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Eligibility Results Toolkit - Phase 2
Purpose of This Toolkit
This document is designed to help Enhanced Direct Enrollment (EDE) Auditors ensure that the application returns accurate eligibility results for specific consumer scenarios. Each test case is
phase-specific, and describes a consumer scenario that must be supported by an EDE application. Auditors should complete each test case by using the information provided to complete an
application through the EDE Entity's user interface (UI). Some information collected by the UI (e.g., phone numbers, contact method preferences, language preferences) is not specified in
the test data. In these cases, Auditors may enter any value or skip optional inputs unless otherwise noted in the test case. The application must display all appropriate application questions
to the Auditor and provide the opportunity to enter the test case information into the application. After all of the information from the test case is entered into the application and the
application is submitted, the Auditor must verify that the eligibility results returned match the expected eligibility results provided in the test case, which is reflected in the Marketplace
Eligibility Determination Notice (EDN) and should be correctly conveyed in the entity's Eligibility Results Page (ERP).
Documentation Requirements
Phase 2 Entities must submit complete eligibility application UI screenshots only for the Phase 2 Eligibility Results Toolkit (ERT). Phase 2 entities must submit EDNs and unparsed JSONs for
all test cases it completes in the Phase 1 and 2 ERTs. In test cases for which an EDN is not generated, but is expected, Auditors must repeat the test case. If the test case ends after the
screening questions (i.e., if the consumer is not eligible to use a Phase 1 or Phase 2 EDE pathway, the consumer must be guided to an alternate pathway), the Auditor will not provide a
screenshot of the EDN, but must still provide screenshots showing the application questions asked from the start of the application through the end of the test case (i.e., the redirect to the
alternate pathway). Please review row 15 of this tab for more information about naming files.
Required Completion Rate
Auditors must conduct all possible test cases. However, depending on the Entity's intended service areas, Auditors may not be able to conduct a test case because the Entity does not intend
to operate in the specific state(s) provided in the test case. Auditors must conduct a minimum number of test cases from each toolkit it completes. Auditors conducting Phase 1 audits must
submit at least 11 of 14 Phase 1 test cases. Auditors conducting Phase 2 audits must submit at least 8 of 14 Phase 1 test cases AND 6 of 9 Phase 2 test cases. Auditors conducting Phase 3
audits must submit at least 8 of 14 phase 1 test cases AND 5 of 9 Phase 2 test cases AND 7 of 9 Phase 3 test cases. If an Auditor is not able to conduct the minimum number of test cases for
each toolkit because of the Entity's planned service areas, it must email DE Support to request instructions to modify test cases so that the Auditor is able to conduct and submit the
minimum number of test cases.
Note:
Each phase-specific set of eligibility results test scenarios are contained within separate toolkits (e.g., there is a Eligibility Results Toolkit specific to Phase 1).
Note on Version
It is important to note that this document is subject to change.
Navigating Updates to the Toolkit
Different font colors are used to indicate when the content of a cell was last updated. Use the key below to navigate updates to the content of these tabs.
Black font: Original value
Tab
Phase 1 (different toolkit)
Tabs for Auditor Review
Description
How to Review
This tab displays an overview of the test scenarios for The Auditor will use this tab to track compliance with each eligibility result test
scenario defined in the subsequent tabs. The Auditor must carefully examine the
the Phase 1 eligibility application.
"Eligibility Results" section of each "Test Case" input tab prior to confirming the
EDE Entity's compliance with each test case.
Note: Auditors for Phase 1 EDE applications must complete all Phase 1 test case
scenarios, if possible. If an entity does not intend to operate in the specific
state(s) provided in the test case, Auditors must submit at least 11 of 14 Phase 1
test cases.
Phase 2
This tab displays an overview of the test scenarios for The Auditor will use this tab to track compliance with each eligibility result test
scenario defined in the subsequent tabs. The Auditor must carefully examine the
the Phase 2 eligibility application.
"Eligibility Results" section of each "Test Case" input tab prior to confirming the
EDE Entity's compliance with each test case.
Note: Auditors for Phase 2 EDE applications must complete all Phase 2 test case
scenarios, as well as the following test cases from Phase 1: 1.A, 1.B, 1.C, 1.D, 1.E,
1.F, 1.K, 1.L, 1.M, 1.N, 1.O (not 1.D.2, 1.H, 1.J which are Phase 1 only test cases),
if possible. If an entity does not intend to operate in the specific state(s)
provided in the test case, Auditors must submit at least 8 of 14 Phase 1 test
cases AND 6 of 9 Phase 2 test cases. Note that because Phase 2 supports more
consumer scenarios than Phase 1, some information that is gathered via
screening question for a Phase 1 application is asked as an application question
for a Phase 2 application. For instance, pregnancy status is included in Phase 1
screening questions, but will be included as an application question in Phase 2
applications.
PRA DISCLOSURE: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0938-NEW, expiration date is XX/XX/20XX. The time required to complete this information
collection is estimated to take up to 144,652 hours annually for all direct enrollment entities. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500
Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents
containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not
pertaining to the information collection burden approved under the associated OMB control number listed on this form
will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your
documents, please contact Brittany Cain at [email protected].
Tab
Phase 3 (different toolkit)
Description
How to Review
This tab displays an overview of the test scenarios for The Auditor will use this tab to track compliance with each eligibility result test
scenario defined in the subsequent tabs. The Auditor must carefully examine the
the Phase 3 eligibility application.
"Eligibility Results" section of each "Test Case" input tab prior to confirming the
EDE Entity's compliance with each test case.
Note: Auditors for Phase 3 EDE applications must complete all Phase 3 test case
scenarios, as well as the following test cases from Phase 1 and Phase 2: 1.A, 1.B,
1.C, 1.D, 1.E, 1.F, 1.K, 1.L, 1.M, 1.N, 1.O (not 1.D.2, 1.H, 1.J which are Phase 1 only
test cases) and 2.A, 2.B, 2.B.2, 2.D, 2.E, 2.E.2, 2.F and 2.G (not 2.H which is a
Phase 2 only test case), if possible. If an entity does not intend to operate in the
specific state(s) provided in the test case, Auditors must submit at least 8 of 14
Phase 1 test cases AND 5 of 9 Phase 2 test cases AND 7 of 9 Phase 3 test cases.
Note that because Phase 3 supports all consumer scenarios, Phase 3 does not
have screening questions. Therefore, information that is gathered via screening
question for a Phase 1 or Phase 2 application is asked as an application question
for a Phase 3 application. For instance, American Indian or Alaska Native status is
included in Phase 1 and 2 screening questions, but will be included as an
application question in Phase 3 applications.
Test Case Input Tabs (e.g., Test Case 2.A input, Test
Case 2.B input)
Each test case input tab details the eligibility
application answers to test the eligibility
determination through the EDE pathway.
Auditors should use each tab to complete an eligibility application with the
answers detailed in the tab. Upon receiving an eligibility determination through
the EDE Pathway, the Auditor should confirm that the eligibility results from the
EDE Pathway are identical to the "Eligibility Result" included at the end of each
test case. The Auditor must take screenshots of the eligibility application process
while progressing through the test case, including a screenshot of the ERP, and
also store the EDN and provide the EDN to CMS (if applicable). The Auditor must
also submit the Get App API response (JSON) from each test case. The Auditor
should name the screenshot files sequentially and clearly identify them as
belonging to a specific test case (e.g., TestCase2A-1, TestCase2A-2). Similarly,
the Auditor should name the JSON files to clearly identify them as belonging to a
specific test case (e.g., TestCase2A-JSON). CMS strongly recommends that
Auditors sequentially aggregate the screenshots in a single document for each
test case (e.g., a Microsoft Word, PowerPoint, or PDF document with each
image labelled “TestCase2-A”) instead of submitting each screenshot as an
individually saved image (e.g., TestCase2A-1.jpg, TestCase2A-2.jpg). This may
help expedite CMS’s audit review.
Audit Requirements by Tab
Tab: Phase 2
In this tab, the Auditor must scroll to the right to complete the last six columns whose column headings are shaded in yellow or marked with "**."
Columns
Test Case ID
Description
Test Case ID that corresponds to each input tab.
State
List of state(s) for testing that corresponds to each
input tab.
Summary/Criteria
Expected Results/What's Tested
Summary of test data for each test case.
Summary of tested functionalities and expected
results for each test case.
Test Scenario Description
Auditor Compliance Conclusion**
How to Review
The Auditor must match the Test Case ID in the "Phase 2" tab to the
corresponding Test Case ID input tab, and use information from both tabs to
complete the audit.
The Auditor must use an approved state (i.e., the state or one of the states
provided for each test case) to complete each test case.
The Auditor may use this summary information to inform the audit.
As stated above, the Auditor must carefully examine the "Eligibility Results"
section of each "Test Case" input tab prior to confirming the EDE Entity's
compliance with each test case.
Summary description of the test case.
The Auditor may use this summary information to inform the audit.
The Auditor must provide a conclusion as to whether The Auditor will use the test case eligibility details from the Test Case input tabs
the scenario or requirement defined in each row is to complete the EDE Entity's eligibility application. Upon completing the
compliant with the CMS requirements. A
eligibility application, the Auditor will verify that the eligibility results on the EDE
compliance conclusion should be indicated as "Yes" Entity's website match the eligibility results defined at the end of each Test Case
or "No."
input tab. The Auditor will document each screen within the eligibility
application with screenshots and store the EDN and provide the EDN to CMS,
unless the test case ends after the screener questions, which is clearly marked in
each input tab. For each test case, the Auditor must provide the raw JSON from
the Get App API response for the application version used to complete the
scenario.
There are several required fields in each cell within this column:
- The first required field in each cell is, "Eligibility results compliance conclusion:
_____." If the test case is compliant, and matches the eligibility results expected
for the test case, the Auditor must indicate "Yes" in this column. If the row is not
compliant, the Auditor must indicate the noncompliance with a "No" in this
column.
