix-
core:StatusIndicator
2. SES Will send SES reason codes for CHIP income status
CHIPIncomeEligibilityBasis/hix-
ee:EligibilityBasisStatusCode
40
56 1. SES will always send CHIPRA status regardless of eligibility. If the MedicaidMAGI-
applicant is CHIP CHIPRA, Medicaid status will be N, CHIP status CHIPRA214EligibilityBasis/StatusIndica
will be Y and CHIPRA status under the Medicaid section of the tor
payload will be Y
2. SES will send SES reason codes for CHIPRA status MedicaidMAGI-
CHIPRA214EligibilityBasis/EligibilityBa
sisStatusCode
CHIPRA214EligibilityBasis/hix-
core:EligibilityBasisIneligibilityReasonT
ext
41
64 1. SES will send CHIP status regardless of eligibility CHIPEligibility/hix-
2. SES will send SES reason codes for CHIP status
CHIPEligibility/hix-
42
389 1. In SES, Unborn Child is evaluated as a separate eligibility from (1) exch:AccountTransferRequest/hix-
CHIP. It will be sent regardless of the eligibility. It is possible that ee:InsuranceApplication/hix-
MedicaidStatus = N, ChipStatus = N, and UnbornChildStatus = Y. ee:InsuranceApplicant/hix-
ee:CHIPEligibility/hix-
2. SES will send SES reason codes for Unborn Child Status ee:CHIPUnbornChildCategoryEligibility
(2) exch:AccountTransferRequest/hix-
ee:InsuranceApplication/hix-
ee:InsuranceApplicant/hix-
ee:CHIPUnbornChildCategoryEligibility
Basis/hix-ee:EligibilityBasisStatusCode
(3) exch:AccountTransferRequest/hix-
ee:InsuranceApplication/hix-
ee:InsuranceApplicant/hix-
ee:CHIPUnbornChildCategoryEligibility
Basis/hix-
xt
43
522.1 1. SES will send CHIP incarceration status when the applicant is CHIPIncarcerationEligibilityBasis/hix-
eligible for CHIP or deterimined not eligible for CHIP because of core:StatusIndicator
their incarceration status.
2. SES will send SES reason codes for incarceration Status ee:CHIPIncarcerationEligibilityBasis/hi
x-ee:EligibilityBasisStatusCode
CHIPIncarcerationEligibilityBasis/hix-
xt
106 1. SES will send dependent child covered status regardless of MedicaidMAGIDependentChildCovera
eligibility geEligibilityBasis/hix-
2. SES will send SES reason codes for dependent child covered
Status MedicaidMAGIDependentChildCovera
geEligibilityBasis/hix-
MedicaidMAGIDependentChildCovera
geEligibilityBasis/hix-
xt
113 1. SES will send emergency Medicaid status regardless of eligibility EmergencyMedicaidEligibility/hix-
2. SES will send SES reason codes for emergency Medicaid
EmergencyMedicaidEligibility/hix-
44
154 1. SES will send five year bar regardless of eligibility. MedicaidMAGIFiveYearBarEligibilityBa
sis/hix-core:StatusIndicator
2. SES will send SES reason codes for five year bar
MedicaidMAGIFiveYearBarEligibilityBa
sis/hix-ee:EligibilityBasisStatusCode
MedicaidMAGIFiveYearBarEligibilityBa
sis/hix-
ext
156 1. SES will send former foster care regardless of eligibility. MedicaidMAGIFormerFosterCareCate
goryEligibilityBasis/hix-
2. SES will send SES reason codes for former foster care core:StatusIndicator
MedicaidMAGIFormerFosterCareCate
MedicaidMAGIFormerFosterCareCate
ext
45
187 1. SES will send RPC under Medicaid Magi or CHIP depending on MedicaidMAGIIncomeEligibilityBasis/
the person's eligibility. If the person is not eligible for either hix-
Medicaid or CHIP, SES will send RPC status under Medicaid Magi ee:IncomeEligibilityBasisRPCRulesAppl
iedIndicator
2. SES will send SES reason codes for RPC
46
239 1. SES will send Medicaid income regardless of eligibility. MedicaidMAGIIncomeEligibilityBasis/
hix-core:StatusIndicator
2. SES will send SES reason codes for Medicaid income
MedicaidMAGIIncomeEligibilityBasis/
3. SES will send emergency Medicaid income regardless of hix-ee:EligibilityBasisStatusCode
eligibility.
4. SES will send SES reason codes for emergency Medicaid income hix-
ee:EligibilityBasisInconsistencyReason
Text
hix-
xt
EmergencyMedicaidIncomeEligibilityB
asis/hix-core:StatusIndicator
asis/hix-ee:EligibilityBasisStatusCode
asis/hix-
Text
asis/hix-
xt
47
245 1. SES will send Medicaid residency status under Medicaid Magi, CHIPMedicaidResidencyEligibilityBasis
CHIP, or Emergency Medicaid depending on the person's /hix-core:StatusIndicator
eligibility. If the person is not eligible for Medicaid, CHIP, or
emergency Medicaid SES will send Medicaid Residency status CHIPMedicaidResidencyEligibilityBasis
under Medicaid Magi /hix-ee:EligibilityBasisStatusCode
2. SES will send SES reason codes for Medicaid Residency CHIPMedicaidResidencyEligibilityBasis
/hix-
xt
CHIPMedicaidResidencyEligibilityBasis
/hix-
ee:EligibilityBasisPendingReasonText
MedicaidMAGIResidencyEligibilityBasi
s/hix-core:StatusIndicator
s/hix-ee:EligibilityBasisStatusCode
s/hix-
xt
s/hix-
ee:EligibilityBasisPendingReasonText
EmergencyMedicaidResidencyEligibilit
yBasis/hix-core:StatusIndicator
yBasis/hix-
48
249 1. SES will send Medicaid status regardless of eligibility. MedicaidMAGIEligibility/hix-
2. SES will send SES reason codes for Medicaid status
MedicaidMAGIEligibility/hix-
MedicaidMAGIEligibility/hix-
ee:EligibilityInconsistencyReasonText
97 SES will only send ExpenseCategoryText when income Source is ExpenseCategoryText

"Other Deduction"
49
271 1. SES will send optionalTargetedLowIncomeChildCategoryStatus MedicaidMAGIOptionalTargetedLowIn
regardless of eligibility. comeChildEligibilityBasis/hix-
2. SES will send SES reason codes for
optionalTargetedLowIncomeChildCategoryStatus MedicaidMAGIOptionalTargetedLowIn
comeChildEligibilityBasis/hix-
MedicaidMAGIOptionalTargetedLowIn
comeChildEligibilityBasis/hix-
xt
102 SES will map Tribal income as a separate line item as a sum of all IncomeSubjectToFederalRestrictionsIn
tribal income. dicator=true/IncomeAmount
278 1. SES will send parentCaretakerStatus regardless of eligibility. MedicaidMAGIParentCaretakerCatego

ryEligibilityBasis/hix-
2. SES will send SES reason codes for parentCaretakerStatus core:StatusIndicator
MedicaidMAGIParentCaretakerCatego
MedicaidMAGIParentCaretakerCatego
xt
50
107 1. SES maps Title II Income verificaitonmetadata as an income VerificationStatusCode
verificationCategoryType
VerificationCategoryCode
2. SES no longer maps in the citizenshipLawfulPresence event as
this event is separated into two events in SES. (Immigration & VerificationAuthorityTDS-FEPS-
Citizenship) AlphaCode
3. SES maps "DHS" to VerificationAuthorityName to avoid errors Note: we do not map

when not sending MajorCode or EligibilityStatementCode. exch:AccountTransferRequest/hix-
core:VerificationMetadata/hix-
4. SES will map DHSComments to core:VerificationAuthorityName
exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-
core:VerificationDescriptionText if DHSComments are available ResponseCode
51
373 1. SES will send traffickingVictimStatus regardless of eligibility. CHIPTraffickingVictimCategoryEligibilit
yBasis/EligibilityBasisStatusIndicator
2. SES will send SES reason codes for traffickingVictimStatus
CHIPTraffickingVictimCategoryEligibilit
yBasis/hix-
CHIPTraffickingVictimCategoryEligibilit
yBasis/hix-
xt
329 1. SES will send sevenYearLimitStatus regardless of eligibility. MedicaidMAGIEligibility/hix-

ee:MedicaidMAGISevenYearLimitEligi
2. SES will send SES reason codes for sevenYearLimitStatus bilityBasis/hix-core:StatusIndicator
MedicaidMAGISevenYearLimitEligibilit
yBasis/hix-
MedicaidMAGISevenYearLimitEligibilit
yBasis/hix-
xt
52
604 SES will send annualIncome verification when annual income is MedicaidMAGIIncomeEligibilityBasis/
used for medicaidIncome verification even if the person is not hix-ee:IncomeCompatibility/hix-
Medicaid eligible ee:IncomeCompatibilityVerificationInd
icator
hix-ee:IncomeCompatibility/hix-
ee:IncomeCompatibilityInconsistency
ReasonText
ee:IncomeCompatibilityVerificationM
ethod[. = ('1', '2','3','4','5')]
ee:IncomeCompatibilityDetermination
/nc:ActivityDate/nc:DateTime
632 SES will send Medicaid Residency correct state indicator MedicaidResidencyEligibilityBasisCorr
regardless of eligibility. ectStateIndicator
233 SES will no longer Send in FFE Policy Information InsurancePolicyAppliedEffectiveDateR

ange/nc:EndDate/nc:Date
53
233.1 SES will no longer Send in FFE Policy Information InsurancePolicyAppliedEffectiveDateR
ange/nc:StartDate/nc:Date
149 SES Is now sending PTN for person S:ID. Because SES will be using Person s:Id
person S:ID to match the data source with the intended person
when an application is returned to the FFE in an OBR PersonReference
FamilyRelationshipCode
(refer to tab 2)
54
226 1. SES will send TitleIIWorkQuarters Status regardless of eligibility. CHIPTitleIIWorkQuartersMetEligibility
2. SES will send SES reason codes for TitleIIWorkQuarters Status
ee:CHIPTitleIIWorkQuartersMetEligibil
ityBasis/hix-
CHIPTitleIIWorkQuartersMetEligibility
Basis/hix-
xt
Note: This is an error in the payload as

work quarters only applies ot
Medicaid.
385 SES is mapping (1) MedicaidHousehold/hix-

typeAdjustAttestedAnnualMedicaidHouseholdIncomeAmt as a ee:HouseholdIncome/hix-
Medicaid Household income with frequency of annual core:IncomeAmount
(2) MedicaidHousehold/hix-
ee:HouseholdIncome/hix-
core:IncomeFrequency/hix-
core:FrequencyCode
55
412 SES is mapping PersonCaretakerDependentCode based on PersonCaretakerDependentCode
updated logic to communicate both if the child is covered and if
the person has a caretaker relative relationship with the child (see Note: This payload indicator combines
column H.) 2 SES indicators
coveredDependentChildIndicator
caretakerRelativeIndicator
524 SES will no longer send InsuranceApplicantLivesWithMinorAg

