1 Reasonable Classification of Individuals under Age 21

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

Medicaid and CHIP Program (MACPro)
S52 – Reasonable Classification of Individuals
under Age 21 RU PRA Document
Version 1.0
08/21/2017

Document Number: 237-QSSI-MACPro-R5.1-S52-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S52 - Reasonable Classification of Individuals under Age 21 Screenshots ....... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15

Package Header ............................................................................................. 1
A. Characteristics, B. Financial Methodologies, .............................................. 1
C. Individuals Covered – Path 1 – Screenshot 1 ............................................. 2
C. Individuals Covered – Path 1 – Screenshot 2 ............................................. 2
C. Individuals Covered – Path 2 ...................................................................... 3
C. Individuals Covered – Path 3 ...................................................................... 3
C. Individuals Covered – Path 4 ...................................................................... 4
C. Individuals Covered – Path 5 ...................................................................... 4
C. Individuals Covered – Path 6 ...................................................................... 4
D. Income Standard Used – Path 1................................................................. 5
D. Income Standard Used – Path 2................................................................. 5
D. Income Standard Used – Path 3................................................................. 6
D. Income Standard Used – Path 4................................................................. 6
E. Basis for Income Standard.......................................................................... 7
F. Additional Information (optional) ................................................................. 7

List of Figures
Figure 1: Package Header .............................................................................................. 1
Figure 2: Section A and Section B .................................................................................. 1
Figure 3: Section C- Path 1– Screenshot 1 ..................................................................... 2
Figure 4 : Section C – Path 1 – Screenshot 2 ................................................................. 2
Figure 5: Section C –Path 2 ............................................................................................ 3
Figure 6: Section C – Path 3 ........................................................................................... 3
Figure 7: Section C – Path 4 ........................................................................................... 4
Figure 8: Section C – Path 5 ........................................................................................... 4
Figure 9: Section C – Path 6 ........................................................................................... 4
Figure 10: Section D – Path 1 ......................................................................................... 5
Figure 11: Section D – Path 2 ......................................................................................... 5
Figure 12 : Section D – Path 3 ........................................................................................ 6
Figure 13: Section D – Path 4 ......................................................................................... 6

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
i

08/21/2017

CMS XLC

List of Tables

Figure 14: Section E ........................................................................................................ 7
Figure 15: Section F ........................................................................................................ 7

List of Tables
No table of figures entries found.

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
ii

08/21/2017

CMS XLC

Package Header

1. S52 - Reasonable Classification of Individuals under
Age 21 Screenshots
1.1

Package Header

Figure 1: Package Header

1.2

A. Characteristics, B. Financial Methodologies,

Figure 2: Section A and Section B

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
1

08/21/2017

CMS XLC

1.3

C. Individuals Covered – Path 1 – Screenshot 1

C. Individuals Covered – Path 1 – Screenshot 1

Figure 3: Section C- Path 1– Screenshot 1

1.4

C. Individuals Covered – Path 1 – Screenshot 2

Figure 4 : Section C – Path 1 – Screenshot 2

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
2

08/21/2017

CMS XLC

1.5

C. Individuals Covered – Path 2

C. Individuals Covered – Path 2

Figure 5: Section C –Path 2

1.6

C. Individuals Covered – Path 3

Figure 6: Section C – Path 3

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
3

08/21/2017

CMS XLC

1.7

C. Individuals Covered – Path 4

C. Individuals Covered – Path 4

Figure 7: Section C – Path 4

1.8

C. Individuals Covered – Path 5

Figure 8: Section C – Path 5

1.9

C. Individuals Covered – Path 6

Figure 9: Section C – Path 6

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
4

08/21/2017

CMS XLC

D. Income Standard Used – Path 1

1.10 D. Income Standard Used – Path 1

Figure 10: Section D – Path 1

1.11 D. Income Standard Used – Path 2

Figure 11: Section D – Path 2

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
5

08/21/2017

CMS XLC

D. Income Standard Used – Path 3

1.12 D. Income Standard Used – Path 3

Figure 12 : Section D – Path 3

1.13 D. Income Standard Used – Path 4

Figure 13: Section D – Path 4

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
6

08/21/2017

CMS XLC

1.14

E. Basis for Income Standard

E. Basis for Income Standard

Figure 14: Section E

1.15 F. Additional Information (optional)

Figure 15: Section F

S52 – Reasonable Classification of Individuals under Age 21 RU PRA Document
Version 1.0
7

08/21/2017