-The subsequent required fields in each cell refer to the "Auditor Checklist"
column and include the item number from the Application UI Toolkit, and the
row number from the test case. For example, the first item in row 31 of the 2.A
Check List is "Check Item 42: Verify that the alien number is optional." After the
Auditor verifies this checklist item, the Auditor must document its compliance
determination in the corresponding field in the "Auditor Compliance Conclusion"
column in the "Phase 2" tab, "Auditor checklist Item 42/row 31 compliance
conclusion:_____"
Columns
Description
How to Review
Risks Identified**
The Auditor must detail any compliance risks
identified during the audit in this column for each
applicable row. Use this column if the Compliance
Conclusion was “No” or if the entity resolved a risk
prior to audit submission. There are two types of
risks: resolved and unresolved. Please document
them both here. Do not document a risk if the
requirement is compliant and there was no
mitigation required
Auditors must assign a risk level to each risk it
identifies.
As the Auditor reviews each test case in its entirety, the Auditor must indicate
any compliance risks identified in this column. This includes any compliance risks
that the EDE Entity has since resolved and come into compliance. One example
finding is the Auditor could not input all of the test data because UI questions
were missing. Another example is if the eligibility result was correct, but the
Auditor found that the Entity's UI did not seem to follow the test data inputs or
display correct questions.
Risk Level**
CMS will take the risk level assigned by the Auditor
into consideration when reviewing the audit, but
may adjust it if necessary.
The Auditor must assign a risk level of "high" or "low" to each risk. High-risk
issues may impact a consumer’s eligibility determination, enrollment disposition
or status, or legal attestation. High-risk issues may also greatly hinder the
consumer experience or impact data collection (e.g., skipping a question that is
required for a EDE Entity to ask, but optional for the consumer to answer).
Low-risk issues are unlikely to affect a consumer’s eligibility determination,
enrollment disposition or status, legal attestation, experience (i.e., in a negative
or confusing way), or data collection. Note: These risk determinations are
applicable for the business audit only and not the privacy and security audit.
Risk Mitigation Strategy**
Auditors must explain how a risk(s) was mitigated.
For example, if the entity had non-compliant
question text, the Auditor must identify that as a risk
and list the specific language used as well as how the
issue was resolved. This field is required for high-risk
findings. The Auditor can work with the EDE Entity to
decide on whether or not to include this for low-risk
findings.
As the Auditor identifies compliance risks, the Auditor and EDE Entity will
identify a mitigation strategy that will mitigate or eliminate the compliance risk.
The Auditor must document that mitigation strategy here. This includes
documenting the mitigation strategy for any identified risk that the EDE Entity
has resolved. One example is, if the initial test did not produce the expected
eligibility results (which would be an identified risk), the EDE Entity made a
system or UI change to correct the issue to produce the correct eligibility result.
Estimated Resolution Date**
Auditors must provide a timeframe for risk
resolution (required for unresolved high-risk
findings).
CMS recommends Auditors work with the EDE Entity to provide a realistic
timeframe of when a risk will be closed or mitigated given other dependencies
and their expertise.
Auditor Comments**
Auditors must use the Auditor comments column for
any additional notes or comments pertaining to each
item. The Auditor must use this column to include
the applicable screenshot file or folder names that
show proof of compliance (or non-compliance) for
this requirement.
For instructions on how to properly document supplemental documentation see
the Enhanced Direct Enrollment (EDE) Business Audit Instructions and Report
Template.
The Auditor can also use this column to provide any additional notes or
comments pertaining to each item. Business requirements audits should not
include comments that describe the Auditor’s process for verifying the
requirement unless there is a specific issue or concern regarding the
requirement that warrants raising a concern.
Tab: Test Case Input
Note: Not all columns are present in all test case tabs.
Columns & Sections
Summary
UI Question Companion Guide Reference
Description
A high-level summary of the test case.
Item numbers from the UI Question Companion
Guide so the Auditor can easily refer back to
requirements.
Application Data
The question, group of questions/application
section, or eligibility result.
Application Input
Test data for the consumer(s) in each test case (i.e.,
test data the EDE Entity and Auditor use to answer
questions in the eligibility application).
Notes to Testers
Additional notes to complete each test case and
provide additional information for the Auditor about
what should or should not appear in the UI.
Auditor Checklist
Each case has 1-7 checklist items for the Auditor to
use when going through the test case to ensure
correct implementation. The Auditor must review
and verify each checklist item.
Testing Notes
The Auditor should note this column does not provide an exhaustive list of item
numbers for each test case and is not intended for audit purposes. It is a tool to
better understand question display requirements by providing an easily
accessible reference to detailed information in the UI Question Companion
Guide.
The Auditor is required to verify all checklist items and include it's compliance
determination for each checklist item in the corresponding field in the "Auditor
Compliance Conclusion" column in the "Phase" tab.
Columns & Sections
Application State & Coverage Year
Description
Testing Notes
This section provides the state and required ZIP Code Some test scenarios require the use of specific application states or ZIP Codes. In
(if any) and coverage year for each test case.
the event an EDE Entity does not support an application state listed in the test
scenario, the Auditor may omit that test case.
Required Completion Rate (Reminder)
Auditors must conduct all possible test cases. However, depending on the
entity's intended service areas, Auditors may not be able to conduct a test case
because the entity does not intend to operate in the specific state(s) provided in
the test case. Auditors must conduct a minimum number of test cases from
each toolkit it completes. Auditors conducting Phase 1 audits must submit at
least 11 of 14 Phase 1 test cases. Auditors conducting Phase 2 audits must
submit at least 8 of 14 Phase 1 test cases AND 6 of 9 Phase 2 test cases. Auditors
conducting Phase 3 audits must submit at least 8 of 14 Phase 1 test cases AND 5
of 9 Phase 2 test cases AND 7 of 9 Phase 3 test cases. If an Auditor is not able to
conduct the minimum number of test cases for each toolkit because of the
entity's planned service areas, it must email DE Support to request instructions
to modify test cases so that the Auditor is able to conduct and submit the
minimum number of test cases.
Screening Questions
This section provides the screener questions and
answers for each test case that determine if
consumer(s) can use a certain phase of EDE.
Screening Pass/Fail
This section describes and explains if the test
consumer(s) may continue the application or if the
test consumer must be guided to an alternate
pathway because the consumer is not eligible for this
phase of EDE.
Household Member Input
Test data for each consumer in the test case.
Household
This section provides the household composition
information such as relationships, whether
household members are applicants/non-applicants,
Social Security Numbers (SSNs), and
citizenship/immigration information.
More About This Household
This section provides information for answering the
Non-MAGI Medicaid eligibility questions (physical
disabilities, assistance with daily living, nursing home
care), pregnancy, foster care, incarceration and fulltime student questions.
Medicaid Block
This section provides information for answering the
questions about Medicaid denial or Medicaid ending
due to a change in eligibility.
Income
This section provides each household member's
current income, deductions, annual income, and
income discrepancies, when applicable.
This section provides additional inputs for each test
case that are specific to APTC, Medicaid, CHIP, SEP,
and QHP eligibility.
Program Questions
Attestations
This section provides information for answering the
legal attestations.
Eligibility Results
This section shows the eligibility results that should
display for each consumer in the ERP. The
information displayed in the UI should accurately
reflect results found in the EDN and use specific
language where noted in the test cases.
All Phase 1 and some Phase 2 scenarios require the use of specific test SSNs
which are provided in the input table. Some Phase 2 and Phase 3 scenarios do
not include SSNs. In these instances, the Auditor should proceed in the
application without entering any values in the SSN field. Entering an invalid SSN
will prevent application submission. Please refer to phase-specific instructions.
Auditors should note that test cases do not include data matching issue (DMI)
status in the Eligibility Result section. If the test case results in a DMI, the ERP
and EDN will provide instruction that the consumer must submit documentation
to confirm information. DMIs can occur for citizenship status; immigration
status; household income; incarceration status; American Indian or Alaska
Native status; eligibility for minimum essential job-based coverage; and eligibility
for coverage through Medicaid or CHIP, TRICARE, Veterans Health Care Program,
Medicare, or Peace Corps.
Auditors should also note that the test cases do include information on Special
Enrollment Verification Issues (SVIs) in the Eligibility Results section, and that
messaging about SVIs is expected on both the ERP and EDN when noted in the
test case. However, SVIs will not be generated for applicants who are current
enrollees or for applications submitted during the annual open enrollment
period. Entities can help ensure they are generating the expected SVIs by always
randomizing demographic data as instructed by the test cases and completing
the toolkit outside of the open enrollment period.
Phase 2
Test Case ID
Test Case 2.A
State
Any state
Summary/Criteria
-Initial application, 1 member household
-Not seeking financial assistance
-Single, no dependents
-U.S. citizen; not born in U.S. (naturalized)
Expected Results/What's Tested
-EDE Entity displays naturalized citizenship
questions properly
-EDE partner allows naturalized citizen to
proceed with the application and is determined
eligible for QHP
Test Scenario Description
This test case demonstrates the functionality for a consumer not applying for
financial assistance. In this scenario, an unmarried 25 year-old in any state with no
dependents completes the screener on the EDE Entity site. Although this consumer is
a U.S. citizen, he was not born in the U.S. and became a naturalized citizen. On the
application, the consumer attests to being a citizen, but citizenship cannot be verified
by SSA. Consumer is able to continue through the application after attesting as a
naturalized citizen and is determined eligible for QHP.
This test case tests the UI and functionality related to pregnant application members
in states with similar Medicaid income limits for pregnant women. The consumers
were married within the last 60 days. The husband is found eligible for QHP and APTC
with a marriage SEP, but the wife is eligible for Medicaid due to her income and
pregnancy status.
This test case should re-access the application from 2.B through a change in
circumstance (CiC). In this scenario, Betty is no longer pregnant and the couple is
adding their child to their application. This demonstrates the EDE partner is able to
support CiCs that result in changes to program eligibility. Because Betty is no longer
pregnant, she is now QHP and APTC with CSRs eligible with an marriage SEP and the
child is eligible for Medicaid.