insuranceApplicantLivesWithMinorAgeDependentIndicator eDependentIndicator
56
240 1. SES will send Medicaid lawful presence status under Medicaid CHIPMedicaidCitizenOrImmigrantEligi
Magi, CHIP, or Emergency Medicaid depending on the person's bilityBasis/hix-core:StatusIndicator
eligibility. If the person is not eligible for Medicaid, CHIP, or
emergency Medicaid SES will send Medicaid lawful presence CHIPMedicaidCitizenOrImmigrantEligi
status under Medicaid Magi bilityBasis/hix-
2. SES will send SES reason codes for Medicaid lawful presence
CHIPMedicaidCitizenOrImmigrantEligi
bilityBasis/hix-
xt
CHIPMedicaidCitizenOrImmigrantEligi
bilityBasis/hix-
Text
MedicaidMAGICitizenOrImmigrantElig
ibilityBasis/hix-core:StatusIndicator
ibilityBasis/hix-
ibilityBasis/hix-
xt
ibilityBasis/hix-
Text
EmergencyMedicaidCitizenOrImmigra
ntEligibilityBasis/hix-
ee:StatusIndicator
57
296 1. SES will send pregnancy category Status regardless of eligibility. CHIPEligibility/hix-
ee:CHIPPregnancyCategoryEligibilityB
2. SES will send SES reason codes for pregnancy category Status asis/hix-core:StatusIndicator
CHIPPregnancyCategoryEligibilityBasis
/hix-ee:EligibilityBasisStatusCode
CHIPPregnancyCategoryEligibilityBasis
/hix-
xt
MedicaidMAGIPregnancyCategoryEligi
bilityBasis/hix-core:StatusIndicator
bilityBasis/hix-
bilityBasis/hix-
x
562 SES maps submission date instead of QHP effective Date for all MedicaidNonMAGIEligibility/hix-
eligibilityStartDates ee:EligibilityDateRange/nc:StartDate/
nc:Date
58
62 1. SES will send chipStateHealthBenefitStatus regardless of CHIPStateHealthBenefitsEligibilityBasi
eligibility. s/hix-core:StatusIndicator
2. SES will send SES reason codes for chipStateHealthBenefitStatus CHIPStateHealthBenefitsEligibilityBasi
s/hix-ee:EligibilityBasisStatusCode
CHIPStateHealthBenefitsEligibilityBasi
s/hix-
xt
68 1. SES will send chipWaitingPeriodStatus regardless of eligibility. CHIPWaitingPeriodEligibilityBasis/hix-

(noting that if CHIPWaitingPeriod is Y, then ChipStatus will be N) core:StatusIndicator
2. SES will send SES reason codes for chipWaitingPeriodStatus CHIPWaitingPeriodEligibilityBasis/hix-

CHIPWaitingPeriodEligibilityBasis/hix-
xt
59
335 1. SES will send SSN Status under Medicaid Magi, CHIP, or CHIPEligibility/hix-ee:CHIP-
Emergency Medicaid depending on the person's eligibility. If the SSNVerificationEligibilityBasis/hix-
person is not eligible for Medicaid, CHIP, or emergency Medicaid core:StatusIndicator
SES will send SSN status under Medicaid Magi
CHIPEligibility/hix-ee:CHIP-
2. SES will send SES reason codes for SSN Status SSNVerificationEligibilityBasis/hix-
CHIP-
SSNVerificationEligibilityBasis/hix-
Text
MedicaidMAGISSNVerificationEligibilit
yBasis/hix-core:StatusIndicator
yBasis/hix-
yBasis/hix-
Text
84.1 Because SES account transfer will exist once V37 is toggled on, ClassOfAdmissionClassificationCode
and because the payload values for nonCitCoaCode only support
V33, SES cannot send nonCitCoaCodes
60
137.1 Because SES account transfer will exist once V37 is toggled on, DHS-SAVEVerificationCode
and because the payload values for eligibilityStatementCode only
support V33, SES cannot send eligibilityStatementCodes
262.1 Because SES account transfer will exist once V37 is toggled on, DHS-G845VerificationCode
and because the payload values for majorCode only support V33,
SES cannot send majorCodes
124 SES will map EmployerAddress as employerAddress. StructuredAddress
537 To denote equifax data, the verification metadata will be linked to IncomeAmount (pay rate from
the incomeAmount node that indicates the hub data. The Equifax)
incomeAmount node that does not have the verification metadata
link is the current income attestation
730 1. SES only sets LawfulPresenceStatusEligibility/EligibilityIndicator EligibilityIndicator

(Attestation) as True if the lawfulPresenceStatusIndicator is True.
SES will map citizenshipStatusIndicator to
PersonUSCitizenIndicator.
2. SES will only have one

LawfulPresenceStatusEligibility/EligibilityIndicator (Attestation.)
The verificationMetadata that it is linked to will show if the person
is verified by DHS.
61
180 1. SES will send either alphanumeric and numeric I94 numbers IdentificationID
End of worksheet
62
Ref # Payload Location
N/A N/A
7 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:InsuranceApplicant/hix-ee:MedicaidMAGIEligibility/hix-
ee:MedicaidMAGIAdultGroupCategoryEligibilityBasis/hix-core:StatusIndicator
(2) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:MedicaidMAGIAdultGroupCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
(3)exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:MedicaidMAGIAdultGroupCategoryEligibilityBasis/hix-
ee:EligibilityBasisIneligibilityReasonText
ee:MedicaidMAGIAdultGroupXXCategoryEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIAdultGroupXXCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIAdultGroupXXCategoryEligibilityBasis/hix-
63
ee:MedicaidMAGIChildCategoryEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIChildCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIChildCategoryEligibilityBasis/hix-
ee:InsuranceApplicant/hix-ee:APTCEligibility/hix-ee:EligibilityIndicator
21 exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-ee:InsuranceApplicant/hix-
ee:APTCEligibility/hix-ee:EligibilityReasonText
64
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:CHIPIncomeEligibilityBasis/hix-
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:CHIPIncomeEligibilityBasis/hix-
ee:InsuranceApplicant/hix-ee:MedicaidMAGIEligibility/hix-ee:MedicaidMAGI-
CHIPIncomeEligibilityBasis/hix-core:EligibilityBasisInconsistencyReasonText
CHIPIncomeEligibilityBasis/hix-core:EligibilityBasisIneligibilityReasonText
65
56 (1)exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPRA214EligibilityBasis/hix-core:StatusIndicator
ee:CHIPRA214EligibilityBasis/hix-ee:EligibilityBasisStatusCode
CHIPRA214EligibilityBasis/hix-core:EligibilityBasisIneligibilityReasonText
66
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:EligibilityIndicator
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:EligibilityReasonText
67
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-
ee:CHIPUnbornChildCategoryEligibilityBasis/hix-core:StatusIndicator
ee:CHIPUnbornChildCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPUnbornChildCategoryEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
68
522.1 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:CHIPIncarcerationEligibilityBasis/hix-

ee:MedicaidMAGIDependentChildCoverageEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIDependentChildCoverageEligibilityBasis/hix-
ee:MedicaidMAGIDependentChildCoverageEligibilityBasis/hix-
core:EligibilityBasisIneligibilityReasonText

ee:InsuranceApplicant/hix-ee:EmergencyMedicaidEligibility/hix-ee:EligibilityIndicator
ee:InsuranceApplicant/hix-ee:EmergencyMedicaidEligibility/hix-ee:EligibilityReasonText
69
ee:MedicaidMAGIFiveYearBarEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIFiveYearBarEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIFiveYearBarEligibilityBasis/hix-core:EligibilityBasisIneligibilityReasonText

ee:MedicaidMAGIFormerFosterCareCategoryEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIFormerFosterCareCategoryEligibilityBasis/hix-
ee:MedicaidMAGIFormerFosterCareCategoryEligibilityBasis/hix-
core:EligibilityBasisIneligibilityReasonText
70
ee:InsuranceApplicant/hix-ee:CHIPIncomeEligibilityBasis/hix-
ee:IncomeEligibilityBasisRPCRulesAppliedIndicator
ee:MedicaidMAGIIncomeEligibilityBasis/hix-
ee:IncomeEligibilityBasisRPCRulesAppliedIndicator
71
ee:MedicaidMAGIIncomeEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIIncomeEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIIncomeEligibilityBasis/hix-ee:EligibilityBasisInconsistencyReasonText
ee:MedicaidMAGIIncomeEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
ee:InsuranceApplicant/hix-ee:EmergencyMedicaidEligibility/hix-
ee:EmergencyMedicaidIncomeEligibilityBasis/hix-core:StatusIndicator
ee:EmergencyMedicaidIncomeEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:EmergencyMedicaidIncomeEligibilityBasis/hix-
ee:EligibilityBasisInconsistencyReasonText
ee:EmergencyMedicaidIncomeEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
72
245 (chip.1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPMedicaidResidencyEligibilityBasis/hix-core:StatusIndicator
(chip.2) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPMedicaidResidencyEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPMedicaidResidencyEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
ee:CHIPMedicaidResidencyEligibilityBasis/hix-ee:EligibilityBasisPendingReasonText
(medicaid.1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:MedicaidMAGIResidencyEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIResidencyEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIResidencyEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
ee:MedicaidMAGIResidencyEligibilityBasis/hix-ee:EligibilityBasisPendingReasonText
(emergency.1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:EmergencyMedicaidResidencyEligibilityBasis/hix-core:StatusIndicator
(emergency.2) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
73
ee:InsuranceApplicant/hix-ee:MedicaidMAGIEligibility/hix-ee:EligibilityIndicator
ee:InsuranceApplicant/hix-ee:MedicaidMAGIEligibility/hix-ee:EligibilityReasonText
ee:EligibilityInconsistencyReasonText
97 exch:AccountTransferRequest/hix-core:Person[@s:id =
/exch:AccountTransferRequest/ext:PhysicalHousehold/hix-
ee:HouseholdMemberReference/@s:ref]/hix-core:PersonAugmentation/hix-
core:PersonExpense/hix-core:ExpenseCategoryText
74
ee:MedicaidMAGIOptionalTargetedLowIncomeChildEligibilityBasis/hix-
102
1/7/2019: update path per what's in schemtrun:

insuranceApplication.Person.PersonAugmentation.PersonIncome.IncomeSubjectToFedera
lRestrictionsIndicator.

ee:MedicaidMAGIParentCaretakerCategoryEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIParentCaretakerCategoryEligibilityBasis/hix-
ee:MedicaidMAGIParentCaretakerCategoryEligibilityBasis/hix-
75
107 (1)exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-
core:VerificationStatus/hix-core:VerificationStatusCode
(2)exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-
core:VerificationCategoryCode
(3) exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-
core:VerificationAuthorityTDS-FEPS-AlphaCode
(4) exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-core:ResponseCode
core:VerificationDate/nc:DateTime
core:VerificationIndicator
core:VerificationAuthorityName
core:VerificationDescriptionText
76
ee:CHIPTraffickingVictimCategoryEligibilityBasis/hix-core:StatusIndicator
ee:CHIPTraffickingVictimCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPTraffickingVictimCategoryEligibilityBasis/hix-

ee:MedicaidMAGISevenYearLimitEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGISevenYearLimitEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGISevenYearLimitEligibilityBasis/hix-
77
ee:MedicaidMAGIIncomeEligibilityBasis/hix-
ee:IncomeCompatibility/hix-ee:IncomeCompatibilityVerificationIndicator
ee:MedicaidMAGIIncomeEligibilityBasis/hix-ee:IncomeCompatibility/hix-
ee:IncomeCompatibilityInconsistencyReasonText
ee:IncomeCompatibilityVerificationMethod[. = ('1', '2','3','4','5')]
ee:IncomeCompatibilityDetermination/nc:ActivityDate/nc:DateTime
ee:MedicaidMAGIEligibility/hix-ee:MedicaidMAGIResidencyEligibilityBasis/hix-
ee:MedicaidResidencyEligibilityBasisCorrectStateIndicator
ee:InsuranceApplicantNonESIPolicy/hix-
ee:InsurancePolicyAppliedEffectiveDateRange/nc:EndDate/nc:Date
78
233.1 exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-ee:InsuranceApplicant/hix-
ee:InsuranceApplicantNonESIPolicy/hix-
ee:InsurancePolicyAppliedEffectiveDateRange/nc:StartDate/nc:Date
149 (1) hix-core:Person s:id
(2) hix-core:Person/hix-core:PersonAugmentation/hix-
core:PersonAssociation/nc:PersonReference
(3) hix-core:Person/hix-core:PersonAugmentation/hix-core:PersonAssociation/hix-
core:FamilyRelationshipCode
79
ee:CHIPTitleIIWorkQuartersMetEligibilityBasis/hix-core:StatusIndicator
ee:CHIPTitleIIWorkQuartersMetEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPTitleIIWorkQuartersMetEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
385 (1) exch:AccountTransferRequest/hix-ee:MedicaidHousehold/hix-

