1 Optional Targeted Low Income Children

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

Medicaid and CHIP Program (MACPro)
S54 - Optional Targeted Low Income Children RU
Document
Version 1.0
08/15/2017

Document Number: 175-QSSI-MACPro-R5.1-S54-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S54 - Optional Targeted Low Income Children Screenshots ............................... 1
1.1
1.2
1.3
1.4
1.5
1.6

Package Header ............................................................................................. 1
A. Characteristics, B. Financial Methodologies and C. Individuals CoveredPath 1 .............................................................................................................. 2
C. Individuals Covered-Path 2......................................................................... 2
D. Income Standard Used ............................................................................... 3
E. Basis for Income Standard.......................................................................... 3
F. Additional Information (optional) ................................................................. 4

List of Figures
Figure 1: Package Header .............................................................................................. 1
Figure 2: Section A, Section B and Section C-Path1 ...................................................... 2
Figure 3: Section C-Path2 ............................................................................................... 2
Figure 4: Section D.......................................................................................................... 3
Figure 5: Section E .......................................................................................................... 3

List of Tables
No table of figures entries found.

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Package Header

1. S54 - Optional Targeted Low Income Children
Screenshots
1.1

Package Header

Figure 1: Package Header

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1.2

A. Characteristics, B. Financial Methodologies and C. Individuals Covered-Path 1

A. Characteristics, B. Financial Methodologies and C. Individuals
Covered-Path 1

Figure 2: Section A, Section B and Section C-Path1

1.3

C. Individuals Covered-Path 2

Figure 3: Section C-Path2

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1.4

D. Income Standard Used

D. Income Standard Used

Figure 4: Section D

1.5

E. Basis for Income Standard

Figure 5: Section E

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1.6

F. Additional Information (optional)

F. Additional Information (optional)

Figure 6: Section F

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