Auditor Compliance Conclusion**
Eligibility results compliance conclusion:
Auditor checklist Item 42/row 31 compliance conclusion:
Auditor checklist Items 153, 174, 181/rows 41-43 compliance
conclusion:
Auditor checklist item to check Eligibility Results Tab, Item 4/row 49
compliance conclusion:
Any state except -Initial application, 2 member household
AK, HI, LA, SD
-Seeking financial assistance
-Married, no dependents
-Application member is pregnant
-Marriage SEP
Test case 2.B.2 State used in Test -CiC on application from Test Case 2.B, 3
Case 2.B
member household
-Seeking financial assistance
-Married, 1 dependent
-Child less than one year old (but older than 60
days) added to application
-EDE Entity demonstrates UI can support
pregnant application members
-Husband is determined eligible for QHP with
APTC; wife may be eligible for Medicaid
Test case 2.D
AK, AZ, DE, KS, LA, -Initial application, 3 member household
MI, NE, SC, TX,
-Seeking financial assistance
UT, VA
-Single, 2 dependents
-Dependent who is a full-time student
-Dependent stepchild with a disability
-EDE Entity properly displays full-time student
question based on tax dependent child's age
-EDE Entity's UI is able to support stepchildren
and non-MAGI attestation
-Household receives a determination of QHP
eligibility with APTC, and stepchild is referred to
the state Medicaid agency for review
In this scenario, a parent applies for coverage along with their 18 year-old child and a
stepchild, who they will claim on their tax return. Because the tax dependent child is
18 and the parent is applying for coverage, the application asks whether or not the 18
year old is a full-time student. The scenario also includes a dependent stepchild who
attests to a disability, demonstrating a Phase 2 application's ability to support
dependent stepchildren. The household receives a determination of QHP eligibility
with APTC, and the stepchild is referred to the State Medicaid agency based on her
attestations to non-MAGI questions.
Eligibility results compliance conclusion:
Auditor checklist Item 28/row 27 compliance conclusion:
Auditor checklist Item 32/row 29 compliance conclusion:
Auditor checklist Items 144 and 268/row 37 compliance conclusion:
Auditor checklist Item 215/row 46 compliance conclusion:
Auditor checklist item to verify the display of the eligibility results
page/row 50 compliance conclusion:
Test case 2.E
AK, AZ, AR, DE, HI,
IL, IN, IA, LA, MI,
MT, NH, ND, OH,
OR, UT, VA, WV,
WI
An applicant is ineligible for Medicaid due to immigration status and attests to a
recent denial from the state Medicaid/CHIP agency. The consumer is determined
eligible for QHP with APTC and CSRs despite having income below 100% FPL and
eligible for the under 150% FPL SEP.
Eligibility results compliance conclusion:
Auditor checklist Item 4/row 26 compliance conclusion:
Auditor checklist Items 72 and 73/row 32 compliance conclusion:
Auditor checklist item to check Eligibility Results Tab, Item 5/row 51
compliance conclusion:
Test case 2.E.2
State used in 2.E
-EDE Entity is able to support non-citizen
applicants and displays appropriate questions
relating to Medicaid/CHIP denial due to
immigration status
-The consumer is determined eligible for QHP
with APTC and CSR and SEP
-EDE Entity is able to support non-citizen
applicants and displays appropriate questions
relating to veteran status
-The consumer may be Medicaid eligible despite
not meeting the five-year bar
-EDE Entity displays attestation or application
question requiring consumer to attest whether
applicants are incarcerated
-UI then collects information about which
applicants are incarcerated and asks if they are
pending disposition of charges
-Applicant and spouse are QHP ineligible due to
immigration and incarceration status respectively,
and child is QHP and APTC/CSR eligible
This scenario involves the applicant from 2.E reporting a change in circumstance
(CiC). Sarah no longer attests to being denied Medicaid and attests her late spouse is
an honorably discharged veteran. Therefore, Sarah is eligible for Medicaid despite not
meeting the five-year bar.
Eligibility results compliance conclusion:
Auditor checklist item to verify test case is updating the application
submitted in 2.E by reporting a life change/row 4 compliance
conclusion:
Auditor checklist Items 56 and 71/row 31 compliance conclusion:
Eligibility results compliance conclusion:
Auditor checklist Item 44/row 31 compliance conclusion:
Auditor checklist Item 251/row 36 compliance conclusion:
Auditor checklist Item 181/row 43 compliance conclusion:
Test Case 2.B
Test case 2.F
-Initial application, 1 member household
-Seeking financial assistance
-Attests to Medicaid denial due to immigration
status
-Under 150% FLP SEP
-CiC on application from Test Case 2.E, 1
member household
-Seeking financial assistance
-Single, no dependents
-Applicant attests to honorably discharged
Any state except -Initial application, 3 member household
AK and HI
-Seeking financial assistance
-Married, 1 dependent
-2 consumers answer affirmatively to
incarceration question; one consumer is
pending disposition of charges, another
consumer is not pending disposition of charges
Test case 2.G
AR, DE, FL, MI,
MS, NC, ND, NE,
OK, SC, VA
-Initial application, 3 member household
-Seeking financial assistance
-Single, 2 dependents
-One child has aged out of foster care and is
eligible for transitional Medicaid
-Other child applying with name different from
SSN
Test case 2.H
Any state
-Initial application, 3 member household
-Seeking financial assistance
-Married, 1 dependent
-Applicant attests to home address outside of
state where applicant is seeking coverage
-EDE Entity is able to support a CiC, and changes
in program eligibility stemming from life events
-Husband and wife are QHP and APTC/CSR
eligible; child may be eligible for Medicaid/CHIP
-EDE Entity properly displays foster care
questions to dependent child applicant who is
between 18-25 years old
-UI allows applicant to continue with application
when applying under name different from their
SSN card
-Primary applicant and one child eligible for QHP
with APTC; child eligible for Medicaid
This test scenario allows the EDE Entity to demonstrate their UI can support
incarcerated application members as part of Phase 2 requirements. The consumer
attests that application members are incarcerated. The consumer indicates the wife
is incarcerated and answers "No" to the follow-up question of if they are
incarcerated pending disposition of charges. The consumer indicates that the son is
incarcerated pending disposition of charges. The consumer attests to not having
eligible immigration status and is therefore not eligible for a QHP. The wife is not
eligible for a QHP due to her incarceration status (not pending disposition of charges).
The son is eligible for a QHP because his incarceration is pending disposition of
This scenario includes a single parent applying for himself and his two children. It
demonstrates functionality and logic related to former foster care applicants. The
older child answers affirmatively to having been formerly in foster care at age 18 or
older, indicates the age they left foster care was 18 (VA), 19 (MI, NE, SC) or 21 (AR,
DE, FL, MS, NC, ND, OK), and that they were in foster care in the application state.
The younger child is applying with a name different than on their SSN card. The
primary applicant and younger child are found eligible for QHP with APTC based on
income while the older child is determined preliminarily eligible for Medicaid based
on former foster care status. The primary applicant is also referred to his state
Medicaid agency based on age.
-EDE Entity demonstrates UI properly screens out This scenario demonstrates proper UI and functionality of the screener tool for a
scenarios not supported by Phase 2 applications married application filer claiming one dependent who is seeking coverage and
-Applicant is routed to HealthCare.gov or
financial assistance. The application filer also lives in a state different from the
alternate channel after answering screening
application state which requires redirecting the application filer to an alternate
questions
pathway because this scenario is not supported by Phase 2 applications. Therefore,
-Proper disclaimer regarding unsupported
the application filer should answer “No” to the screener question "does everyone
scenarios is displayed on Entity UI
have the same permanent home address and currently live in [application state]?".
Upon doing so, the consumer should be screened out of EDE and directed to
HealthCare.gov or an alternate channel.
Eligibility results compliance conclusion:
Auditor checklist Item 28/row 27 compliance conclusion:
Auditor checklist Item 186 (and Items 185, 187)/row 44 compliance
conclusion:
Auditor checklist items 213, 218, 224/row 48 compliance conclusion:
Eligibility results compliance conclusion:
Auditor checklist item to verify test case is updating the application
submitted in 2.B by reporting a life change/row 4 compliance
conclusion:
Auditor checklist Item 155, Column G/row 41 compliance conclusion:
Auditor checklist Item 186/row 44 compliance conclusion:
Eligibility results compliance conclusion:
Auditor checklist Item 9/row 12 compliance conclusion:
Auditor checklist Item 28/row 26 compliance conclusion:
Auditor checklist Item 37/row 30 compliance conclusion:
Auditor checklist Item 151/row 35 compliance conclusion:
Auditor checklist Item 239/row 46 compliance conclusion:
Auditor checklist item to check Eligibility Results Tab, Item 4/row 51
compliance conclusion:
Eligibility results compliance conclusion:
Auditor checklist Item 9/row 12 compliance conclusion:
Auditor checklist Item 12/row 16 compliance conclusion:
Auditor checklist item to verify the consumer is guided to an alternate
pathway with consumer friendly language/row 21 compliance
conclusion:
Risks Identified**
Risk Level**
Risk Mitigation Strategy**
Estimated Resolution Date**
Auditor Comments**
Test Case 2.A input
Summary: This test case demonstrates the functionality for a consumer not applying for financial assistance. In this scenario, an unmarried 25 year-old in any state with no
dependents completes the screener on the EDE entity site. Although this consumer is a U.S. citizen, he was not born in the U.S. and became a naturalized citizen. On the
application, the consumer attests to being a citizen, but citizenship cannot be verified by SSA. Consumer is able to continue through the application after attesting as a
UI Question Companion Guide
Application Data
Reference
Tab: UI Questions
Item 1
State
Item 2
Coverage Year
Tab: Phase 2 Screening
Item 1
Item 2
Item 3
Item 5
Items 4, 6, 7 (depending on
implementation)
Item 8
Item 9
Item 10
Item 11
Item 17
Item 12
Item 13
Item 14
Item 16
Application Input
Notes to Testers
Application State & Coverage Year
Any state
Current year
Screening Questions
Marital Status
Number of tax dependents
Who is applying for coverage?
Seeking financial assistance?
Single
0
Application filer
No
Resides in application state
Yes
Tax filing status
Responsible for a child 18 or younger not
on tax return
American Indian/Alaska Native
Offer of individual coverage HRA (ICHRA)
or a qualified small employer Health
Reimbursement Arrangement (QSEHRA)
Offer of coverage through job or COBRA
Claiming all dependents on tax return
Dependent is child or stepchild, single
(not married), 25 or younger
Dependents live with parent not on tax
return
N/A (should not display)
N/A (should not display)
Pass Screener?