ee:HouseholdIncome/hix-core:IncomeAmount
(2) exch:AccountTransferRequest/hix-ee:MedicaidHousehold/hix-
ee:HouseholdIncome/hix-core:IncomeFrequency/hix-core:FrequencyCode
80
412 exch:AccountTransferRequest/hix-core:Person[@s:id = /exch:AccountTransferRequest/hix-
ee:InsuranceApplication/hix-ee:InsuranceApplicant/hix-
core:RoleOfPersonReference/@s:ref]/hix-core:PersonAugmentation/hix-
core:PersonAssociation/hix-core:PersonCaretakerDependentCode
ee:InsuranceApplicantLivesWithMinorAgeDependentIndicator
81
240 (chip.1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPMedicaidCitizenOrImmigrantEligibilityBasis/hix-core:StatusIndicator
ee:CHIPMedicaidCitizenOrImmigrantEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPMedicaidCitizenOrImmigrantEligibilityBasis/hix-
ee:CHIPMedicaidCitizenOrImmigrantEligibilityBasis/hix-
ee:MedicaidMAGICitizenOrImmigrantEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGICitizenOrImmigrantEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGICitizenOrImmigrantEligibilityBasis/hix-
ee:MedicaidMAGICitizenOrImmigrantEligibilityBasis/hix-
82
296 (CHIP. 1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPPregnancyCategoryEligibilityBasis/hix-core:StatusIndicator
(CHIP. 2) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:CHIPPregnancyCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPPregnancyCategoryEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
(Medicaid. 1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:MedicaidMAGIPregnancyCategoryEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGIPregnancyCategoryEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGIPregnancyCategoryEligibilityBasis/hix-
ee:MedicaidNonMAGIEligibility/hix-ee:EligibilityDateRange/nc:StartDate/nc:Date
83
ee:CHIPStateHealthBenefitsEligibilityBasis/hix-core:StatusIndicator
ee:CHIPStateHealthBenefitsEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:CHIPStateHealthBenefitsEligibilityBasis/hix-ee:EligibilityBasisIneligibilityReasonText
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:CHIPWaitingPeriodEligibilityBasis/hix-
84
335 (CHIP. 1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-
ee:InsuranceApplicant/hix-ee:CHIPEligibility/hix-ee:CHIP-
SSNVerificationEligibilityBasis/hix-core:StatusIndicator
SSNVerificationEligibilityBasis/hix-ee:EligibilityBasisStatusCode
SSNVerificationEligibilityBasis/hix-ee:EligibilityBasisInconsistencyReasonText
ee:MedicaidMAGISSNVerificationEligibilityBasis/hix-core:StatusIndicator
ee:MedicaidMAGISSNVerificationEligibilityBasis/hix-ee:EligibilityBasisStatusCode
ee:MedicaidMAGISSNVerificationEligibilityBasis/hix-
84.1 exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-ee:InsuranceApplicant/hix-
ee:InsuranceApplicantLawfulPresenceStatus/scr:ClassOfAdmissionClassificationCode
85
137.1 exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-core:DHS-
SAVEVerificationCode
262.1 exch:AccountTransferRequest/hix-core:VerificationMetadata/hix-core:DHS-
G845VerificationCode
core:PersonEmploymentAssociation/hix-
core:Employer/nc:OrganizationPrimaryContactInformation/nc:ContactMailingAddress/nc:
StructuredAddress
core:PersonIncome[not(hix-core:IncomeDate)]/hix-core:IncomeAmount
ee:InsuranceApplicantLawfulPresenceStatus/hix-ee:LawfulPresenceStatusEligibility/hix-
86
ee:InsuranceApplicantLawfulPresenceStatus/hix-
ee:LawfulPresenceStatusImmigrationDocument/hix-
ee:LawfulPresenceDocumentPersonIdentification/nc:IdentificationID
End of worksheet
87
Ref # Logic
N/A N/A
7 Eligible
IfadultGroupCategoryStatus = Y AND adultGroupCategoryStatusReason = 999, map (1)="true"
and (2)="Complete" and do not map (3)
Ineligible
If adultGroupCategoryStatus = N, map (1)="false" and (2)="Complete" and map
(3)=adultGroupCategoryStatusReason
Not Applicable
If adultGroupCategoryStatus = X, map (2)="NotApplicable" and map
(3)=adultGroupCategoryStatusReason
Note: only map if Medicaid eligible
9 Eligible
If adultGroupXXCategoryStatus = Y AND adultGroupCategoryXXStatusReason = "587", map
(1)="true" and (2)="Complete" and do not map (3)
Ineligible
If adultGroupXXCategoryStatus = N, map (1)="false" and (2)="Complete" and
(3)=adultGroupCategoryXXStatusReason
Not Applicable
If adultGroupXXCategoryStatus = X, map (2)="NotApplicable" and
(3)=adultGroupCategoryXXStatusReason
Reason code Reference:

587: Applicant is under age 65
Note: only map if Medicaid eligible
88
Ref # Logic
53 Eligible:
If childCategoryStatus = Y, map (1)="true" and (2)="Complete" and and do not map (3)
Ineligible:
If childCategoryStatus = N, map (1)="false" and (2)="Complete" and
(3)=childCategoryStatusReason
Not Applicable:
If childCategoryStatus = X, map (2)="NotApplicable" and (3)=childCategoryStatusReason
Reason Code Reference:

115: Applicant is 19 years of age or older
394: Applicant is over the age limit for the young adult threshold in the state
589: Applicant is age 18 or younger or applicant is age 19 or older and under the young adult
age threshold
20 if APTC_RESULT.status = Y, map to true;

if APTC_RESULT.status = N, map to false;
else don’t map
21 Straight Map
89
Ref # Logic
55 Verified:
If chipIncomeStatus = Y AND memberCurrentIncomeResult.statusReason = 564 OR 427, map
(1)="true" and (2)="Complete" and and do not map (3)
Inconsistent:
If chipIncomeStatus = Y AND memberCurrentIncomeResult.statusReason=359 OR 403, do not
map (1), map (2)="Inconsistent" and map (3)= memberCurrentIncomeResult.statusReason
CHIP Ineligible
If chipIncomeStatus=N , map (1)="false" and (2)="Complete" and (4)=chipIncomeStatus
Else do not map

ReasonCode Reference
564: Verified based on external data source
427: Attested monthly above CHIP standard, but attested annual below CHIP standard in RPC
state
359: Attested below Medicaid or CHIP Standard
403: Attested income below CHIP standard, no data sources available for verification
90
Ref # Logic
56
Eligible:
If (chipra214MedicaidStatus = Y AND chipra214MedicaidStatusReason = 999) OR
(chipra214ChipStatus = Y AND chipra214ChipStatusReason = 999, map (1)="true" and
(2)="Complete" and do not map (3)
Ineligible:
If chipra214MedicaidStatus = N AND chipra214ChipStatus = N, map (1)="false" and
(2)="Complete" and (3)=chipra214MedicaidStatusReason
Not applicable:
If chipra214MedicaidStatus=X AND chipra214ChipStatus = X, map (2)="NotApplicable" and
(3)="555"
Note: SES will map the Medicaid result if Medicaid ineligible when CHIP Eligible and CHIP
CHIPRA eligible, in order to communicate the CHIP CHIPRA result.
91
Ref # Logic
64 Eligible
If chipStatus="Y" and chipStatusReason="999", map (1)="true" and (2)="999"
Pend/Inconsistent
chipStatus="Y" and chipStatusReason<>"999", map (1)="true" and (2)=chipStatusReason
Ineligible for CHIP, (Communicates Unborn, Work_Quarters, Full Determination etc.)

If chipStatus="N", map (1)="false" and (2)=chipStatusReason
Note: with the change in SES to have Unborn has a separate eligibility, we need to send CHIP
ineligible result when unborn is eligible to communicate the unborn result, which is a
subelement of chip eligibility in the payload. Also need to send result when ineligible for CHIP
because subject to waiting period so state can apply exceptions.
Note: there is no EligibilityInconsistencyReasonText for CHIP.
Related to ref#389
ReasonCode Reference:
139: CHIP waiting period is stll in effect.
92
Ref # Logic
389 Eligible:
If unbornChildCHIPStatus = Y AND unbornChildCHIPStatusReason = 426, 564 map (1)="true" and
Pending
If unbornChildCHIPStatus = Y AND unbornChildCHIPStatusReason = 360, 365; do not map (1),
Map (2) = "Pending" and (3)=unbornChildCHIPStatusReason
Ineligible
If unbornChildCHIPStatus = N, map (1) = "false" and (2) = "Complete" and
(3)=unbornChildCHIPStatusReason
Not Applicable
If unbornChildCHIPStatus = X, map (2) = "NotApplicable" and (3)=unbornChildCHIPStatusReason
Else, do not map
Related to ref#64
Reason Code Reference

426 - Attested monthly above CHIP standard, but attested annual below CHIP standard in RPC
state
564 - Verified based on external data source
360 - Attested below Medicaid standard, but data sources were above Medicaid Standard, or
data sources are not compatible with attested line items
365 - Attested income below CHIP standard, no data sources available for verification
Note, payload only has reason code of 151 (mother is eligible for Medicaid) for unborn CHIP. SES
does not set this and so if unbornChildCHIPStatus = N no reason code is written.
93
Ref # Logic
522.1 If chipStatus=Y, map (1)="false" (not incarcerated) and (2)="Complete" and do not map (3)
If chipStatus=N, and chipStatusReason = 443 map (1)="true" (attested to being incarcerated) and
(2)="Complete" and (3) = 443
Else do not map
106 Eligible:
If dependentChildCoveredStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Ineligible
If dependentChildCoveredStatus = N, map (1)="false" and (2)="Complete" and
(3)=dependentChildCoveredStatusReason
Not Applicable
If dependentChildCoveredStatus =X, map (2)="NotApplicable" and
(3)=dependentChildCoveredStatusReason
Else do not map
113 Eligible:
If emergencyMedicaidStatus = Y, map (1)="true" and (2)=emergencyMedicaidStatusReason
Ineligible:
If emergencyMedicaidStatus = N, map (1)="false" and (2)=emergencyMedicaidStatusReason
else do not map
94
Ref # Logic
154 Eligible
If fiveYearBarStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Ineligible
If fiveYearBarStatus = N, map (1)="false" and (2)="Complete" and
(3)=fiveYearBarStatusStatusReason
Not Applicable
If fiveYearBarStatus = X, map (2)="NotApplicable" and (3)=fiveYearBarStatusStatusReason
Else do not map
Note: the payload only has FiveYearBarEligibilityBasis under Medicaid eligibility, not CHIP.
156 Eligible:
If formerFosterCareStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Ineligible
IfformerFosterCareStatus = N, map (1)="false" and (2)="Complete" and
(3)=formerFosterCareStatusReason
Not Applicable
If formerFosterCareStatus = N, map (2)="NotApplicable" and (3)=formerFosterCareStatusReason
else do not map
95
Ref # Logic
187 If chipStatus = Y, straight map to (1)
Else, straight map to (2)
96
Ref # Logic
239 Verified
If medicaidIncomeStatus = Y and memberCurrentIncomeResult.statusReason in (180, 404, 534,
535, 536, 557, 564), map (1)&(5)="true" and (2)&(6)="Complete" and do not map (3)&(7)
Inconsistent with External Data
If medicaidIncomeStatus = Y and memberCurrentIncomeResult.statusReason = (194 or 360) ,
map (2)&(6)="Pending" and (3)&(7)=memberCurrentIncomeResult.statusReason
Inconsistent No External Data

