1 Optional Eligibility Groups

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

Medicaid and CHIP Program (MACPro)
S3 - Optional Eligibility Groups RU PRA
Document
Version 1.0
08/16/2017

Document Number: 178-QSSI-MACPro-R5.1-S3-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

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Table of Contents

Table of Contents
1. S3 - Optional Eligibility Groups Screenshots ........................................................ 1
1.1
1.2
1.3
1.4
1.5
1.6

Package Header ............................................................................................. 1
A. Options for Coverage – Part 1 .................................................................... 1
A. Options for Coverage – Part 2 .................................................................... 2
A. Options for Coverage – Part 3 .................................................................... 2
B. Medically Needy Options for Coverage –Part 1 .......................................... 3
B. Medically Needy Options for Coverage-Part 2, C. Additional Information
(optional) and Eligibility Groups Deselected from Coverage ........................... 4

List of Figures
Figure 1: Package Header .............................................................................................. 1
Figure 2: Section A-Part 1 ............................................................................................... 1
Figure 3: Section A-Part 2 ............................................................................................... 2
Figure 4: Section A-Part 3 ............................................................................................... 2
Figure 5: Section B-Part 1 ............................................................................................... 3

List of Tables
No table of figures entries found.

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Package Header

1. S3 - Optional Eligibility Groups Screenshots
1.1

Package Header

Figure 1: Package Header

1.2

A. Options for Coverage – Part 1

Figure 2: Section A-Part 1

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1.3

A. Options for Coverage – Part 2

A. Options for Coverage – Part 2

Figure 3: Section A-Part 2

1.4

A. Options for Coverage – Part 3

Figure 4: Section A-Part 3

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1.5

B. Medically Needy Options for Coverage –Part 1

B. Medically Needy Options for Coverage –Part 1

Figure 5: Section B-Part 1

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Coverage”

B. Medically Needy Options for Coverage-Part 2, C. Additional Information (optional) and “Eligibility Groups Deselected from

1.6

B. Medically Needy Options for Coverage-Part 2, C. Additional
Information (optional) and “Eligibility Groups Deselected from
Coverage”

Figure 6: Section B-Part 2, Section C and Section “Eligibility Groups Deselected from
Coverage”

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