No one in household has AI/AN status
Does not have an ICHRA or QSEHRA offer
N/A (should not display)
N/A (should not display)
N/A (should not display)
N/A (should not display)
Screening Pass/Fail
Yes, continue with application
Must provide a valid zip code for the application
state
Auditor Checklist
UI Question Companion Guide
Reference
Tab: UI Questions
Items 4, 28 Name
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Application Data
Household Member Input
Notes to Testers
Auditor Checklist
Household
Household member
John Matthews *
Age: 25
Male
*Do not use Matthews as the last name. Use a
different last name that is unique (it can be a
random string of letters). Do not change the first
name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct
age for each household member
Item 28
Items 27, 29
Item 32
Item 36
Items 38, 40, 41, 42
Items 131, 132
Item 147
Item 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Item 250
Item 268 (depending on
implementation)
Application Filer/Relationship to
Application Filer
Applicant/Non-Applicant
SSN
Application Filer
Applying with same name as name on
SSN card?
Citizenship/Immigration
Yes
Applicant
421-94-1551
Attests to U.S. citizenship
Attests to being a naturalized U.S. citizen
Select Naturalization Certificate Document:
Alien Number: 660020811
Naturalization Number: 600060020811
More About This Household
Non-MAGI Medicaid Eligibility Questions N/A (should not display)
(physical disabilities, assistance with
daily living, nursing home care)
Pregnancy Questions
N/A (should not display)
Foster Care Questions
N/A (should not display)
Incarceration Questions
Not incarcerated
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value unless
otherwise noted.
Find additional information in the UI Question
Companion Guide:
- Items 4, 5, 7, 8, 9 Household Contact
Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
SSN must be entered exactly for test case to
function
Due to unverified SSN, the UI should ask if the
consumer is a naturalized or derived citizen
Check Item 42: Verify that the alien number
and naturalization number are optional
UI Question Companion Guide
Application Data
Reference
Item 144
Full-Time Student Questions
Item 268 (depending on
implementation)
Household Member Input
Medicaid Block
N/A (should not display)
Income
N/A (should not display)
N/A (should not display)
N/A (should not display)
Program Questions
None of these changes
Attestations
Medicaid/CHIP Denial
Item 153
Item 174
Item 181
Current Month Income
Deductions
Annual Income
Items 213, 218, 224
Recent Life Changes (SEPs)
Items 246, 254, 255, 256, 258
Application Review & Legal Attestations Answers affirmatively to all application
attestations
Sample HealthCare.gov Eligibility
Results Messaging
Eligibility Results Page (ERP)
Auditor Checklist
N/A (should not display)
Items 133, 138
Reference Materials
UI Q CG Eligibility Results Tab:
Items 1, 4, 5
Notes to Testers
Eligibility Results
Eligible to buy a Marketplace plan
Not eligible for a Special Enrollment Period*
Check Items 153, 174 and 181: Verify no
income information is collected since this is
a non-financial assistance application
Auditors should review the application review
page (Item 246) to ensure all information
accurately reflects the attestations inputted
during the test case
Auditors should review the Eligibility Results Page Check Eligibility Results Tab, Item 4: Verify UI
displays exact language "What should I do if I
to ensure it accurately reflects the eligibility
results found in the EDN and complies with ERP think my eligibility results are wrong?"
messaging requirements outlined in the
documentation listed in Column A
*Optional to display if consumer is not eligible
for a Special Enrollment Period
Test Case 2.B.1 input
Summary: This test case tests the UI and functionality related to pregnant application members in states with similar Medicaid income limits for pregnant women. The consumers
were married within the last 60 days. The husband is found eligible for QHP and APTC with a marriage SEP, but the wife is eligible for Medicaid due to her income and pregnancy
UI Question Companion
Guide Reference
Tab: UI Questions
Item 1
Item 2
Tab: Phase 2 Screening
Item 1
Item 2
Item 3
Application Data
Application Input
Marital Status
Application State & Coverage Year
Any state except AK, HI, LA, SD
Current year
Screening Questions
Married
Number of tax dependents
Who is applying for coverage?
0
Application filer, spouse
State
Coverage Year
Item 5
Seeking financial assistance?
Items 4, 6, 7 (depending on
implementation)
Item 8
Resides in application state and
lives at same address
Item 9
Tax filing status
Item 10
Responsible for a child 18 or
younger not on tax return
Item 11
American Indian/Alaska Native
Item 17
Offer of individual coverage HRA
(ICHRA)or a qualified small
employer Health Reimbursement
Arrangement (QSEHRA)
Item 12
Offer of coverage through job or
COBRA
Item 13
Claiming all dependents on tax
return
Item 14
Dependent is child or stepchild,
single (not married), 25 or
younger
Item 16
Dependents live with parent not
on tax return
Pass Screener?
Notes to Testers
Yes
Yes, all household members live at same address in application state Must provide a valid zip code for the application
state
Filing jointly
No one in household is responsible for a child 18 or younger who
they live with but isn't on their tax return
No one in household has AI/AN status
No applicants have an ICHRA or QSEHRA offer
No applicants have access to coverage through a job or COBRA
N/A (should not display)
N/A (should not display)
N/A (should not display)
Yes, continue with application
Screening Pass/Fail
Auditor Checklist
UI Question Companion
Guide Reference
Tab: UI Questions
Application Data
Household Member Input
Household Member Input
Notes to Testers
Auditor Checklist
Household
Items 4, 28 Name
Household member
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Betty Curtis*
Age: 21
Female
Dwayne Curtis*
Age: 21
Male
*Do not use Curtis as the last name. Use a
different last name that is unique (it can be a
random string of letters). Do not change the first
name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct
age for each household member
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value unless
otherwise noted. Find additional information in
the UI Question Companion Guide:
- Items 4, 5, 7, 8, 9 Household Contact Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
Item 28
Application Filer/Relationship to Application Filer
Application Filer
Spouse
Items 27, 29
Item 32
Applicant/Non-Applicant
SSN
Applicant
317-20-1410
Applicant
317-20-1411
Item 36
Applying with same name as
name on SSN card?
Citizenship/Immigration
Yes
Yes
Item 38
Items 131, 132
Items 147, 148
Item 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Item 250
Item 268 (depending on
implementation)
Item 144
Item 268 (depending on
implementation)
Non-MAGI Medicaid Eligibility
Questions (physical disabilities,
assistance with daily living,
nursing home care)
Pregnancy Questions
Attests to U.S. citizenship
Attests to U.S. citizenship
More About This Household
Do not answer affirmatively to Do not answer affirmatively to any
any non-MAGI questions
non-MAGI questions
Pregnant
Expecting 1 baby
N/A (should not display for this
household member)
Foster Care Questions
Not former foster care
Not former foster care
Incarceration Questions
Not incarcerated
Not incarcerated
Full-Time Student Questions
Not a full time student
Not a full time student
Medicaid Block
Check Item 28: Verify that the
application collects relationship
between Dwayne and Betty
SSN must be entered exactly for test case to
function
UI Question Companion
Guide Reference
Items 133, 138
Medicaid/CHIP Denial
Does not have Medicaid/CHIP
that recently ended or will end
soon;
Not denied Medicaid/CHIP
Items 153, 154, 155, 209
Current Month Income
Job: $2,087.75 per month
Item 174
Item 181
Item 186
Deductions
Annual Income
Income Discrepancies
No deductions
No deductions
$25,053
$9,999.96
Answer "Other reason" for "Betty's and Dwayne's household income The question will be asked once for the household Verify only Item 186 displays, and
seems like it will be lower than what our records from the past 2
and not for each household member
other income discrepancy
years show. Is there a reason why?"
questions (Items 185, 187) do not
Item 191
Item 239
Current coverage
Help paying for medical bills
None
Do not answer affirmatively
Items 213, 218, 224, 225,
226
Recent Life Changes (SEPs)
Items 246, 247, 252, 254,
255, 256, 258
Application Review & Legal
Attestations
Reference Materials
UI Q CG Eligibility Results
Tab: Items 1, 3, 4, 5
Eligibility Results Page (ERP)
Sample HealthCare.gov
Eligibility Results
Messaging
Application Data
Household Member Input
Household Member Input
Assessment states:
"May be eligible for Medicaid"
Auditor Checklist
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Income
Job: $833.33 per month
Program Questions
None
N/A (should not display for this
household member)
N/A (should not display for this Got married
household member)
Provide date in last 60 days
Attest "Yes" to prior coverage
questions
Attestations
Answers affirmatively to all application attestations
Determination states:
"May be eligible for Medicaid"
Notes to Testers
Eligibility Results
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Employer name (and phone number, where Item
209 is included) fields are required but any value
may be entered (ex: ABC corp; 555-555-5555)
Check Items 213, 218 and 224:
These questions should only display
for Dwayne
Auditors should review the application review
page (Item 246) to ensure all information
accurately reflects the attestations inputted
during the test case
Auditors should review the Eligibility Results Page Check Eligibility Results Tab, Item 3:
to ensure it accurately reflects the eligibility
UI should display Full Medicaid
results found in the EDN and complies with ERP
Determination for Dwayne
messaging requirements outlined in the
documentation listed in Column A
Eligible for lower copayments,
coinsurance, and deductibles (cost- Betty is not eligible for a Special Enrollment
sharing reductions) on Silver plans Period because she qualifies for Medicaid
Eligible for a Special Enrollment
Period
Test Case 2.B.2 input
Summary: This test case should re-access the application from 2.B through a change in circumstance (CiC). In this scenario, Betty is no longer pregnant and the couple is adding their child to their application. This demonstrates the EDE
partner is able to support CiCs that result in changes to program eligibility. Because Betty is no longer pregnant, she is now QHP and APTC with CSRs eligible with a marriage SEP and the child is eligible for Medicaid.
UI Question Companion Guide
Reference
Tab: UI Questions
Item 1
Application Data
Application Input
Application State & Coverage Year
State
State used in Test Case 2.B
Item 2
Tab: Phase 2 Screening Questions
Item 1
Item 2
Item 3
Coverage Year
Current year
Marital Status
Number of tax dependents
Who is applying for coverage?
Married
1
Application filer, spouse, dependent
Item 5
Items 4, 6, 7 (depending on
implementation)
Seeking financial assistance?
Yes
Item 8
Resides in application state and
lives at same address
Tax filing status
Responsible for a child 18 or
younger not on tax return
American Indian/Alaska Native
Offer of individual coverage HRA
(ICHRA) or a qualified small
employer Health Reimbursement
Arrangement (QSEHRA)
Offer of coverage through job or
COBRA
Claiming all dependents on tax
return
Dependent is child or stepchild,
single (not married), 25 or
younger
Dependents live with parent not
on tax return
Yes, all household members live at same address in application state
Pass Screener?