If medicaidIncomeStatus = Y and memberCurrentIncomeResult.statusReason = 365 , map
(2)&(6)="Pending" and (3)&(7)=memberCurrentIncomeResult.statusReason
Ineligible for Income (Includes Eligible for Medicaid Under Foster Care, and Full Determination)
If medicaidIncomeStatus = N map (1) = "False", (2) = "Complete" and
(4)=memberCurrentIncomeResult.statusReason
Else do not map
Reason Codes:
180: Both attested and EDS below Medicaid MAGI standard
404: Attested below Medicaid standard and minimum threshold; no data sources available or
data sources are compatible with attested line
534: edsDifferencePercent within the configurable percent of the Medicaid standard
535: Attested or IRS below the Medicaid standard
536: Attested or irsDifferencePercent within the configurable percent of the Medicaid standard
557: Medicaid income verified using attested income or explanation for annual income
discrepancy
564: Verified based on external data sources
194: External data source not reasonably compatible
360:Attested below Medicaid standard, but data sources were above Medicaid Standard, or data
sources are not compatible with attested line items
365: Attested below Medicaid standard, no data sources available for verification
97
Ref # Logic
245 Only map the residency result to the program the person is eligible for. Map to Medicaid if the
person is requesting full determination
CHIP eligible
If medicaidResidencyStatus = Y and medicaidResidencyStatusReason=999 AND chipStatus = Y,
map (chip.1)="true" and (chip.2)="Complete" and do not map (chip.3)
Else EmergencyMedicaid eligible

If medicaidResidencyStatus = Y and medicaidResidencyStatusReason=999 AND
emergencyMedicaidStatus = Y, map (emergency.1)="true" and (emergency.2)="Complete") and
do not map (emergency.3)
Medicaid Residency eligible or full determination

If medicaidResidencyStatus = Y and medicaidResidencyStatusReason=999 , map
(medicaid.1)="true" and (medicaid.2)="Complete" and do not map (medicaid.3)
Pend Medicaid Residency

Else CHIP eligible - student rule
If medicaidResidencyStatus = "Y" and medicaidResidencyStatus="308" AND chipStatus = "Y",
map (chip.2)="Pending" and (chip.4)=medicaidResidencyStatusReason
Else CHIP eligible, no home address or temporarily outside state

If (medicaidResidencyStatus="Y" and medicaidResidencyStatusReason="604" AND chipStatus =
"Y", (chip.2)="Pending" and (chip.4)=medicaidResidencyStatusReason
Else Emergency Medicaid - student rule:

If medicaidResidencyStatus="Y" and medicaidResidencyStatusReason="308" AND
emergencyMedicaidStatus="Y", map (emergency.2)="Pending" and
(emergency.4)=medicaidResidencyStatusReason
Else Emergency Medicaid, no home address or temporarily outside state

If medicaidResidencyStatus = "Y" and medicaidResidencyStatusReason="604" AND
emergencyMedicaidStatus = "Y", map (emergency.2)="Pending" and
(emergency.4)=medicaidResidencyStatusReason
Medicaid eligible - student rule or full determination

If (medicaidResidencyStatus = "Y" and medicaidResidencyStatusReason="308") , map
(medicaid.2)="Pending" and (medicaid.4)=medicaidResidencyStatusReason
98
Ref # Logic
249 Eligible
If medicaidStatus="Y" and medicaidStatusReason="999" or "648", map (1)="true" and (2)="999"
Inconsistent/Pend
medicaidStatus="Y" and "medicaidStatusReason <> 999 or 648, map (1)="true" and
(3)=medicaidStatusReason
Ineligible
If medicaidStatus = "N" (1)="false" and (2)=medicaidStatusReason
Else do not map

648: Eligible for Medicaid under foster care
97 If the incomeSourceType = "OTHER_DEDUCTION", Map for the generated

currentIncome.SequenceNumber and append spaces if needed to make min length = 5
else do not map
99
Ref # Logic
271 Eligible:
If optionalTargetedLowIncomeChildCategoryStatus = Y, map (1)="true" and (2)="Complete" and
(3)=optionalTargetedLowIncomeChildCategoryStatusReason
Ineligible
If optionalTargetedLowIncomeChildCategoryStatus = N, map (1)="false" and (2)="Complete" and
do not map (3)
Not Applicable
If optionalTargetedLowIncomeChildCategoryStatus = X, map (2)="NotApplicable" and
(3)=optionalTargetedLowIncomeChildCategoryStatusReason
Else do not map
102 Sum up all tribalIncomeAmounts and map as a separate line item along with all the other data in
the PersonIncome segment for a given currentIncome.SequenceNumber
cross reference ref#: 395,94, 95,96,103,104, 188, 100,426
278 Eligible:
If parentCaretakerStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Ineligible
If parentCaretakerStatus = N, map (1)="false" and (2)="Complete" and
(3)=parentCaretakerStatus
Not Applicable
If parentCaretakerStatus = X, map (2)="NotApplicable" and (3)=parentCaretakerStatus
Note: there is no PCR eligiiblity basis for Emergency Medicaid in the AT Mapping spreadsheet.
100
Ref # Logic
107 For each SES data event*, map (1) as follows:
If status = D and dataFoundIndicator="false", map 4 (data source delayed)
Else if dataFoundIndicator="true", map to 5 (Data found);
else if dataFoundIndicator=false, map to 6 (Data not found);
else do not map
For each condition above:
also map (2), (3), (4) and (5) based on Data Events*(below)
Else do not map
*Data Events (VerificationCategoryCodeSimpleType) [TDS-FEPS-AlphaCodeSimpleType]

CITIZENSHIP_SSA_DATA (2) = (Citizenship) (3) = [SSA] (6) = personUSCitizenIndicator
CURRENT_INCOME_DATA (2) = (CurrentIncome) (3) = [Equifax]
IMMIGRATION_STEP2_DATA if it exists, else IMMIGRATION_STEP1_DATA (2) =
(EligibleImmigrationStatus) ) (7) = [DHS] (8) = dhsComments if <> null. Truncate end characters
to 160 charcters if longer than 160 characters
INCARCERATION_SSA_DATA (2) = (IncarcerationStatus) (3) = [SSA] (6) = inverse of
inmateStatusIndicator
INCOME_IRS_DATA (2) = (AnnualIncome) (3) = [IRS] - only if able to receive FTI
SSN_SSA_DATA (2) = (SSN) (3) = [SSA]
TITLE_2_WORK_QUARTERS_DATA_EVENT (2) = (EligibleImmigrationStatus) (3) = [SSA]
TITLE2_INCOME_SSA_DATA (2) = (CurrentIncome) (3) = [SSA]
Do Not Map
ESC_MEC_DATA_EVENT (ESI-MEC)
NON_ESC_MEC_DATA_EVENT (NonESI-MEC)
MEDICARE_ENTITLEMENT_DATA_EVENT
Intentionally only mapped the 3 values, did not map the other value options as SES does not
have data expected:
1 Hub response expected
2 Hub response not expected (delayed)
3 Data source response expected
101
Ref # Logic
373 Eligible:
If traffickingVictimStatus = Y AND traffickingVictimStatusReason = 999, map (1)="true" and
Inconsistent
If traffickingVictimStatus = Y AND traffickingVictimStatusReason <> 999, do not map (1) map (2)
= "Inconsistent" and (3) = traffickingVictimStatusReason
NotApplicable
If traffickingVictimStatus=X, map (2) = "NotApplicable" and (3) =traffickingVictimStatusReason
Note: the payload does not have traffickingVictimStatus under Medicaid Eligibility
329 Eligible:
If sevenYearLimitStatus = Y AND sevenYearLimitStatus = 999, 623, or 622 map (1)="true" and
Ineligible
If sevenYearLimitStatus = N AND sevenYearLimitStatusReason = 111, map (1)="true" and (2) =
"Complete" and (3) =" 111"
Not Applicable
If sevenYearLimitStatus = X map (2) = "NotApplicable" and (3) = sevenYearLimitStatusReason
Else, do not map

623: Seven year limit will be reached within 30 days
622: Status start date is not available to calculate 7 year limit
111: Applicant has exceeded the 7 year limit of Medicaid coverage for his/her immigration status
102
Ref # Logic
604 only map to this result when annual income was used for MedicaidIncome verification
If (incomeEligibleUnderRpcIndicator = "true" OR medicaidGapFillingIndicator = "true") AND

MedicaidIncomeStatus = "Y",
map (1) = "true" And (2) = memberCurrentIncomeResult.${memberId}.statusReason and (4) =
CURRENT_INCOME_DATA.createdDateTime
AND
map (3) as follows:
IF CURRENT_INCOME_RESULT.finalizingDataSourceType = "None" or "Attestation", map (3) = '4'
(Attestation)
ELSE IF CURRENT_INCOME_RESULT.finalizingDataSourceType = "ESD" or "PAPER VERIFICATION",
map (3) = '5' (Paper Verification)
ELSE IF CURRENT_INCOME_RESULT.finalizingDataSourceType = "EDS" or"IRS"or "External
Income", map (3) = '3' (External Data Source)
ELSE do not map (3)
Note: SES JSON does not have FTI reason codes
Question for CMS/Hub #65: There does not seem to be an equivalent result for Annual income
verification status (MedicaidMAGI) in the payload for CHIP. Please confirm. Would not expect to
have CHIP Gap Filling, but would expect to have for RPC.
MedicaidMAGIIncomeEligibilityBasis/hix-ee:IncomeCompatibility/hix-
ee:IncomeCompatibilityVerificationIndicator
632 For each InsuranceApplicant:

If MedicaidResidencyStatus = "Y" and MedicaidResidencyStatusReason = "999", map "true"
ELSE map, "false"
Note: this value does not exist in the payload for CHIP
233 Straight Map

Note: this AT payload is also where FFE policy information is mapped by legacy but will not be
mapped by SES.
103
Ref # Logic
233.1 Straight Map
Note: this AT payload is also where FFE policy information is mapped by legacy but will not be
mapped by SES.
149 To generate (1):

