T-MSIS Valid Value List Crosswalk (Change Log) Version 4.0.0 to Version 4.1.1

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Centers for Medicaid and CHIP Services (CMCS)

Transformed Medicaid Statistical Information System (T-MSIS)
T-MSIS Valid Value List Crosswalk (Change Log) - Version 4.0.0 to Version 4.1.1
Last Modified: 2026-05-29

PRA Disclosure Statement: The Transformed Medicaid Statistical Information System (T-MSIS) is used to assist the Centers for Medicare & Medicaid Services (CMS) with monitoring
and oversight of Medicaid and CHIP programs, to enable evaluation of demonstrations under section 1115 of the Social Security Act and to calculate quality measures and other metrics, including those reported
through the new Medicaid and CHIP Scoreboard. Section 4735 of the Balanced Budget Act of 1997 included a statutory requirement for states to submit claims data, enrollee encounter data,
and supporting information. Section 6504 of the Affordable Care Act strengthened this provision by requiring states to include data elements the Secretary determines necessary for program integrity, program
oversight, and administration. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. 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 0938-0345 (Expires: 11/30/2027).
The time required to complete this information collection is estimated to average 11.25 hours per response, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. 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.

1

Date

Name And/ Or
Number

202605-29

Field(s)

Action

Before

After

IMMIGRATIONSTATUS

Description,
Effective
End Date

REPLACE

IMMIGRATION-STATUS|1|Qualified alien||01/01/0001|12/31/9999

IMMIGRATION-STATUS|1|Qualified alien|Noncitizen beneficiaries who are
qualified noncitizens. Not an applicable immigration status after
9/30/2026.|01/01/0001|09/30/2026

202605-29

IMMIGRATIONSTATUS

Description

REPLACE

IMMIGRATION-STATUS|2|Lawfully present under CHIPRA
214||01/01/0001|12/31/9999

IMMIGRATION-STATUS|2|Lawfully present under CHIPRA 214|Lawfully
present women or children in states that elect to cover under CHIPRA
214.|01/01/0001|12/31/9999

202605-29

IMMIGRATIONSTATUS

Name,
Description

REPLACE

IMMIGRATION-STATUS|3|Eligible only for payment for emergency
services|aliens who are either not qualified for Medicaid or who are
currently subject to a five-year bar.|01/01/0001|12/31/9999

IMMIGRATION-STATUS|3|Eligible for payment for emergency Medicaid
services only|Noncitizen who is not FFP-eligible, not eligible under CHIPRA
214, or who is currently subject to a five-year waiting period, seven-year
limit or 40 quarters requirements in Medicaid
only.|01/01/0001|12/31/9999

202605-29

IMMIGRATIONSTATUS

All valid
value
attributes

ADD

N/A

IMMIGRATION-STATUS|4|Eligible noncitizen|FFP-eligible noncitizen:
Lawful Permanent Resident, Cuban/Haitian entrant, or Compact of Free
Association (COFA) Migrant.
Use on or after 10/1/2026.|10/01/2026|12/31/9999

202605-29

IMMIGRATIONSTATUS

Name

REPLACE

IMMIGRATION-STATUS|8|Not Applicable (U.S. citizen or U.S.
national)||01/01/0001|12/31/9999

IMMIGRATION-STATUS|8|U.S. citizen or U.S.
national||01/01/0001|12/31/9999

202605-29

ELIGIBILITYTERMINATIONREASON

Name,
Effective
End Date

REPLACE

ELIGIBILITY-TERMINATION-REASON|17|Lack of verifications (e.g.,
unable to successfully verify citizenship status, immigration status,
income, or other information from an application; if unverifiable due
to non-response, document as "Failure to
respond)||01/01/0001|12/31/9999

ELIGIBILITY-TERMINATION-REASON|17|Do not use after 06/30/2027
- Lack of verifications (e.g., unable to successfully verify citizenship
status, immigration status, income, or other information from an
application; if unverifiable due to non-response, document as
"Failure to respond) ||01/01/0001|06/30/2027

202605-29

ELIGIBILITYTERMINATIONREASON

All valid
value
attributes

ADD

N/A

ELIGIBILITY-TERMINATION-REASON|32|Beneficiary income could
not be verified (if unable to verify due to non-response, report with
"failure to respond" using valid value '13')||01/01/0001|12/31/9999

2

Date
202605-29

Name And/ Or
Number
ELIGIBILITYTERMINATIONREASON

Field(s)
All valid
value
attributes

Action
ADD

Before
N/A

After
ELIGIBILITY-TERMINATION-REASON|33|The individual's immigration
status or citizenship status could not be verified - or - the individual's
immigration status is verified and their status is not satisfactory for
full benefits (i.e., IMMIGRATION-STATUS does not equal 2 [CHIPRA
214] or 4 [eligible noncitizen])
If unable to verify due to non-response, report with "failure to
respond" using valid value '13'||01/01/0001|12/31/9999

202605-29

ELIGIBILITYTERMINATIONREASON

202605-29

ADD

N/A

ELIGIBILITY-TERMINATION-REASON|36|Unable to verify other
information from a beneficiary's case file (if unable to verify due to
non-response, report with "failure to respond" using valid value
'13')||01/01/0001|12/31/9999

TRANSACTION- Name
TYPE

REPLACE

TRANSACTION-TYPE|03|Direct reimbursement to beneficiaries for
retroactive period cost (e.g. 42 CFR
447.25)||01/01/0001|12/31/9999

TRANSACTION-TYPE|03|Direct reimbursement to beneficiaries for
retroactive period cost (e.g. 42 CFR
447.25)||01/01/0001|12/31/9999

202605-29

TRANSACTION- Name
TYPE

REPLACE

TRANSACTION-TYPE|04|Direct reimbursement to beneficiaries for
non-emergency transportation||01/01/0001|12/31/9999

TRANSACTION-TYPE|04|Direct reimbursement to beneficiaries for
non-emergency transportation||01/01/0001|12/31/9999

202605-29

TRANSACTION- All valid
TYPE
value
attributes
MANAGEDName
CARE-PLANTYPE

ADD

N/A

TRANSACTION-TYPE|05|PMPM Health Home Service
Payment||01/01/0001|12/31/9999

REPLACE

MANAGED-CARE-PLAN-TYPE|03|Enhanced PCCM
Provider||01/01/0001|12/31/9999

MANAGED-CARE-PLAN-TYPE|03|PCCM
Entity||01/01/0001|12/31/9999

202605-29

All valid
value
attributes

3