CMS-R-308 Statistical Enrollment Reports Screenshots (Forms: CMS-2

State Children's Health Insurance Program and Supporting Regulations (CMS-R-308)

Complete SEDS Report_Example

State Children's Health Insurance Program and Supporting Regulations in 42 CFR 457.525, 457.740, and 457.1180

OMB: 0938-0841

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Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida

Program Code: FL

Age Range: Under 0
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
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0
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Created On: Tuesday, July 17, 2018 12:35 PM

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Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida

Program Code: FL

Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
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0
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0
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0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida

Program Code: FL

Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
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0
0
0
0

0
0
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0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
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0
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0
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0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida

Program Code: FL

Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
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0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
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0
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0
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0
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0
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0
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0
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0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida

Program Code: FL

Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
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0
0
0
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0
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0
0
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0
0
0
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0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida

Type of Eligible: U2

Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
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0
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0
0
0
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0
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0
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0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
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0
0

0
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0
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0
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0
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0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida

Type of Eligible: U2

Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida

Type of Eligible: U2

Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida

Type of Eligible: U2

Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E

Transaction File

Quarter:4/2018

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 0 - 1
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 1 - 5
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 6 - 12
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 13 - 18
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida

Transaction File

Quarter:4/2018

Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida

Transaction File

Quarter:4/2018

Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida

Transaction File

Quarter:4/2018

Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida

Transaction File

Quarter:4/2018

Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida

Transaction File

Quarter:4/2018

Age Range: 19 - 20
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 0 - 1
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 1 - 5
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 6 - 12
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 13 - 18
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 20
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 20
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI

Transaction File

Quarter:4/2018

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services

Transaction file
CHIP Statistical Enrollment Data System

State: Florida
Gender, Race, Ethnicity
1 - Female
2 - Male
3 - Unspecified Gender
1 - White
2 - Black or African American
3 - American Indian or Alaska Native
4 - Asian Indian
5 - Chinese
6 - Filipino
7 - Japanese
8 - Korean
9 - Vietnamese
10 - Other Asian
11 - Asian Unknown
12 - Native Hawaiian
13 - Guamanian or Chamorro
14 - Samoan
15 - Other Pacific Islander
16 - Native Hawaiian or Other Pacific Islander Unknown
17 - Some other race
18 - Two or more races (regardless of ethnicity)
19 - Unspecified Race
1 - Not of Hispanic, Latino/a, or Spanish origin
2 - Mexican, Mexican American, Chicano/a
3 - Puerto Rican
4 - Cuban
5 - Another Hispanic, Latino, or Spanish Origin
6 - Hispanic or Latino Unknown
7 - Unspecified Ethnicity
Form: Gndr./Race/Ethn.

21E Enrolled

64.21E Enrolled
Gender
0
0
0
Race
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Ethnicity
0
0
0
0
0
0
0

Total CHIP Enrolled

Quarter: 4/2018
21PW Enrolled

64.EC Enrolled

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0

0
0
0
0
0
0
0

Created On: Tuesday, July 17, 2018 12:35 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served
State: Colorado

Program Code: CO

Quarter:4/2018

Age Range: 19 - 64
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)

0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21PW

Transaction File

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served (Informational)
State: Colorado
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 64
Program Code: CO
Percentage of FPL
0-133
134-200
201-250
251-300
(A)
(B)
(C)
(D)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 21PWI

Transaction File

Quarter:4/2018

301
(E)

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served (Informational)
State: Colorado
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 64
Program Code: CO
Percentage of FPL
0-133
134-200
201-250
251-300
(A)
(B)
(C)
(D)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 21PWI

Transaction File

Quarter:4/2018

301
(E)

Total
(F)
0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration
State: Colorado

Transaction File

Quarter:4/2018

Age Range: 19 - 64
Pregnant women

0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21Waiver

Percentage of FPL
201-250
251-300
(C)
(D)

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration (Informational)
State: Colorado
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 64

Transaction File

Quarter:4/2018

Sub-Category: Pregnant
women

0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21WaiverI

Percentage of FPL
201-250
251-300
(C)
(D)

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration (Informational)
State: Colorado
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 64

Transaction File

Quarter:4/2018

Sub-Category: Pregnant
women

0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21WaiverI

Percentage of FPL
201-250
251-300
(C)
(D)

301
(E)

Total
(F)

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0.0
0.0
0.0
0.0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
CHIP Statistical Enrollment Data System
State: Colorado
Waiver Gender, Race, Ethnicity

Transaction file

Quarter: 4/2018
Adults Enrolled
Gender

1 - Female
2 - Male
3 - Unspecified Gender
Race
1 - White
2 - Black or African American
3 - American Indian or Alaska Native
4 - Asian Indian
5 - Chinese
6 - Filipino
7 - Japanese
8 - Korean
9 - Vietnamese
10 - Other Asian
11 - Asian Unknown
12 - Native Hawaiian
13 - Guamanian or Chamorro
14 - Samoan
15 - Other Pacific Islander
16 - Native Hawaiian or Other Pacific Islander Unknown
17 - Some other race
18 - Two or more races (regardless of ethnicity)
19 - Unspecified Race
Ethnicity
1 - Not of Hispanic, Latino/a, or Spanish origin
2 - Mexican, Mexican American, Chicano/a
3 - Puerto Rican
4 - Cuban
5 - Another Hispanic, Latino, or Spanish Origin
6 - Hispanic or Latino Unknown
7 - Unspecified Ethnicity

Form: Waiver Gndr./Race/Ethn.

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Created On: Tuesday, July 17, 2018 12:44 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: Under 0
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI

Created On: Wednesday, July 18, 2018 2:26 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI

Created On: Wednesday, July 18, 2018 2:26 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI

Created On: Wednesday, July 18, 2018 2:26 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI

Created On: Wednesday, July 18, 2018 2:26 PM

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI

Created On: Wednesday, July 18, 2018 2:26 PM


File Typeapplication/pdf
File Modified2018-07-19
File Created2018-07-18

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