Begin with "pe" and map from personTrackingNumber
For each familyRelationships [array] find the (1) that relates to (a). Map (2) = Person s:ref of (c)
and also map, (3) = mirrored relationship of (b)
AND
If (a) <> (c):
find the (1) that relates to (c). Map (2) = Person s:ref of (a) and also map, (3) = relationship of (b)
104
Ref # Logic
226 Verified:
If MEDICAID_WORK_QUARTER_EVENT.status = Y AND
MEDICAID_WORK_QUARTER_EVENT.statusReason = 999, map (1)="true" and (2)="Complete"
and do not map (3)
Inconsistent:
If MEDICAID_WORK_QUARTER_EVENT.status = Y AND
MEDICAID_WORK_QUARTER_EVENT.statusReason <> 999, map (2)="Inconsistent" and
(3)=MEDICAID_WORK_QUARTER_EVENT.statusReason
Not Applicable:
MEDICAID_WORK_QUARTER_EVENT.status = X map (2)="NotApplicable" and
(3)=MEDICAID_WORK_QUARTER_EVENT.statusReason
Else do not map
Note: Since work quarters is under CHIP in the payload, will map CHIP result to communicate
work quarters when CHIP is N and Medicaid is Y. Will not map when not applicable or not
eligible.
Note: Until App3 asks the full set of Work Quarters questions and we add a new data element to
record the attested quarters, SES will not set an ineligible result for an applicant for work
quarters.
385 Straight map (1) and set (2)="Annual"
Note the legacy does not map this correctly, they are mapping current income detail line items
including income category, which is already available in the person income segment.
Delete either this or ref#384
105
Ref # Logic
412 If (a) = "true" and (b) = "true" map to "YesCovered"
If (a) = "false" and (b) = "true" map to "YesNotCovered"
If (a) = "false" and (b) = "false" map to "No"
If (a) = "true" and (b) = "false" map to "No"
else do not map
524 Do not map
106
Ref # Logic
240 Note: the payload, like legacy, has a combo event for imm/cit
Assume for design that we only map mlp result for the program for which person is eligible
Verified MLP:
CHIP eligible
If (medicaidLawfulPresenceStatus = Y and medicaidLawfulPresenceStatusReason=999 or 432)
OR (citizenshipStatus = Y and citizenshipStatusReason =999 or 432) AND =
chipStatus = Y, map (chip.1)="true" and (chip.2)="Complete" and do not map (chip.3)
Else EmergencyMedicaid eligible

OR (citizenshipStatus = Y and citizenshipStatusReason =999 or 432) AND
emergencyMedicaidStatus = Y, map (emergency.1)="true" and (emergency.2)="Complete") and
do not map (emergency.3)
ELSE Medicaid eligible or full determination

OR (citizenshipStatus = Y and citizenshipStatusReason=999 or 432), map (medicaid.1)="true"
and (medicaid.2)="Complete" and do not map (medicaid.3)
Inconsistent MLP
Attested LP and CHIP eligible:
If (medicaidLawfulPresenceStatus = Y and medicaidLawfulPresenceStatusReason<>999 or 432)
AND lawfulPresenceStatusIndicator = true AND chipStatus = Y, map (chip.2)="Inconsistent" and
(chip. 4)=medicaidLawfulPresenceStatusReason
Else attested citizen and CHIP eligible

AND citizenshipIndicator = truee AND chipStatus = Y, map (chip.2)="Inconsistent" and (chip.
4)=medicaidLawfulPresenceStatusReason
Else attested LP and Emergency Medicaid eligible:
AND lawfulPresenceStatusIndicator = true AND emergencyMedicaidStatus = Y, map
(emergency.2)="Inconsistent" and (emergency. 4)=medicaidLawfulPresenceStatusReason
Else attested citizen and Emergency Medicaid eligible
107
Ref # Logic
296 Eligible:
If chipStatus = Y and pregnancyCategoryStatus = Y, map (CHIP. 1)="true" and (CHIP.
2)="Complete" and do not map (CHIP. 3)
Else If pregnancyCategoryStatus = Y, map (Medicaid. 1)="true" and (Medicaid. 2)="Complete"
and do not map (Medicaid. 3)
Ineligible
If chipStatus = Y and pregnancyCategoryStatus=N, map (CHIP. 1)="false" and (CHIP.
2)="Complete" and (CHIP. 3)=pregnancyCategoryStatusReason
Else If pregnancyCategoryStatus=N, map (Medicaid. 1)="false" and (Medicaid. 2)="Complete"

and (Medicaid. 3)=pregnancyCategoryStatusReason
NotApplicable
If chipStatus = Y andpregnancyCategoryStatus=X, map (CHIP. 2)="NotApplicable" and (CHIP.
3)=pregnancyCategoryStatusReason
Else If pregnancyCategoryStatus=X, map (Medicaid. 2)="NotApplicable" and (Medicaid.

3)=pregnancyCategoryStatusReason
Else do not map
562 If medicaidNonMagiReferralStatus =Y, straight map

else do not map
108
Ref # Logic
62 Eligible:
If chipStateHealthBenefitStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Not applicable:
If chipStateHealthBenefitStatus = X, map (2)="NotApplicable" and
(3)=chipStateHealthBenefitStatus
Else do not map
68 Eligible (not in waiting period)

If chipWaitingPeriodStatus = Y, map (1)="true" and (2)="Complete" and do not map (3)
Ineligible (in waiting period)

If chipWaitingPeriodStatus=N and chipWaitingPeriodStatusReason=139, map (1)="false" and
(2)="Complete" and (3)=chipWaitingPeriodStatusReason
Not Applicable
If chipWaitingPeriodStatus = X, map (2)="NotApplicable" and
(3)=chipWaitingPeriodStatusReason
Else do not map
Note: If ineligible for CHIP due to waiting period, we will map CHIP result to communicate
waiting period result.
109
Ref # Logic
335 Verified
CHIP eligible
If chipStatus=Y and SSN_RESULT.status = Y AND
SSN_RESULT.statusReason = 999 or 432, map (CHIP.1)=true and (CHIP. 2) = "Complete" and do
not map (CHIP. 3)
Else Medicaid eligible or Full Determination

If SSN_RESULT.status = Y AND
SSN_RESULT.statusReason = 999 or 432, map (Medicaid. 1) = true and(Medicaid.2) = "Complete"
and do not map & (Medicaid. 3)
Inconsistent
CHIP Eligible
If chipStatus=Y and SSN_RESULT.status = Y AND SSN_RESULT.statusReason <> 999 or 432, map
(CHIP. 2)= "Inconsistent" and (CHIP. 3) = SSN_RESULT.statusReason

If SSN_RESULT.status = Y AND SSN_RESULT.statusReason <> 999 or 432, map (Medicaid.2) =
"Inconsistent" and (Medicaid. 3) = SSN_RESULT.statusReason
Ineligible
CHIP Eligible
If chipStatus=Y and SSN_RESULT.status = N, map (CHIP. 1) = "false" and (CHIP.2) = "Complete"
and (CHIP. 3) = SSN_RESULT.statusReason

If SSN_RESULT.status = N, map (Medicaid. 1) = "false" and (Medicaid.2) = "Complete" and
(Medicaid. 3) = SSN_RESULT.statusReason
Not applicable
CHIP eligible
If chipStatus=Y and SSN_RESULT.status = X map (CHIP. 2)="NotApplicable" and (CHIP.
3)=SSN_RESULT.statusReason
Medicaid eligible or Full Determination

