1 Parents and Other Caretaker Relatives

Centers for Medicare & Medicaid Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
S25-Parents and Other Caretaker Relatives PRA
document
Version 1.0
08/18/2017

Document Number: 212-QSSI-MACPro-PRA-S25-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

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Table of Contents

Table of Contents
1. S25-Parents and Other Caretaker Relatives – Screenshots ................................. 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Section A. “Characteristics” ............................................................................. 1
Section A. “Characteristics” Option C.ii – Path 1 ............................................. 2
Section A. “Characteristics” Option C.ii – Path 2 ............................................. 2
Section A. “Characteristics” Option C.ii – Path 3 ............................................. 2
Section C. “Income Standard Used” – Path 1 ................................................. 2
Section C. “Income Standard Used” – Path 2 ................................................. 3
Section D. “Basis for Income Standard” – Path 1 ............................................ 3
Section D. “Basis for Income Standard” – Path 2 ............................................ 4
Section E. “Additional Information” .................................................................. 4

List of Figures
Figure 1: Characteristics – 1 ........................................................................................... 1
Figure 2: Characteristics – 2 ........................................................................................... 1
Figure 3: Characteristics Option C.ii – 1 .......................................................................... 2
Figure 4: Characteristics Option C.ii – 2 .......................................................................... 2
Figure 5: Characteristics Option C.ii – 3 .......................................................................... 2
Figure 6: Income Standard Used – 1............................................................................... 2
Figure 7: Income Standard Used – 2............................................................................... 3
Figure 8: Basis for Income Standard – 1 ......................................................................... 3
Figure 9: Basis for Income Standard – 2 ......................................................................... 4
Figure 10: Additional Information .................................................................................... 4

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S25-Parents and Other Caretaker Relatives – Screenshots

1. S25-Parents and Other Caretaker Relatives –
Screenshots
1.1

Section A. “Characteristics”

Figure 1: Characteristics – 1

Figure 2: Characteristics – 2

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1.2

S25-Parents and Other Caretaker Relatives – Screenshots

Section A. “Characteristics” Option C.ii – Path 1

Figure 3: Characteristics Option C.ii – 1

1.3

Section A. “Characteristics” Option C.ii – Path 2

Figure 4: Characteristics Option C.ii – 2

1.4

Section A. “Characteristics” Option C.ii – Path 3

Figure 5: Characteristics Option C.ii – 3

1.5

Section C. “Income Standard Used” – Path 1

Figure 6: Income Standard Used – 1

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1.6

S25-Parents and Other Caretaker Relatives – Screenshots

Section C. “Income Standard Used” – Path 2

Figure 7: Income Standard Used – 2

1.7

Section D. “Basis for Income Standard” – Path 1

Figure 8: Basis for Income Standard – 1

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1.8

S25-Parents and Other Caretaker Relatives – Screenshots

Section D. “Basis for Income Standard” – Path 2

Figure 9: Basis for Income Standard – 2

1.9

Section E. “Additional Information”

Figure 10: Additional Information

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