Yes, continue with application
Item 9
Item 10
Item 11
Item 17
Item 12
Item 13
Item 14
Item 16
Notes to Testers
The tester should update the application submitted in
Test Case 2.B through a change in circumstance (CiC),
which will use the same application state
Screening Questions
Filing jointly
No one in household is responsible for a child 18 or younger who they live with but isn't on their tax return
No one in household has AI/AN status
No applicants have an ICHRA or QSEHRA offer
No applicants have access to coverage through a job or COBRA
Yes
Yes
No
Screening Pass/Fail
Must provide a valid zip code for the application state
Auditor Checklist
Verify entity is updating the
application submitted in 2.B by
reporting a life change in order to
complete test case 2.B.2
UI Question Companion Guide
Reference
Application Data
Household Member Input
Household Member Input
Tab: UI Questions
Items 4, 28 Name
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Household Member Input
Notes to Testers
Auditor Checklist
Household
Household member
Betty Curtis *
Age: 21
Female
Dwayne Curtis *
Age: 21
Male
Baby Curtis*
Age: more than 60 days old, but
less than 1 year old
Male
*Do not use Curtis as the last name. Use a different last
name that is unique (it can be a random string of letters).
Do not change the first name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct age for
each household member
Item 28
Items 27, 29
Item 32
Item 36
Items 38, 40
Items 131, 132
Item 147
Item 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Item 250
Item 268 (depending on
implementation)
Item 144
Item 268 (depending on
implementation)
Application Filer/Relationship to Application Filer
Application Filer
Applicant/Non-Applicant
Applicant
SSN
317-20-1410
Spouse
Son/Daughter
Applicant
317-20-1411
Applicant
Does not have SSN, continue
SSN must be entered exactly for test case to function
without providing SSN
Yes
N/A (should not display for this
household member)
Attests to U.S. citizenship
Attests to U.S. citizenship, not
naturalized or derived
More About This Household
Do not answer affirmatively to any Do not answer affirmatively to any
non-MAGI questions
non-MAGI questions
Applying with same name as on
name on SSN card?
Citizenship/immigration
Yes
Non-MAGI Medicaid Eligibility
Questions (physical disabilities,
assistance with daily living,
nursing home care)
Pregnancy Questions
Do not answer affirmatively to any
non-MAGI questions
Not pregnant
N/A (should not display for this
household member)
N/A (should not display for this
household member)
Foster Care Questions
Not former foster care
Not former foster care
N/A (should not display for this
household member)
Incarceration Questions
Not incarcerated
Not incarcerated
Not incarcerated
Full-Time Student Questions
Not a full time student
Not a full time student
N/A (should not display for this
household member)
Items 133, 138
Medicaid/CHIP Denial
Items 153, 154, 155, 209
Current Month Income
Item 174
Item 181
Item 186
Deductions
Annual Income
Income Discrepancies
Attests to U.S. citizenship
Other household contact and information fields (i.e.
email, phone, language preference, race/ethnicity, etc.)
may contain any value unless otherwise noted. Find
additional information in the UI Question Companion
Guide:
- Items 4, 5, 7, 8, 9 Household Contact Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant information Race and Ethnicity
Medicaid Block
Does not have Medicaid/CHIP that Does not have Medicaid/CHIP that Does not have Medicaid/CHIP that
recently ended or will end soon; Not recently ended or will end soon; Not recently ended or will end soon;
denied Medicaid/CHIP
denied Medicaid/CHIP
Not denied Medicaid/CHIP
Income
Job: $2,087.75 per month
Job: $833.33 per month
No income
Employer name (and phone number, where Item 209 is
included) fields are required but any value may be
entered (ex: ABC corp; 555-555-5555)
No deductions
No deductions
$25,053
$9,999.96
Answer "Other reason" for "Betty's and Dwayne's household income
seems like it will be lower than what our records from the past 2 years
show. Is there a reason why?"
No deductions
$0
N/A (should not display for this
household member)
Program Questions
The question will be asked once for the household and
not for each household member
Check Item 155, Column G: Verify all
required job income frequencies
display as answer options
Check Item 186: Verify that this is the
only income discrepancy question
that displays. Verify that the question
only displays once for the whole
household
UI Question Companion Guide
Reference
Application Data
Item 191
Item 239
Current coverage
Help paying for medical bills
Items 213, 218, 224, 225, 226
Recent Life Changes (SEPs)
Items 246, 247, 252, 254, 255,
256, 258
Application Review & Legal
Attestations
Reference Materials
UI Q CG Eligibility Results Tab:
Items 1, 3, 4, 5
Eligibility Results Page (ERP)
Sample HealthCare.gov Eligibility
Results Messaging
Household Member Input
Household Member Input
None
N/A (should not display for this
household member)
Got married
Provide date in last 60 days
Attest "Yes" to prior coverage
questions
None
N/A (should not display for this
household member)
Got married
Provide date within last 60 days
Attest "Yes" to prior coverage
questions
Attestations
Answers affirmatively to all application attestations
Household Member Input
None
Do not answer affirmatively
N/A (should not display for this
household member)
Eligible for lower copayments,
coinsurance, and deductibles (costsharing reductions) on Silver plans
Eligibility Results
Eligible to buy a Marketplace plan
Determination states:
with a premium tax credit of up to "May be eligible for Medicaid"
[amount] each month for your tax
household
Assessment states:
"May be eligible for Medicaid"
Eligible for lower copayments,
coinsurance, and deductibles (costsharing reductions) on Silver plans
Eligible for a Special Enrollment
Period
Eligible for a Special Enrollment
Period
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Notes to Testers
Auditors should review the application review page (Item
246) to ensure all information accurately reflects the
attestations inputted during the test case
Auditors should review the Eligibility Results Page to
ensure it accurately reflects the eligibility results found in
the EDN and complies with ERP messaging requirements
outlined in the documentation listed in Column A
Auditor Checklist
Test Case 2.D input
Summary: In this scenario, a parent applies for coverage along with their 18 year-old child and a stepchild, who they will claim on their tax return. Because the tax dependent child is 18 and the parent is applying for coverage, the
application asks whether or not the 18 year old is a full-time student. The scenario also includes a dependent stepchild who attests to a disability, demonstrating a Phase 2 application's ability to support dependent stepchildren. The
household receives a determination of QHP eligibility with APTC, and the stepchild is referred to the State Medicaid agency based on her attestations to non-MAGI questions.
UI Question Companion Guide
Application Data
Application Input
Notes to Testers
Reference
Tab: UI Questions
Application State & Coverage Year
Item 1
State
AK, AZ, DE, KS, LA, MI, NE, SC, TX, UT, VA
Item 2
Coverage Year
Current year
Tab: Phase 2 Screening
Screening Questions
Item 1
Marital Status
Single
Item 2
Number of tax dependents
2
Item 3
Who is applying for coverage?
Application filer, both dependents
Item 5
Seeking financial assistance?
Yes
Items 4, 6, 7 (depending on
implementation)
Item 8
Item 9
Item 10
Item 11
Item 17
Item 12
Item 13
Item 14
Item 16
Resides in application state and
lives at same address
Tax filing status
Responsible for a child 18 or
younger not on tax return
American Indian/Alaska Native
Offer of individual coverage HRA
(ICHRA) or a qualified small
employer Health Reimbursement
Arrangement (QSEHRA)
Offer of coverage through job or
COBRA
Tab: UI Questions
Items 4, 28 Name
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Application Data
Household member
Must provide a valid zip code for the application
state
Filing taxes
No one in household is responsible for a child 18 or younger who they live with but isn't on their tax return
No one in household has AI/AN status
No applicants have an ICHRA or QSEHRA offer
No applicants have access to coverage through a job or COBRA
Claiming all dependents on tax
Yes
Dependent is children or
Yes
stepchildren, single (not married),
Dependents live with parent not on No
tax return
Pass Screener?
UI Question Companion Guide
Reference
Yes, all household members live at same address in application state
Auditor Checklist
Screening Pass/Fail
Yes, continue with application
Household Member Input
Peter Linnade*
Age: 49
Male
Household Member Input
Nelly Linnade*
Age: 18
Female
Household
Household Member Input
Lisa Linnade*
Age: 15
Female
Notes to Testers
*Do not use Linnade as the last name. Use a
different last name that is unique (it can be a
random string of letters). Do not change the first
name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct
age for each household member
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value
unless otherwise noted. Find additional
information in the UI Question Companion
Guide:
- Items 4, 5, 7, 8, 9 Household Contact
Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
Auditor Checklist
UI Question Companion Guide
Reference
Application Data
Household Member Input
Household Member Input
Item 28
Application Filer/Relationship to
Application Filer
Application Filer
Parent of Nelly
Stepparent of Lisa
Items 27, 29
Item 32
Applicant/Non-Applicant
SSN
Applicant
Applicant
Applicant
Does not have SSN, continue without Does not have SSN, continue without Does not have SSN, continue without
providing SSN
providing SSN
providing SSN
Item 36
Applying with same name as on
name on SSN card?