If SSN_RESULT.status = X map (Medicaid.2)="NotApplicable" and (Medicaid. 3)=
84.1 SSN_RESULT.statusReason
Do Not Map
Note: The decision was made to not map majorCode as it is not supported by the hub payload in
V37 - because V37ToggleOn will be true before SES AT, we will never map this field
110
Ref # Logic
137.1 Do not Map
262.1 Do Not Map
124 Straight map
537 Map value for the Person s:id where PersonIncome s:metadata= VerificationMetadata s:id and
VerificationAuthorityTDS-FEPS-AlphaCode="Equifax"
730 Straight map
111
Ref # Logic
180 map to LawfulPresenceDocumentPersonIdentification/IdentificationID where
IdentificationCategoryCode includes string “i94” or “I 94” or “i-94” (case insensitive);
End of worksheet
112
ReasonCode Description
999 N/A (rule indicator = Y)
555 N/A (rule does apply)
100 SSA data available
101 Applicant did not meet all immigration requirements
102 Applicant did not receive foster care in this state
103 Applicant did not receive Medicaid while receiving foster care
104 Applicant does not have 40 work quarters
105 Applicant does not meet all of the eligibility requirements
106 Applicant does not meet all of the Medicaid eligibility criteria
107 Applicant does not meet criteria for CHIP eligibility
108 Applicant does not meet requirements for a non-MAGI referral
109 Applicant does not meet the criteria for emergency Medicaid.
110 Applicant eligible under another Medicaid category
111 Applicant has exceeded the 7 year limit of Medicaid coverage for his/her immigration status
112 Applicant has exceeded the 8 month limit for Refugee Medical Assistance
113 Applicant has fewer than 40 work quarters, no spouse or parent information provided
114 Applicant has other insurance
115 Applicant is 19 years of age or older and the state does not cover young adults under age 20 or 21
116 Applicant is eligible for Medicaid/CHIP in another category
117 Applicant is entitled to or enrolled for Medicare
118 Applicant is not a child
119 Applicant is not a child or pregnant woman
120 Applicant is not a pregnant woman
121 Applicant is not Medicaid eligible
122 Applicant is pregnant
123 Applicant is not between the ages of 19 and 64 inclusive
124 Applicant not pregnant or within post partum period
125 Applicant was not on foster care when they attained age 18 or until aged out
126 Applicant’s age is greater than or equal to 26
127 Applicant’s age is not within the allowed age range
128 Applicant’s dependent child does not have minimal essential coverage
129 Both parents are employed
130 Caretaker does not meet any adult definition for child
131 Caretaker does not meet any relative definition for child
117
132 Caretaker does not meet standard definition for child
133 Caretaker is not a domestic partner of a caretaker or does not live with child
134 Caretaker is not a relative or domestic partner or does not live with child
135 Caretaker’s spouse does not qualify as a caretaker
136 Child does not have minimum essential coverage, caretaker not eligible for Medicaid
137 Child is 18 years old but not a student
138 Medicaid household income exceeds the FPL threshold to be covered by CHIP if the applicant has access to state employee
health coverage
139 CHIP waiting period is still in effect
140 CHIP-eligible applicant attested to being incarcerated
141 Citizenship cannot be verified
142 Citizenship verification is pending
143 Five-year bar in effect
144 Income exceeds FPL standard for this category
145 Maximum hours worked exceeded
146 No child met all criteria for parent caretaker category
147 No child of required age living with the parent or caretaker relative
148 No deprived child is associated with the caretaker
150 SAVE verification is pending
151 The mother is eligible for Medicaid
152 Unable to verify lawful presence or qualified non-citizen status
153 Child lives with less than two parents
154 Applicant does not have access to state health coverage through a public employee
155 State does not provide CHIP to applicants with access to state health insurance
165 Accepted attestation
166 Address contains the word “Prison” or “jail” or “correctional”
167 Address not in Exchange Service Area
168 Address not within the service area of the Exchange(if QHP) or Home state does not match Medicaid State(if Medicaid)
169 Adjudicated exception
170 Annualized current income not within state limit of attested annual income.
171 Applicant attested to being not lawfully present
172 Applicant is 19 years or older and also pregnant
173 Applicant not a child nor a pregnant woman.
174 Applicant’s MAGI standard in excess of Medicaid limits.
118
175 Applicant’s state does not match Medicaid State for this Exchange
176 APTC Ineligible and not an Indian
177 Attested citizenship status was not verified
178 Attested Not Indian
179 Both attested and EDS above CHIP and Medicaid MAGI standard
180 Both attested and EDS below Medicaid MAGI standard
181 Both attested and EDS below CHIP MAGI standard
182 Both the Current and Annual income
183 CSR eligibility level changed
184 Current Household Income not Consistent with Social Security Administration
185 Current Household Income not Consistent with Unemployment
186 Current Household Income not Consistent with Wages
187 Death data present
188 Determination made by Medicaid agency.
189 DHS data does not match attested information
190 EDS data did not match attested information
191 EDS not available
192 Eligible for employee sponsored affordable coverage
193 Eligible for other MEC
194 External data source not reasonably compatible
195 Further information needed
197 Granted for acquiring a status that makes them eligible for the Exchange
198 Granted for adoption in household
199 Granted for baby born in household
200 Granted for having moved to a new service area
201 Granted for Indian who has not changed plans this month
202 Granted for intent to move to a new service area
203 Granted for marriage in household
204 Granted for placement for adoption in household
205 Granted for plan decertification
206 Granted for prospective acquisition that makes them eligible for the Exchange
207 Granted for prospective release from incarceration
208 Granted for release from incarceration
209 Granted for MEC loss
119
210 Home state is not served by the Medicaid agency associated with this Exchange.
211 Household Income for Primary Taxpayer is below 100% of FPL and does not include any lawfully present individual that would
have qualified for special rule.
212 Household Income for Primary Taxpayer is over 400% of FPL and does not qualify.
213 IDS Inconsistent and no EDS found
214 IDS not available
215 Indian and Ineligible for APTC
216 Indian and ptcFPL above 300percentage
217 Ineligibility by Default
218 Internal Data Sources Not Reasonably Compatible
219 IRS Records indicate that the primary taxpayer and/or current indicated spouse received APTC tax credit in the previous year
and did not comply with HHS’s requirement to file a return for that year.
220 Lawfully present but exceeds FPL
221 Lawfully present but not completed 5 year ban
222 Manual Adjudication Not Reasonably Compatible
223 Medicaid covers EHB
224 Neither SSA nor DHS data matched attested information
225 Neither SSA or internal data compatible
226 No change in PTC or CSR
227 No data found in EDS
228 Consult School
229 No prior data found
230 No SSA data found, result based on attestation
231 NonESI MEC - All Verifications with Electronic Data Source (EDS) is consistent with attestation that applicant is NOT eligible for
Public Non-ESI MEC during requested coverage dates indicated on application
232 NonESI MEC - Applicant has attested on application to be eligible for BHP Minimum Essential Coverage (MEC).
233 NonESI MEC - Applicant has attested on application to be eligible for CHIP Minimum Essential Coverage (MEC).
234 NonESI MEC - Applicant has attested on application to be eligible for Medicaid Minimum Essential Coverage (MEC).
235 NonESI MEC - Applicant has attested on application to be eligible for PeaceCorps Minimum Essential Coverage (MEC).
236 NonESI MEC - Applicant has attested on application to be eligible for TRICare Minimum Essential Coverage (MEC).
237 NonESI MEC - Applicant has attested on application to be enrolled in VA Minimum Essential Coverage (MEC).
238 NonESI MEC - At least 1 verification with Electronic Data Source (EDS) is inconsistent with attestation and at least 1 EDS
indicates applicant is eligible for Public Non-ESI MEC during requested coverage dates indicated on application
239 NonESI MEC - Data from Electronic Data Source (EDS) not in usable format.
120
240 NonESI MEC - No Data Found at Electronic Data Source (EDS).
241 NonESI MEC - Verification with EDS indicated that applicant is eligible for Public Non-ESI MEC during requested coverage dates,
which is in agreement with applicant's attestation on application.
242 NonESI MEC - Verification with EDS indicated that applicant is not eligible for Public Non-ESI MEC during requested coverage
dates, which is in agreement with applicant's attestation on application.
243 Not Applicable, as household of primary taxpayer is eligible for APTC.
244 Not compatible with EDS data source
245 Not compatible with IDS data source
246 Not eligible for Exchange
247 Not entitled to social security or railroad disability benefits for the last 24 months.
248 Not granted because a plan change has already occurred this month
249 Not granted because change is too far in the future.
250 Not granted because current date is prior to incarceration release
251 Not granted because current plan covers new location
252 Not granted because did not qualify for any SEP.
253 Not granted because event did not occur in the coverage household
254 Not granted because individual is not an Indian
255 Not granted because individual was already eligible for the Exchange
256 Not granted because ineligible for Exchange
257 Not granted because loss date is too far in the future.
258 Not granted because more than 60 days after acquisition of new status
259 Not granted because more than 60 days after incarceration release
260 Not granted because more than 60 days after MEC loss date
261 Not granted because more than 60 days after qualifying event
262 Not granted because more than 60 days after relocation
263 Not granted because more than 60 days since date of change
264 Not granted because more than X days until new status is expected.
265 Not granted because no claim of a marriage, birth or adoption
266 Not granted because no HHS involvement
267 Not granted because no new plans and current plan covers new location
268 Not granted because of failure to pay premiums
269 Not granted because plan not decertified
270 Not granted because qualifying event is too far in the future
271 Not granted because relocation date is too far in the future
121
272 Not in service area of Exchange
273 Not Indian
274 Not Indian and ptcFPL above 250percentage
275 Not lawfully present
276 Not offered in State
277 Not receiving Medicare disability benefits
278 Primary Taxpayer indicated that his/her planned return filing status to be “Married Filing Separately”. For married primary
taxpayer to qualify, the planned return filing status needs to be indicated as “Married Filing Jointly”.
279 Prior data does not match attested information
280 Prior temporary lawful presence has expired
281 PTC eligibility changed
282 QHP Ineligible
283 Release Date is more than 30 days from now
284 Residency state does not offer EHB
285 Resident state does not match the Medicaid state for this exchange
286 SSA data did not match attested information
287 SSN was not matched with attested information
288 SSN was not verified
289 State does not elect the section 214 CHIPRA option.
290 State does not provide Emergency Medicaid
291 Temporary lawful presence has expired
292 The difference between the data source and the calculated tax household size exceeds 3.
293 The tax household of the primary taxpayer does not include any individual that is eligible for QHP while being also ineligible
for any Minimum Essential Coverage (Public or ESI).
294 Verified against EDS
295 Verified against IDS
296 Verified by Review and Adjudicate
297 You didn't meet the eligibility criteria for Disability and Blindness.
298 Granted for release from incarceration
299 Income exceeds FPL standard for CHIP
300 Residency, Income or Household size are inconsistent
301 Lawful presence or qualified non-citizen status verification is delayed
302 Residency, Income or Household size information is Pending
304 Internal data did not match attested information
122
305 Citizenship or Income status are inconsistent
306 Applicant’s state does not match Medicaid State for this Exchange
307 Applicant meets Medicaid residency criteria and student criteria, but state does not allow residency for full-time students
308 Medicaid student residency rule applies, state denies Medicaid for students
309 Applicant does not meet residency requirements
310 Granted for being on same policy as someone who qualifies for PTC/CSR SEP
311 not granted because applicant was not enrolled in a QHP
312 Granted for being on a policy with someone who is moving
313 Granted SEP for Exceptional Circumstance
314 Granted SEP for contract violation
315 Granted SEP for Inadvertent, Erroneous, or Unintentional Action by an officer, employee, or agent of the Exchange
316 Insurance Plan is not in Area provided
317 Plan is not effective
318 Dependent is too old
319 Same sex partners are not allowed
320 Domestic partners are not allowed
321 Dependent type not allowed
322 No rate for subscriber type
323 Granted SEP through administrative casework settings with a custom coverage start date
324 Granted SEP through administrative casework settings with a coverage start date following the fifteenth of the month rule
325 Not granted because not a qualified employee
326 Incarceration was not verfiied, accepting attestation
327 Healthcare sharing ministry is not valid
328 Determined not eligible for Hardship Exemption
329 Not a member of a Federally recognized Indian tribe
330 Healthcare sharing ministry was not verfiied, accepting attestation
331 Religious organization was not verfiied, accepting attestation
332 Residency state is in the exchange service area, but zip code is not provided
333 Income above the Medicaid MAGI standard
334 Documentation provided did not resolve the inconsistency, inconsistency period is closed
336 Annual income not compatible with IRS income and not current income data source available for alternate annual income
verification
337 Temporarily absent from state or no fixed address and alternative address provided was not in state.
338 Applicant did not meet all the criteria for Income Override Rule
123
339 Applicant Title II Work Quarters did not meet the criteria.
340 Income is greater that 100% FPL.
341 Hub did not respond
342 IRS System down
343 IRS has no data
344 IRS does not have data for all tax filers in household
345 Medicaid Household not equal to Tax household
346 Indian in the household
347 IRS household Income below Medicaid & CHIP Standard
348 Projected annual income is below Medicaid & CHIP standard
349 Unable to project annual income
350 EDS current income above the Medicaid standard
351 SSA system is down
352 Individual did not provide an SSN
353 Individual attested to being a non-tax filer
354 applicant not a tax filer or tax dependent (isn’t this same as non-filer?
355 The difference between the internal data source and the calculated tax household size exceeds configurable number
356 No EDS, No IDS and attested household size above configurable limit
357 No external income data sources available for annual income verification.
358 Annual income not within specified threshold percent of IRS income
359 Attested below CHIP standard, but data sources were above CHIP Standard
360 Attested below Medicaid standard, but data sources were above Medicaid Standard, or data sources are not compatible with
line items
361 Attested current above standard, attested annual below standard, reasonable predictable changes elected, no IRS data for
verification, provided reasonable explanation for income
362 Attested current above standard, attested annual below standard, reasonable predictable changes elected, no IRS data for
verification, did not provide reasonable explanation for income
363 attested current income above standard, attested annual income below standard, state elects reasonably predictable changes,
applicant did not provide reasonable explanation
364 attested current income below standard, attested annual income below standard
365 Attested below Medicaid or CHIP Standard, no data sources available for verification
366 Applicant current and annual income above standard and below 100% and applicant has not met the five year bar. Overriding
income to 100% so applicant can get APTC
124
367 Applicant current and annual income above standard and below 100% and applicant has not met the five year bar. Overriding
income to 100% so applicant can get APTC
368 SSN has not been validated
369 Unable to determine Medicaid eligibility because child’s application submitted by non-custodial parent. This applying
individual may be potentially eligible for Medicaid. For consideration, application must be submitted by the custodial parent.
370 Unable to determine eligibility for financial assistance because this applicant cannot share a financial assistance application
with the Account Holder/Household Contact. This individual may be potentially eligible for Medicaid (or other financial
assistance), on a separate application.
371 Unable to determine Medicaid eligibility because applicant selected to apply without providing family information. This
applying individual may be potentially eligible for Medicaid. For consideration, application must include identity and income
information of the parents and siblings that live with the applicant.
372 Veteran status has not been verified
373 Income exceeds the FPL level for Refugee Medical Assistance
374 Attested annual income is greater than IRS income and more than a configurable percentage (200%) higher than annualized
current income
375 Projected annual income is below Medicaid standard
376 Applicant current income above standard, annual income below 100%, hardship exemption applies
377 Attested current above standard, attested and IRS annual below applicable Medicaid or CHIP standard, reasonable predictable
changes elected
378 Attested income below standard and external data source income above standard
380 Applicant is ineligible for CHIP due to Medicaid eligibility as a former foster care child
381 Applicant's status as a trafficking victim has not yet been verified
382 Applicant's Qualified Non-Citizen status is pending
383 Income or household composition found inconsistent
384 Documentation provided did not resolve the inconsistency, inconsistency period is closed
385 Documentation provided did not resolve the inconsistency, inconsistency period remains open
386 inconsistency period expired without resolution
387 Income or household composition inconsistency period expired without resolution
388 Adjudicated inconsistency found applicant not eligible
389 Caretaker does not meet the definition of domestic parter
390 Applicant is not within the post partum period
391 Did not attest citizenship or lawful presence or did not substantiate an inconsistent verification
392 Did attest incarceration or did not substantiate an inconsistent verification
125
393 Did not attest to meeting the residency requirements or did not substantiate an inconsistent verification
394 Applicant is over the age limit for the young adult threshold in the state
395 Applicant did not attest to naturalized citizenship or eligible immigration status
396 Applicant is a tax dependent
397 Applicant did not provide SSN with attestation of US Citizenship
398 Applicant attested to a SAVE non verifiable status
399 Applicant did not provide enough information to verify eligible immigration status
400 Verified status is not considered a citizen, lawfully present, or qualified non citizen
402 Annual income not within specified percent or amount threshold of IRS or annualized external current income
403 Attested income below CHIP standard, no data sources available for verification
404 Attested below Medicaid standard and minimum threshold; no data sources available or data sources are not compatible with
line items
405 Verified status is known to have expired
406 Attested income is greater than 400% FPL
407 Tax household income is below 100% FPL
408 Attested above Medicaid and CHIP standards
409 NonESI MEC - Applicant has attested on application to be eligible for Medicare Minimum Essential Coverage (MEC).
410 Applicant is not eligible to enroll in a QHP
411 Tax household attested above the APTC limit
412 Tax filers attested to married filing separately
413 Tax filers did not comply with the filing requirements for the previous year
414 Applicant is enrolled in or has an offer for other MEC and is therefore not eligible for APTC
415 Applicant did not attest to a filing status
416 Tax household attested below the APTC limit and did not qualify for an override statement
417 Attested ESC status not reasonably compatible with trusted data sources.
419 ptcFPL greater than 250% and not an Indian
420 Neither internal nor external data compatible with attestation
422 Applicant did not give sufficient information; put in pend period
426 Attested monthly income above Medicaid standard, but attested annual below Medicaid standard in RPC state
427 Attested monthly above CHIP standard, but attested annual below CHIP standard in RPC state
429 Inconsistency set for further verification.
430 Granted for loss of ESC MEC
431 Failed to adjudicate another clock
432 Inconsistency resolved by Eligibility Worker adjudication
126
433 Expired
434 Under review
435 Pending documentation
436 not subject to sampling and accepting attestation
437 Contacting employer because subject to ESC sampling
438 Pending additional documentation
439 Evidence disproved attestation
440 Pursuing further verification
441 Did not agree with attestation to give Medicaid Agency right to pursue
442 Did not agree with absent parent attestation
443 Attested to being incarcerated.
444 Did not agree to report changes
445 Did not agree to non-perjury attestation
446 Tax Filer is believed to be double dipping
447 Adjudicated with documentation
448 ESD Override
449 Determined ineligible by state
450 Failed to adjudicate within time period
451 Not in a filing status for aptc eligibility
452 Determined eligible by state
453 DSH system is down
454 Applicant did not meet all of the requirements for QHP eligibility
455 Attested Member of Federally Recognized Tribe must be verified through paper
456 Data source not called due to failed ID Proofing
457 State did not respond to the FFM account transfer within the prescribed timeframe
458 User failed to act upon the state agency's account transfer within the prescribed timeframe
459 Applicable Medicaid and CHIP Standards = 0 or null, not eligible for Medicaid and CHIP
460 Applicant did not accept one of the Medicaid or CHIP attestations
462 Income is below 100% and applicant is not eligible for GAP filling, hardship exemption applies
463 Employer sponsor coverage has not yet been verified
464 Applicant did not provide enough information to verify naturalized citizenship status
465 Hub call returned transactional error
465 Income override applies but annual income has not been verified
127
466 Eligible for Emergency Medicaid, need to ask APTC questions
467 Changed income attestation to above Medicaid/CHIP level
468 ESC change expected user will need to return to process
469 Applicant is not pregnant of income not below the unborn child standard FPL
470 Applicant was recently denied Medicaid/CHIP; prevent return to State
471 Non-sep SEP: Plan is no longer available so the consumer needs to go back into Plan Compare to choose a new plan
472 Applicant granted SEP for attesting to being denied Medicaid
473 Five Year Bar met status is pending
474 Attested to not having met the Five Year Bar
475 Applicant has already been denied nonMAGI; block transfer for non-MAGI
476 Eligibility Worker expired inconsistency
477 Expired when eligibility worker expired another inconsistency resulting in ineligibility
478 Earliest effective date crosses into the next year, SEP Indicator changed to No
479 Expired Annual Income inconsistency and tax data was not available.
480 Temporary SEP granted due to attested difficulty enrolling during Annual Open Enrollment Period
481 Eligibility Worker expired Medicaid/CHIP inconsistency/pend
482 Expired when eligibility worker expired Medicaid/another inconsistency resulting in ineligibility
483 Medicaid/CHIP Inconsistency resolved by Eligibility Worker adjudication
484 Medicaid/CHIP Inconsistency resolved by MAGI2 following Eligibility Worker adjudication
485 MAGI2 determined applicant ineligible following Eligibiilty Worker adjudication
486 APTC ineligible because QHP ineligible.
487 CSR ineligible because QHP ineligible.
488 APTC ineligible because there is no external income available
489 CSR Ineligible because APTC ineligible because no external income available
490 APTC ineligible due to expiring ESC MEC/non-ESC MEC inconsistency
491 CSR ineligible because APTC ineligible due to expiring ESC MEC/non-ESC MEC inconsistency
492 There was a prior resolved inconsistency and income did not change
493 SSN has not changed and was previously inconsistent, do not recall EDS.
494 SSN validated, citizen status is inconsistent, not attestation change – do not recall EDS.
495 Annual Income inconsistency resolved for tax household member.
496 Annual Income inconsistency redetermined for tax household member.
497 Immigration status is inconsistent and attestation did not change, do not recall EDS.
498 Stripped APTC/income-based CSR because application opt-out of IRS verification.
499 Stripped APTC/income-based CSR because member of the Special Notice Group (OIV group 5).
128
500 Set by auto re-enrollment process to avoid duplicating account transfer.
501 Expedited income path no longer in use
502 Prior transfer event exists, new Transfer event with indicator ‘N’ inserted to avoid sending duplicate AT’s upon inconsistency
expiration.
503 No prior transfer event exists, new transfer event inserted to avoid sending duplicated, Full Determination AT upon
inconsistency expiration.
504 APTC and CSR eligibility changed from “Y” to “N” because FPL exceeded 400% during execution of APTC recalculation logic in
auto re-enrollment processing.
505 CSR eligibility changed from “Y” to “N” because FPL exceeded 250% during execution of APTC recalculation logic in auto re-
enrollment processing.
506 Attested annual income is not within the configurable threshold of the documented tax household annual income
556 Five year bar does not apply as determined by the five year bar rule.
507 APTC and income-based CSR ineligible because enrollee is Medicaid/CHIP eligible on future year application.
508 Secretary's Hardship Exemption turned off for applicant included in Under 100% FPL group and determined eligible for APTC
following resolution of a QHP immigration inconsistency.
509 Applicant ineligible for Medicaid based on immigration status determined by ESW's offline job-aid.
510 Applicant eligible for Medicaid based on immigration status as determined by ESW’s offline job-aid.
514 Annual income not within specified threshold percent of external income data sources and all available
DocumentedAnnualTaxIncome had either effective end date < current date or the TaxHouseholdSizeQuantity does not match
the current tax household size.
DocumentedAnnualTaxIncome had effective end date < current date.
DocumentedAnnualTaxIncome had TaxHouseholdSizeQuantity that does not match the current tax household size.
517 All available DocumentedAnnualTaxIncome had either effective end date < current date or the TaxHouseholdSizeQuantity does
not match the current tax household size.
518 All available DocumentedAnnualTaxIncome had effective end date < current date
519 All available DocumentedAnnualTaxIncome had TaxHouseholdSizeQuantity that does not match the current tax household
size.
520 Immigration income override indicator inserted for Under 100% FPL population following resolution of a QHP immigration
inconsistency
521 Not applicable because APTC was removed via BAR
522 OIV data used to determine max APTC
129
523 Applicant eligible for the immigration override on subsequent CIC for a consumer whose annual income is under 100 percent
FPL, whose Medicaid immigration status is determined to be inconsistent, and whose QHP immigration inconsistency was
resolved in ESD resulting in APTC/CSR eligibility.
524 Data source not available, non-ESC MEC status based on attestation.
525 Applicant ineligible due to Batch Auto- Stop APTC for PDM
526 Not applicable because APTC was stopped by batch
528 Applicant's non-ESC MEC status ineligible due to batch auto stop APTC for FTR.
530 Stripped APTC/income-based CSR because identified as repeat re-enrollee from BAR
531 Attested non-citizen
532 exceeds SSA call counter
533 Attested above Medicaid standard and applicable CHIP Standard = 0, not eligible for Medicaid and CHIP
534 edsDifferencePercent within the configurable percent of the Medicaid standard
535 Attested and IRS below the Medicaid standard
536 IrsDifferencePercent within the configurable percent of the Medicaid standard
537 Annual income verified using percent threshold limit if attested income below or equal to IRS data (or if IRS data is null and
EDS data is available for annual income verification
538 Annual income verified using amount threshold limit if attested income below or equal to IRS data (or if IRS data is null and
EDS data is available for annual income verification)
539 Annual income verified attested above EDS (and also above IRS if available)
541 Annual income verified using attested income above IRS data and no EDS data available for verification
542 Annual income verified using explanation for annual income discrepancy
543 EDS system is down
544 Annual income verified using percent threshold limit compared to documented income
545 Annual income verified using amount threshold limit compared to documented income
546 Hub call held due to SSN
547 Response Code Received with No Data for this Individual
548 SSA Reported No Monthly Title II Income
549 EDS Reported No Usable Income
550 IRS Responded with no value for MAGI/AGI
551 Application is not requesting Financial Assistance
552 Not eligible for APTC based on tax role
553 Attested and IRS below the CHIP standard
554 irsDifferencePercent within the configurable percent of the CHIP standard
557 Medicaid income verified using explanation for annual income discrepancy
130
558 CHIP income verified using explanation for annual income discrepancy
559 No citizenship attestation
560 Individual not requesting coverage
561 edsDifferencePercent within the configurable percent of the CHIP standard
562 Individual is not a Medicaid anchor
563 The applicant has ESC MEC; APTC is blocked.
564 Verified based on external data source
565 No tax households on the application
566 SEVIS ID required
567 Not verified, pending SAVE Step 2
568 Not verified, pending paper verification
569 Applicant is an attested citizen
570 Expiration date <= 90 days
571 Applicant attests to having non-ESC MEC, status set based on attestation
572 Hub not called, applicant attests to having Medicare, Tricare, Peace Corp, or VHA
573 SSA hub call held due to call counter >= 3
574 Applicant with a previously verified Indian status attests to being a member of a different tribe
575 Non applicant and not previously verified
576 Applicant is within the post partum period
577 Application member is under the age 18
578 State elects the full time student option and the application member is age 18 and a full time student
579 State did not retain the deprivation requirement
580 Information needed to determine if the child meets the deprivation requirement have not yet been collected (Legacy
Description: Further information needed)
581 Parent is unemployed or works less then the state defined minimum number of hours
582 Caretaker meets the required relationship to the child
583 Caretaker does not meet the any relative plus domestic partner definition to the child
584 At least one child qualifies the applicant for the Parent / Caretaker Relative category
585 At least one child temporarily qualifies the applicant for the Parent / Caretaker Relative category
586 State did not elect the Adult Group XX option
587 Applicant is under age 65
588 Applicant is not under age 65
589 Applicant is age 18 or younger or applicant is age 19 or older and under the young adult age threshold
590 State does not cover the optional targeted low income child group
131
591 Information needed to determine if the child is enrolled in other health insurance coverages have not yet been collected
592 Applicant does not have other insurance
593 State does not cover the targeted low income child group
594 Applicant has Other Limited Benefit Coverage and/or CHIP only
595 State does not elect the unborn child option
596 Information needed to determine eligibility for the Unborn Child category have not yet been collected
597 Spouse, former spouse or domestic partner qualifies the applicant for the Parent / Caretaker Relative category
598 Applicant meets the requirements for a non-MAGI referral
599 Applicant is not female
600 APTC eligibility does not apply; applicant eligible for Medicaid or CHIP
601 Applicant has no home address or is temporarily outside of the state and did not provide an mailing or transient address in
the state of the exchange.
602 Applicant has Limited Benefit or Medicaid and/or CHIP only or Marketplace Coverage
603 Indian status previously verified and attested tribe name has not changed
604 Applicant has no home address or is temporarily outside of the state and did not provide an mailing or transient address in the
state of the exchange.
605 Hub returned LPV and QNC = N
606 Hub call successful, no data found
607 Applicant is not an attested immigration or an attested citizen
608 Applicant is eligible under CHIPRA
609 QNC hub indicator is still pending
610 QNC hub indicator is N
611 Applicant is subject to the seven year limit rule
612 State does not elect CHIPRA for either Medicaid or CHIP
613 State does not elect CHIPRA for CHIP
615 Applicant is not Medicaid income eligible
616 Applicant is not CHIP income eligible
617 Applicant does not have a VOT status
618 VOT Status always requires documentation
619 Applicant older than 18, documentation required
620 Grant date not available to calculate years with status, documentation required
621 Does not meet the required years with status, documentation required
622 Status start date is not available to calculate 7 year limit
623 Seven year limit will be reached within 30 days
132
624 State does not elect the 7 year limit rule
625 Seven year limit does not apply to applicant's immigration status
626 Applicant is an attested veteran
627 Five year bar does not apply
628 Grant date not available from hub and no attested grant date
629 Five year bar not met based on attested grant date
630 Five year bar inconsistent based on attested grant date
632 State does not elect work quarters
633 Applicant is not a Lawful Permanent Resident
634 Applicant is not Medicaid income eligible or inconsistent
635 Applicant did not provide an SSN for work quarters
635 DHS data does not match attested Birthdate
636 Applicant does not have an SSA validated SSN for work quarters
636 DHS data does not match attested document number
637 Spouse or parent did not provide an SSN for work quarters
638 Spouse or parent does not have an SSA validated SSN for work quarters
639 Applicant has 40 or more work quarters
640 Applicant and spouse together have 40 or more work quarters
641 Applicant, spouse and parent(s) together have 40 or more work quarters
642 Applicant attests to not having help available for work quarters
643 Applicant attests to having 40 work quarters through self or eligible family members
644 Have applicant, spouse, and parents work quarters but less than 40
645 Have applicant, spouse and parents but missing work quarters
646 Spouse and/or parent(s) not on application for work quarters
647 Applicant did not attest to foster care
648 Eligible for Medicaid under foster care
649 Eligibility worker expired SVI
650 SSA Data indicates that the applicant is incarcerated
651 Hub not called, ESD resolved within last 2 years
652 Applicant is neither Prelim Medicaid or Prelim CHIP
653 Health benefits question not displayed
654 Applicant attest to not receiving State Health Benefits through a public employee
655 Applicant not Prelim Medicaid eligible
656 Attested to a CHIP Waiting Period exception
133
657 Applicant not Prelim CHIP eligible
658 Applicant is Medicaid eligible
659 Did not agree to all final legal attestations for Medicaid
660 Parent did not agree to the absent parent agreement attestations
661 Did not agree to all final legal attestations for CHIP
662 Applicant’s Claiming tax filer not provided on the application
663 Applicant is a Non-filer
664 Non application family information for non-filer applicant
665 Granted Accelerated SEP through CCR with a coverage start date of the first of the following month
667 Medicaid or CHIP eligible, inconsistent or pend transfer
668 Non-MAGI Referral, Emergency Medicaid, Unborn Child eligible or in a CHIP Waiting period
669 Ineligible for Medicaid, CHIP, Non-MAGI Referral, Emergency Medicaid, Unborn Child and not in a CHIP waiting Period
670 Applicant ineligible for APTC due to disagreeing to one of the Medicaid/CHIP legal attestations
671 Applicant not be able to enroll due to Limited Plan Availability
672 Does not apply during Open Enrollment
673 Does not apply when not QHP eligible
674 Account Transfer SEP verification not applicable based on circumstance change attestation
675 Account Transfer SEP verification not applicable because verified by inbound Account Transfer or inbound found and outbound
verification not applicable based on circumstance change attestation
676 Account Transfer data matching search criteria not found
677 Applicant is eligible for Medicaid or CHIP, Dual eligibility toggle is off
678 Ineligible due to Medicaid Residency status
679 SEP eligible, circumstance change attestation pending verification
680 SEP eligible, circumstance change attestation and prior coverage pending verification
681 Account transfer SEP verification not applicable when SEP already verified
682 FiveYearBarMet = P, need to request Grant Datae, and expiration date of immigration status is after 90 days
683 FiveYearBarMet = P, need to request Grant Date, and expiration date of temporary immigration status is within 90 days
684 Applicant requires step 3
685 Applicant pushed to step 2 but hub call failed
686 Attested annual income >= 100% FPL and exceeds configurable threshold of IRS/SSA income and IRS/SSA income < 100% FPL.
687 Verified by IRS data when attested income > IRS and either IRS >= 100% FPL OR both attested and IRS < 100% FPL and no
available DocumentedAnnualTaxIncome
134
688 Verified by IRS data when attested income > IRS and either IRS >= 100% FPL OR both attested and IRS < 100% FPL and all
available DocumentedAnnualTaxIncome had either effective end date < current date or the TaxHouseholdSizeQuantity does
not match the current tax household size.
available DocumentedAnnualTaxIncome had effective end date < current date.
available DocumentedAnnualTaxIncome had TaxHouseholdSizeQuantity that does not match the current tax household size.
691 Attested annual income >= 100% FPL and exceeds configurable threshold of IRS/SSA income when IRS/SSA income < 100% FPL
and no usable DocumentedAnnualTaxIncome for alternate annual income verification
692 Circuit Breaker open
693 Annual income not within specified percent or amount threshold of IRS or annualized external current or documented income.
694 Verified as attested above documented income.

695 Annual income verified using percent threshold limit when attested income >= 100% FPL, attested > IRS/SSA income, and
IRS/SSA income < 100% FPL.
696 Annual income verified using amount threshold limit when attested income >= 100% FPL, attested > IRS/SSA income, and
IRS/SSA income < 100% FPL.
697 AI verified when IRS < 100% and attested > 100 and EDS >= 100% and EDS < attested and within percent threshold
698 AI verified when IRS < 100% and attested > 100 and EDS >= 100% and EDS < attested and within amount threshold
699 AI verified when IRS < 100% and attested > 100 and EDS >= 100% and EDS < attested income
700 AI verified when IRS < 100% and attested >= 100 and a usable documented income > 100% and < attested income and within
percent threshold
701 AI verified when IRS < 100% and attested >= 100 and a usable documented income > 100% and < attested and within amount
threshold
702 AI verified when IRS < 100% and attested >= 100 and a usable documented income > 100% and >= attested income
703 AI not within under 100 percent or amount threshold of IRS or usable documented income, EDS data does not exist
704 AI not within under 100 percent or amount threshold of IRS and Documented Income and EDS data do not exist
705 AI not within under 100 percent or amount threshold of IRS and all DocumentedAnnualTaxIncome had either effective end
date < current date or the TaxHouseholdSizeQuantity does not match the current tax household size and EDS data does not
exist
706 AI not within under 100 percent or amount threshold of IRS and all DocumentedAnnualTaxIncome had effective end date <
current date and EDS data does not exist
135
707 AI not within under 100 percent or amount threshold of IRS and all DocumentedAnnualTaxIncome had
TaxHouseholdSizeQuantity that does not match the current tax household size and EDS data does not exist
708 AI not within under 100 percent or amount threshold of IRS and EDS and usable documented income did not verify
709 AI not within under 100 percent or amount threshold of IRS and EDS did not verify and no documented income exists
710 AI not within under 100 percent or amount threshold of IRS and EDS did not verify and all DocumentedAnnualTaxIncome had
either effective end date < current date or the TaxHouseholdSizeQuantity does not match the current tax household size.
effective end date < current date.
TaxHouseholdSizeQuantity that does not match the current tax household size.
End of
worksheet
136
ReasonCode Notes
999
555
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
137
ReasonCode Notes
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
462
463
464
465 Code 465 is used for different reasons in lawful presense verification and APTC eligibility.
465 Code 465 is used for different reasons in lawful presense verification and APTC eligibility.
138
ReasonCode Notes
624
625
626
627
628
629
630
632
633
634
635 Code 635 is used for different reasons in Title 2 work quarter and lawful presense verification.
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
656
139