Citizenship/immigration
N/A (should not display for this
household member)
Attests to U.S. citizenship, not a
naturalized or derived citizen
Items 38, 40
Child of Peter
Household Member Input
Stepchild of Peter
Non-MAGI Medicaid Eligibility
Do not answer affirmatively to any
Questions (physical disabilities,
non-MAGI questions
assistance with daily living, nursing
home care)
Item 147
Item 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Item 250
Item 268 (depending on
implementation)
Item 144
Item 268 (depending on
implementation)
Pregnancy Questions
N/A (should not display for this
household member)
Not pregnant
Not pregnant
Foster Care Questions
N/A (should not display for this
household member)
Not former foster care
N/A (should not display for this
household member)
Incarceration Questions
Not incarcerated
Not incarcerated
Not incarcerated
Full-Time Student Questions
N/A (should not display for this
household member)
Full-time student
N/A (should not display for this
household member)
Items 133, 138
Medicaid/CHIP Denial
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Items 153, 154, 155, 209
Current Month Income
Item 174
Item 181
Job: $5,683.75 per month
Medicaid Block
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Income
Job: $272.08 per month
No income
Deductions
Annual Income
No deductions
$68,205
No deductions
$3,264.96
No deductions
$0
Item 191
Items 213, 214, 215, 218, 224
Current coverage
Recent Life Changes (SEPs)
None
Recent loss of minimum essential
coverage (MEC)
Provide date within last 60 days; Do
not provide the name of the plan
Program Questions
None
None of these changes
None
None of these changes
Items 246, 252, 254, 255, 256,
258
Application Review & Legal
Attestations
Answers affirmatively to all application attestations
Reference Materials
UI Q CG Eligibility Results Tab:
Items 1, 3, 4, 5
Eligibility Results Page (ERP)
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Eligibility Results
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Eligible for a Special Enrollment
Period
Eligible for a Special Enrollment
Period
Auditor Checklist
Check Item 28: Verify that the UI collects
both dependents' relationship with the
filer and that child and stepchild are
distinct answer options
Check Item 32: Verify that applicants can
proceed without entering an SSN and that
wording and answer option format
conform to UI Q CG requirements
N/A (should not display for this
N/A (should not display for this
household member)
household member)
Attests to U.S. citizenship, not a
Attests to U.S. citizenship, not a
naturalized or derived citizen
naturalized or derived citizen
More About This Household
Do not answer affirmatively to any
Physical disability, Needs help with
non-MAGI questions
activities of daily living
Items 131, 132
Sample HealthCare.gov
Eligibility Results Messaging
Notes to Testers
Check Items 144 and 268: Verify full time
student question displays for Nelly
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Attestations
Employer name (and phone number, where Item
209 is included) fields are required but any value
may be entered (ex: ABC corp; 555-555-5555)
Check Item 215: Verify that plan name is
marked as "optional" and that the
consumer can proceed to the next screen
without providing a response in the UI
Auditors should review the application review
page (Item 246) to ensure all information
accurately reflects the attestations inputted
during the test case
Eligible to buy a Marketplace plan with
a premium tax credit of up to
[amount] each month for your tax
household
Eligible for a Special Enrollment Period
May be eligible for Medicaid*
Auditors should review the Eligibility Results
Page to ensure it accurately reflects the
eligibility results found in the EDN and complies
with ERP messaging requirements outlined in
the documentation listed in Column A
*Optional to display for QHP applicant who is
also being referred to the state Medicaid agency
based on age/disability (non-MAGI)
Verify eligibility results page displays that
Peter, Nelly, and Lisa are "eligible to buy a
Marketplace plan with a premium tax
credit of up to [amount]," and "eligible for
a Special Enrollment Period"
Test Case 2.E.1 input
Summary: An applicant is ineligible for Medicaid due to immigration status and attests to a recent denial from the state Medicaid/CHIP agency. The consumer is determined eligible for
QHP with APTC and CSRs despite having income below 100% FPL and eligible for the under 150% FPL SEP.
UI Question Companion Guide
Reference
Application Data
Tab: UI Questions
Application Input
Marital Status
Number of tax dependents
Who is applying for coverage?
Seeking financial assistance?
Application State & Coverage Year
AK, AZ, AR, DE, HI, IL, IN, IA, LA, MI, MT, ND, NH, OH,
OR, UT, VA, WV, WI
Current Year
Screening Questions
Single
0
Application filer
Yes
Resides in application state
Yes
Item 1
State
Item 2
Tab: Phase 2 Screening
Item 1
Item 2
Item 3
Item 5
Items 4, 6, 7 (depending on
implementation)
Item 8
Coverage Year
Item 9
Item 10
Tax filing status
Filing taxes
Responsible for a child 18 or younger not on No one in household is responsible for a child 18 or
tax return
younger who they live with but isn't on their tax
return
American Indian/Alaska Native
No one in household has AI/AN status
Offer of individual coverage HRA (ICHRA)or Does not have an ICHRA or QSEHRA offer
a qualified small employer Health
Reimbursement Arrangement (QSEHRA)
Offer of coverage through job or COBRA
Does not have access to coverage through a job or
COBRA
Item 11
Item 17
Item 12
Item 13
Item 14
Claiming all dependents on tax return
Dependent is children or stepchildren,
single (not married), 25 or younger
N/A (should not display)
N/A (should not display)
Item 16
Dependents live with parent not on tax
return
N/A (should not display)
Pass screener?
Screening Pass/Fail
Yes, continue with application
Notes to Testers
Must provide a valid zip code for the application
state
Auditor Checklist
UI Question Companion Guide
Reference
Tab: UI Questions
Items 4, 28 Name
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Application Data
Household Member Input
Notes to Testers
Auditor Checklist
Household
Household member
Sarah Noelfl*
Age: 20
Female
*Do not use Noelfl as the last name. Use a different Check Item 4: Verify Answer fields for Middle
last name that is unique (it can be a random string Name and Suffix are optional
of letters). Do not change the first name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct age
for each household member
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value unless
otherwise noted. Find additional information in the
UI Question Companion Guide:
- Items 4, 5, 7, 8, 9 Household Contact Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
Item 28
Items 27, 29
Item 32
Item 36
Items 38, 39, 44, 46, 48, 56, 71
Application Filer/Relationship to Application
Filer
Applicant/Non-Applicant
SSN
Applying with same name as name on SSN
card?
Citizenship/Immigration
Application Filer
Applicant
717-07-6993
Yes
Not a U.S. citizen/national
Attest to eligible immigration status
Document Type:
I-327 Reentry permit
Alien Number:
660031769
Items 72, 73
Five-Year Bar/Veteran Status Questions
Items 131, 132
Non-MAGI Medicaid Eligibility Questions
(physical disabilities, assistance with daily
living, nursing home care)
Do not enter expiration date
Do not answer affirmatively to honorably discharged
Veteran or active-duty member of the U.S. military
questions (including for deceased spouse)
More About This Household
Do not answer affirmatively to any non-MAGI
questions
Check Items 72 and 73: Verify that Item 72 does
not display (applicant's birthday is after 1996).
Verify that both Sarah and Sarah's deceased
spouse are listed as answer options for Item
73's question "Are any of these people an
honorable discharged veteran or active duty
member of the military?"
UI Question Companion Guide
Reference
Application Data
Household Member Input
Item 147
Item 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Item 250
Item 268(depending on
implementation)
Item 144
Item 268 (depending on
implementation)
Pregnancy Questions
Not pregnant
Foster Care Questions
Not former foster care
Incarceration Questions
Not incarcerated
Full-Time Student Questions
Not a full-time student
Items 133, 138, 141, 142, 143
Medicaid/CHIP Denial
Medicaid Block
Does not have Medicaid/CHIP that recently ended or
will end soon
Notes to Testers
Not denied Medicaid/CHIP in the last 90 days
Denied Medicaid/CHIP due to immigration status in
the last five years
Answer "No" to question: "Has Sarah had their
current immigration status since [current year minus
5 years]?"
Items 153, 154, 155, 209
Current Month Income
Answer "No" to question: "Has Sarah had a change
in their immigration status since they were found
not eligible for [state Medicaid program name] or
[state CHIP program name]?"
Income
Job: $750 per month
Item 174
Item 181
Deductions
Annual Income
No deductions
$9,000
Item 191
Items 213, 218, 224
Current coverage
Recent Life Changes (SEPs)
Program Questions
None
None of these changes
Items 246, 252, 254, 255, 256,
258
Application Review & Legal Attestations
Attestations
Answers affirmatively to all application attestations
Reference Materials
Eligibility Results
Employer name (and phone number, where Item
209 is included) fields are required but any value
may be entered (ex: ABC corp; 555-555-5555)
Auditors should review the application review
page (Item 246) to ensure all information
accurately reflects the attestations inputted during
the test case
Auditor Checklist
UI Question Companion Guide
Reference
UI Q CG Eligibility Results Tab:
Items 1, 3, 4, 5
Sample HealthCare.gov Eligibility
Results Messaging
Application Data
Eligibility Results Page (ERP)
Household Member Input
Notes to Testers
Auditor Checklist
Eligible to buy a Marketplace plan with a premium Auditors should review the Eligibility Results Page Check Eligibility Results Tab, Item 5: UI should
tax credit of up to [amount] each month for your tax to ensure it accurately reflects the eligibility results display link to voter registration
household
found in the EDN and complies with ERP messaging
requirements outlined in the documentation listed
in Column A
Eligible for lower copayments, coinsurance, and
deductibles (cost-sharing reductions) on Silver plans
Eligible for a Special Enrollment Period
Test Case 2.E.2 input
Summary: This scenario involves the applicant from 2.E reporting a change in circumstance (CiC). Sarah no longer attests to being denied Medicaid and attests her late spouse is an honorably
discharged veteran. Therefore, Sarah is eligible for Medicaid despite not meeting the five-year bar.
UI Question Companion Guide
Reference
Tab: UI Questions
Item 1
State
Application Data
Application Input
Application State & Coverage Year
State used in 2.E
Item 2
Tab: Phase 2 Screening
Item 1
Item 2
Item 3
Item 5
Items 4, 6, 7 (depending on
implementation)
Item 8
Coverage Year
Current Year
Marital Status
Number of tax dependents
Who is applying for coverage?
Seeking financial assistance?
Single
0
Application filer
Yes
Resides in application state
Yes
Item 9
Item 10
Tax filing status
Responsible for a child 18 or younger not on
tax return
Filing taxes
No one in household is responsible for a child 18 or
younger who they live with but isn't on their tax return
Item 11
Item 17
American Indian/Alaska Native
Offer of individual coverage HRA (ICHRA)or a
qualified small employer Health
Reimbursement Arrangement (QSEHRA)
Offer of coverage through job or COBRA
No one in household has AI/AN status
Does not have an ICHRA or QSEHRA offer
Item 12
Item 13
Item 14
Item 16
Notes to Testers
The tester should update the application
submitted in Test Case 2.E through a change in
circumstance (CiC), which will use the same
application state
Screening Questions
Does not have access to coverage through a job or
COBRA
N/A (should not display)
N/A (should not display)
Claiming all dependents on tax return
Dependent is children or stepchildren, single
(not married), 25 or younger
Dependents live with parent not on tax return N/A (should not display)
Screening Pass/Fail
Pass screener?