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High Level Category Detailed Category Explanation

When same sub-eligibility appears under

2. Legacy does not send DHSComments.

3. SES maps "DHS" to

2. The payload has

If a sub-eligibility applies to multiple sections and correctly appears in

2. Legacy will send legacy reason

3. Legacy will only send emergency

4. Legacy will send legacy reason

2. Legacy will send legacy reason

2. Legacy will send legacy reason

278 Mapping Change 1. Mapping All 1. Legacy will only send

3. DHS SAVE V37 impacts 2. Legacy maps the FFE

3. Legacy maps "DHS" to

4. Legacy does not map

329 Mapping Change 1. Mapping All 1. Legacy will only send

233 Mapping Change Not Sending Legacy sends in FFE policy

2. Legacy will send legacy reason

524 Mapping Change Not Sending Legacy mapped

2. Legacy will send legacy reason

68 Mapping Change 1. Mapping All 1. Legacy will only send

2. Legacy will send legacy reason

9 1. SES will send adultGroupXXCategoryStatus regardless of MedicaidMAGIAdultGroupXXCategory

2. SES Will send SES reason codes for adultGroupXXCategoryStatus MedicaidMAGIAdultGroupXXCategory

20 SES will send APTC status regardless of eligibility APTCEligibility/hix-

21 SES Will Send SES APTC reason codes APTCEligibility/hix-

97 SES will only send ExpenseCategoryText when income Source is ExpenseCategoryText

278 1. SES will send parentCaretakerStatus regardless of eligibility. MedicaidMAGIParentCaretakerCatego

3. SES maps "DHS" to VerificationAuthorityName to avoid errors Note: we do not map

329 1. SES will send sevenYearLimitStatus regardless of eligibility. MedicaidMAGIEligibility/hix-

233 SES will no longer Send in FFE Policy Information InsurancePolicyAppliedEffectiveDateR

Note: This is an error in the payload as

385 SES is mapping (1) MedicaidHousehold/hix-

524 SES will no longer send InsuranceApplicantLivesWithMinorAg

68 1. SES will send chipWaitingPeriodStatus regardless of eligibility. CHIPWaitingPeriodEligibilityBasis/hix-

2. SES will send SES reason codes for chipWaitingPeriodStatus CHIPWaitingPeriodEligibilityBasis/hix-

124 SES will map EmployerAddress as employerAddress. StructuredAddress

730 1. SES only sets LawfulPresenceStatusEligibility/EligibilityIndicator EligibilityIndicator

2. SES will only have one

106 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-

113 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-

156 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-

1/7/2019: update path per what's in schemtrun:

278 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-

329 (1) exch:AccountTransferRequest/hix-ee:InsuranceApplication/hix-

149 (1) hix-core:Person s:id

385 (1) exch:AccountTransferRequest/hix-ee:MedicaidHousehold/hix-

Note: only map if Medicaid eligible

Reason code Reference:

Note: only map if Medicaid eligible

Reason Code Reference:

20 if APTC_RESULT.status = Y, map to true;

Else do not map

Ineligible for CHIP, (Communicates Unborn, Work_Quarters, Full Determination etc.)

Note: there is no EligibilityInconsistencyReasonText for CHIP.

Else, do not map

Reason Code Reference

Else do not map

else do not map

Else do not map

else do not map

Else, straight map to (2)

Inconsistent No External Data

Else do not map