Yes, continue with application
Must provide a valid zip code for the application
state
Auditor Checklist
Verify partner is updating the
application submitted in 2.E by
reporting a life change in order to
complete test case 2.E.2
UI Question Companion Guide
Application Data
Reference
Tab: UI Questions
Items 4, 28 Name
Household member
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Household Member Input
Notes to Testers
Auditor Checklist
Household
Sarah Noelfl*
Age: 20
Female
*Do not use Noelfl as the last name. Use a
different last name that is unique (it can be a
random string of letters). Do not change the first
name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct
age for each household member
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value
unless otherwise noted. Find additional
information in the UI Question Companion
Guide:
- Items 4, 5, 7, 8, 9 Household Contact
Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
Item 28
Items 27, 29
Item 32
Item 36
Items 38, 39, 44, 46, 48, 56, 71
Application Filer/Relationship to Application
Filer
Applicant/Non-Applicant
SSN
Applying with same name as name on SSN
card?
Citizenship/Immigration
Application Filer
Applicant
717-07-6993
Yes
Not a U.S. citizen/national
Attest to eligible immigration status
Document Type:
I-327 Reentry permit
Alien Number:
660031769
Item 73
Five-Year Bar/Veteran Status Questions
Items 131, 132
Non-MAGI Medicaid Eligibility Questions
(physical disabilities, assistance with daily
living, nursing home care)
Pregnancy Questions
Item 147
Item 268 (depending on
implementation)
Do not enter expiration date
Answer "Yes" to question: "Are any of these people an
honorable discharged veteran or active duty member
of the military?" and select Sarah's deceased spouse
More About This Household
Do not answer affirmatively to any non-MAGI questions
Not pregnant
Check Item 56: Verify that alien
number, expiration date, and
additional document type text fields
are optional to provide
Check Item 71: Verify that document
type is optional
UI Question Companion Guide
Application Data
Reference
Item 149
Foster Care Questions
Item 268 (depending on
implementation)
Item 250
Incarceration Questions
Item 268 (depending on
implementation)
Item 144
Full-Time Student Questions
Item 268 (depending on
implementation)
Items 133, 138, 142
Medicaid/CHIP Denial
Household Member Input
Notes to Testers
Not former foster care
Not incarcerated
Not a full time student
Medicaid Block
Does not have Medicaid/CHIP that recently ended or
will end soon
Not denied Medicaid/CHIP in the last 90 days
Items 153, 154, 155, 209
Current Month Income
Item 174
Item 181
Deductions
Annual Income
Item 191
Item 239
Current coverage
Help paying for medical bills
Items 246, 247, 252, 254, 256,
258
Application Review & Legal Attestations
Reference Materials
UI Q CG Eligibility Results Tab:
Items 1, 4, 5
Sample HealthCare.gov Eligibility
Results Messaging
Eligibility Results Page (ERP)
Not denied Medicaid/CHIP due to immigration status in
the last five years
Income
Job: $750 per month
Employer name (and phone number, where Item
209 is included) fields are required but any value
may be entered (ex: ABC corp; 555-555-5555)
No deductions
$9,000.00
Program Questions
None
Do not answer affirmatively
Attestations
Answers affirmatively to all application attestations
Eligibility Results
Determination states:
"May be eligible for Medicaid"
Assessment states:
"May be eligible for Medicaid"
Auditors should review the application review
page (Item 246) to ensure all information
accurately reflects the attestations inputted
during the test case
Auditors should review the Eligibility Results
Page to ensure it accurately reflects the eligibility
results found in the EDN and complies with ERP
messaging requirements outlined in the
documentation listed in Column A
Auditor Checklist
Test Case 2.F input
Summary: This test scenario allows the EDE Entity to demonstrate their UI can support incarcerated application members as part of Phase 2 requirements. The consumer attests that application members are incarcerated. The consumer indicates
the wife is incarcerated and answers "No" to the follow-up question of if they are incarcerated pending disposition of charges. The consumer indicates that the son is incarcerated pending disposition of charges. The consumer attests to not
having eligible immigration status and is therefore not eligible for a QHP. The wife is not eligible for a QHP due to her incarceration status (not pending disposition of charges). The son is eligible for a QHP because his incarceration is pending
UI Question Companion Guide
Application Data
Reference
Tab: UI Questions
Item 1
State
Item 2
Coverage Year
Tab: Phase 2 Screening
Item 1
Item 2
Item 3
Item 5
Items 4, 6, 7 (depending on
implementation)
Item 8
Item 9
Item 10
Item 11
Item 17
Item 12
Item 13
Item 14
Item 16
Application Input
Any state Except AK and HI
Current year
Auditor Checklist
Screening Questions
Marital Status
Number of tax dependents
Who is applying for coverage?
Seeking financial assistance?
Married
1
Application filer, spouse, dependent
Yes
Resides in application state and
lives at same address
Tax filing status
Responsible for a child 18 or
younger not on tax return
American Indian/Alaska Native
Offer of individual coverage HRA
(ICHRA)or a qualified small
employer Health Reimbursement
Arrangement (QSEHRA)
Offer of coverage through job or
COBRA
Claiming all dependents on tax
return
Dependent is child or stepchild,
single (not married), 25 or younger
Dependents live with parent not on
tax return
Yes, all household members live at same address in application state
Pass Screener?
Yes, continue with application
UI Question Companion Guide
Application Data
Reference
Tab: UI Questions
Items 4, 28 Name
Household member
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Notes to Testers
Application State & Coverage Year
Must provide a valid zip code for the application
state
Filing jointly
No one in household is responsible for a child 18 or younger who they live with but isn't on their tax return
No one in household has AI/AN status
No applicants have an ICHRA or QSEHRA offer
No applicants have access to coverage through a job or COBRA
Yes
Yes
No
Household Member Input
John Smyth*
Age: 38
Male
Screening Pass/Fail
Household Member Input
Rita Smyth*
Age: 38
Female
Household
Household Member Input
Todd Smyth*
Age: 19
Male
Notes to Testers
Auditor Checklist
*Do not use Smyth as the last name. Use a different
last name that is unique (it can be a random string
of letters). Do not change the first name
Must provide a valid county and zip code for the
application state
Use any date of birth that results in the correct age
for each household member
Other household contact and information fields
(i.e. email, phone, language preference,
race/ethnicity, etc.) may contain any value unless
otherwise noted. Find additional information in the
UI Question Companion Guide:
- Items 4, 5, 7, 8, 9 Household Contact Information
- Items 10-14 Communication Preferences
- Items 15-20 Help Applying for Coverage
- Items 128-130 Applicant and non-applicant
information - Race and Ethnicity
Item 28
Items 27, 29
Item 32
Item 36
Items 38, 40, 44, 45
Application Filer/Relationship to
Application Filer
Application Filer
Spouse of Rita
Parent of Todd
Applicant/Non-Applicant
Applicant
SSN
Does not have SSN, continue without
providing SSN
Applying with same name as name N/A (should not display for this
on SSN card?
household member)
Citizenship/Immigration
Not a U.S. citizen/national;
Proceed without attesting to eligible
immigration status
Spouse of John
Parent of Todd
Child of John
Child of Rita
Applicant
Does not have SSN, continue without
providing SSN
N/A (should not display for this
household member)
Attests to U.S. citizenship, not
naturalized or derived
Applicant
Does not have SSN, continue without
providing SSN
N/A (should not display for this
household member)
Attests to U.S. citizenship, not
naturalized or derived
Check Item 44: Verify partner's implementation is
compliant with answer options and format outlined
in the UI Q CG (see Item 44, Columns G and R). For
privacy reasons, this question cannot be presented as
a "Yes/No" choice to consumers
UI Question Companion Guide
Reference
Items 131, 132
Item 147
Items 268 (depending on
implementation)
Item 149
Item 268 (depending on
implementation)
Items 250, 251
Item 268 (depending on
implementation)
Item 144
Item 268 (depending on
implementation)
Application Data
Household Member Input
Household Member Input
Household Member Input
Non-MAGI Medicaid Eligibility
Questions (physical disabilities,
assistance with daily living, nursing
home care)
Pregnancy Questions
N/A (should not display for this
household member)
Not pregnant
N/A (should not display for this
household member)
Not former foster care
Foster Care Questions
N/A (should not display for this
household member)
N/A (should not display for this
household member)
Incarceration Questions
Not incarcerated
Incarcerated, not pending disposition of Incarcerated, pending disposition of
charges
charges
Full-Time Student Questions
N/A (should not display for this
household member)
N/A (should not display for this
household member)
Items 133, 138
Medicaid/CHIP Denial
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Items 153, 154, 155, 209
Current Month Income
Job: $3,333.33 per month
Items 174, 175, 176
Items 181, 182, 183
Deductions
Annual Income
Alimony: $100 per month
No deductions
Disagree with calculated annual
$0
income;
Income is not hard to predict; Attest to
$42,000 per year
No deductions
$0
Item 191
Current coverage
None
Items 213, 218, 224
Recent Life Changes (SEPs)
N/A (should not display for this
household member)
N/A (should not display for this
household member)
Items 246, 252, 254, 255, 256,
258
Application Review & Legal
Attestations
Reference Materials
UI Q CG Eligibility Results Tab:
Items 1, 3, 4, 5
Eligibility Results Page (ERP)
Sample HealthCare.gov Eligibility
Results Messaging
Notes to Testers
Auditor Checklist
More About This Household
Do not answer affirmatively to any non- Do not answer affirmatively to any non- Do not answer affirmatively to any
MAGI questions
MAGI questions
non-MAGI questions
Medicaid Block
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Income
No income
Program Questions
N/A (should not display for this
household member)
N/A (should not display for this
household member)
Attestations
Answers affirmatively to all application attestations
Not eligible for health plans, premium
tax credits, lower copayments,
coinsurance, and deductibles (costsharing reductions), or state health
benefits
Eligibility Results
Not eligible for health plans, premium
tax credits, lower copayments,
coinsurance, and deductibles (costsharing reductions), or state health
benefits
Check Item 251: Verify this question displays
conditionally for Rita and Todd after indicating these
applicants are incarcerated
Not a full-time student
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
No income
Employer name (and phone number, where Item
209 is included) fields are required but any value
may be entered (ex: ABC corp; 555-555-5555)
Check Item 181: Verify all household members are
asked of their current income and deductions
regardless of age. The UI should display expected
annual income for each household member
None of these changes
Auditors should review the application review page
(Item 246) to ensure all information accurately
reflects the attestations inputted during the test
case
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Eligible for lower copayments,
coinsurance, and deductibles (costsharing reductions) on Silver plans
Not eligible for a Special Enrollment
Period*
Auditors should review the Eligibility Results Page
to ensure it accurately reflects the eligibility results
found in the EDN and complies with ERP messaging
requirements outlined in the documentation listed
in Column A
*Optional to display if consumer is not eligible for
SEP
Test Case 2.G input
Summary: This scenario includes a single parent applying for himself and his two children. It demonstrates functionality and logic related to former foster care applicants. The older child answers affirmatively to having been formerly in
foster care at age 18 or older, indicates the age they left foster care was 18 (VA), 19 (MI, NE, SC), or 21 (AR, DE, FL, MS, NC, ND, OK), and that they were in foster care in the application state. The younger child is applying with a name
different than on their SSN card. The primary applicant and younger child are found eligible for QHP with APTC based on income while the older child is determined preliminarily eligible for Medicaid based on former foster care status.
The primary applicant is also referred to his state Medicaid agency based on age.
UI Question Companion Guide
Application Data
Application Input
Notes to Testers
Reference
Tab: UI Questions
Application State & Coverage Year
Item 1
State
AR, DE, FL, MI, MS, NC, ND, NE, OK, SC, VA
Item 2
Coverage Year
Current Year
Item 1
Marital Status
Single
Item 2
Number of tax dependents
2
Item 3
Who is applying for coverage?
Application filer, both dependents
Item 5
Items 4, 6, 7 (depending on
implementation)
Seeking financial assistance?
Yes
Item 8
Resides in application state and
lives at same address
Yes, all household members live at same address in application state
Item 9
Tax filing status
Filing taxes
Item 10
Responsible for a child 18 or
younger not on tax return
No one in household is responsible for a child 18 or younger who they live with but isn't on their tax return
Item 11
American Indian/Alaska Native
No one in household has AI/AN status
Item 17
Offer of individual coverage HRA
(ICHRA)or a qualified small
employer Health Reimbursement
Arrangement (QSEHRA)
Offer of coverage through job or
COBRA
No applicants have an ICHRA or QSEHRA offer
Tab: Phase 2 Screening Questions
Item 12
Item 13
Auditor Checklist
Screening Questions
Must provide a valid zip code for the
application state
Check Item 9: Verify the current coverage year
displays in question text
No applicants have access to coverage through a job or COBRA
Claiming all dependents on tax
Yes
return
Dependents are children or
Yes
stepchildren, single (not married),
25 or younger
Dependents live with parent not
No
on tax return
Item 14
Item 16
Screening Pass/Fail
Pass screener?
UI Question Companion Guide
Yes, continue with application
Application Data
Household Member Input
Household Member Input
Tab: UI Questions
Household Member Input
Items 4, 28 Name
Item 5 Home address
Items 7, 8 Mailing address
Item 10 Preferred language
Item 28
Household member
Martin Hartman*
Age: 78
Male
Helen Hartman*
Age: 22
Female
Robert Hartman*
Age: 8
Male
Application Filer/Relationship to
Application Filer
Application Filer
Son/Daughter
Son/Daughter
Items 27, 29
Applicant/Non-Applicant
Applicant
Applicant
Applicant
Item 32
SSN
339-18-0391
339-18-1790
339-18-4454
Items 36, 37
Applying with same name as name Yes
on SSN card?
Yes
No, name on SSN card is William
[last name chosen for scenario]
Item 38
Citizenship/immigration
Attests to U.S. citizenship
Attests to U.S. citizenship
Attests to U.S. citizenship
More About This Household
Items 131, 132
Notes to Testers
Auditor Checklist
Household
Non-MAGI Medicaid Eligibility
Do not answer affirmatively to any
non-MAGI questions
Questions (physical disabilities,
assistance with daily living, nursing
home care)
Do not answer affirmatively to any
non-MAGI questions
Do not answer affirmatively to any
non-MAGI questions
*Do not use Hartman as the last name. Use a
different last name that is unique (it can be a
random string of letters). Do not change the
first name
Check Item 28: Help text appears for Martin
because he is over 65 years old that states if he
has Medicare then he can still get a Marketplace
plan but will not be eligible for tax credits or extra
SSN must be entered exactly for test case to
function
Check Item 37: Verify this open text field only
displays for Robert because he answered "No" to
Item 36
UI Question Companion Guide
Application Data
Household Member Input
Household Member Input
Household Member Input
Item 147
Item 268 (depending on
implementation)
Pregnancy Questions
N/A (should not display for this
household member)
Not pregnant
N/A (should not display for this
household member)
Items 149, 150, 151, 152
Item 268 (depending on
implementation)
Foster Care Questions
N/A (should not display for this
household member)
Former foster care;
State of application state;
Attest "Yes" to receiving Medicaid
N/A (should not display for this
household member)
Item 250
Item 268 (depending on
implementation)
Incarceration Questions
Not incarcerated
Not incarcerated
Not incarcerated
Item 144
Item 268 (depending on
implementation)
Full-Time Student Questions
N/A (should not display for this
household member)
Not a full time student
N/A (should not display for this
household member)
Items 133, 138
Medicaid/CHIP Denial
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Medicaid Block
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Income
Does not have Medicaid/CHIP that
recently ended or will end soon;
Not denied Medicaid/CHIP
Items 153, 154, 155, 209
Current Month Income
Job: $5,458.33 per month
No income
No income
Item 174
Deductions
No deductions
No deductions
No deductions
Item 181
Annual Income
$65,499.96
$0
Notes to Testers
Auditor Checklist
Check Item 151: Verify the question references
the state Medicaid program that is in the state
where the consumer was in foster care
Employer name (and phone number, where
Item 209 is included) fields are required but
any value may be entered (ex: ABC corp; 555555-5555)
$0
Program Questions
Item 191
Current coverage
None
None
None
Item 239
Help paying for medical bills
N/A (should not display for this
household member)
Do not answer affirmatively
N/A (should not display for this
household member)
Items 213, 218, 224, 231, 232, 233, Recent Life Changes (SEPs)
234
Recently moved;
Provide zip code in a different
county than zip code provided in
home address;
N/A (should not display for this
household member)
None of these changes
Items 246, 247, 252, 254, 255, 256, Application Review & Legal
258
Attestations
Answers affirmatively to all application attestations
Check Item 239: Verify "Would any of these
people like help paying for medical bills from the
last 3 months?" only displays for Helen because
she is prelim Medicaid eligible
If a date outside of the last 60 days is entered,
then an error message will appear
Attestations
Reference Materials
UI Q CG Eligibility Results Tab: Items Eligibility Results Page (ERP)
1, 3, 4, 5
Sample HealthCare.gov Eligibility
Results Messaging
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Not eligible for a Special Enrollment
Period*
May be eligible for Medicaid**
Eligibility Results
Determination states:
"Eligible for Medicaid"
Assessment states:
"May be eligible for Medicaid"
Auditors should review the application
review page (Item 246) to ensure all
information accurately reflects the
attestations inputted during the test case
Eligible to buy a Marketplace plan
with a premium tax credit of up to
[amount] each month for your tax
household
Auditors should review the Eligibility Results
Check Eligibility Results Tab, Item 4: Verify UI
Page to ensure it accurately reflects the
displays exact language "What should I do if I
eligibility results found in the EDN and
think my eligibility results are wrong?"
complies with ERP messaging requirements
outlined in the documentation listed in Column
Not eligible for a Special Enrollment A
Period*
*Optional to display if consumer is not eligible
for SEP
**Optional to display for QHP applicant who is
also being referred to the state Medicaid
Test Case 2.H input
Summary: This scenario demonstrates proper UI and functionality of the screener tool for a married application filer claiming one dependent who is seeking coverage and financial assistance.
The application filer also lives in a state different from the application state which requires redirecting the application filer to an alternate pathway because this scenario is not supported by
Phase 2 applications. Therefore, the application filer should answer “No” to the screener question "does everyone have the same permanent home address and currently live in [application
UI Question Companion
Guide Reference
Tab: UI Questions
Item 1
Item 2
Tab: Phase 2 Screening
Questions
Item 1
Item 2
Item 3
Item 5
Items 4, 6, 7 (depending on
implementation)
Item 8
Application Data
State
Coverage Year
Application Input
Any state
Current Year
Screening Questions
Married
1
Application filer, spouse, dependent
Yes
Resides in application state and lives at
same address
No, application filer lives in separate state from application state
Item 9
Tax filing status
Filing jointly
Item 10
Responsible for a child 18 or younger not
on tax return
American Indian/Alaska Native
Offer of individual coverage HRA (ICHRA)
or a qualified small employer Health
Reimbursement Arrangement (QSEHRA)
Offer of coverage through job or COBRA
No one in household is responsible for a child 18 or younger who they
live with but isn't on their tax return
No one in household has AI/AN status
Does not have an ICHRA or QSEHRA offer
Item 12
Item 13
Item 14
Item 16
Auditor Checklist
Application State & Coverage Year
Marital Status
Number of tax dependents
Who is applying for coverage?
Seeking financial assistance?
Item 11
Item 17
Notes to Testers
No applicants have access to coverage through a job or COBRA
Claiming all dependents on tax return
Yes
Dependent is child or stepchild, single (not Yes
married), 25 or younger
Dependents live with parent not on tax
No
return
Pass Screener?
Screening Pass/Fail
No, consumer should be guided to alternate pathway and should not
complete application
This scenario is not supported by Phase 2
applications. This answer will result in the
consumer being redirected to an alternate
pathway
Check Item 9: Verify that the question is
worded as or similarly to "Do you plan to
file a joint federal income tax return with
your spouse for [insert coverage year]?"
Check Item 12: The question should be
worded as or similarly to "Are either of
you offered health coverage through your
job, someone else's job, or COBRA?"
When a consumer fails the screening
Verify the consumer is guided to an
questions, the UI should redirect the
alternate pathway with consumer friendly
consumer to HealthCare.gov or a Direct
language
Enrollment pathway and display consumer
friendly language as to why they cannot
continue the application on the entity site
| File Type | application/pdf |
| File Title | Eligibility Results Toolkit - Phase 2 |
| Subject | CMS, Eligibility Results Toolkit, Auditor, Phase 2, Test Case 2.A Input, Test Case 2.B.1 Input, Test Case 2.B.2 Input, Test Case |
| Author | Centers for Medicare & Medicaid Services (CMS) |
| File Modified | 2023-10-31 |
| File Created | 2023-10-11 |