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pdfDepartment of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida
Program Code: FL
Age Range: Under 0
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
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0
0
0
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Created On: Tuesday, July 17, 2018 12:35 PM
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Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida
Program Code: FL
Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida
Program Code: FL
Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida
Program Code: FL
Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program
State: Florida
Program Code: FL
Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
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0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida
Type of Eligible: U2
Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida
Type of Eligible: U2
Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida
Type of Eligible: U2
Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program
State: Florida
Type of Eligible: U2
Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.21E
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 0 - 1
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 1 - 5
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 6 - 12
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 13 - 18
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served in Medicaid Expansion Program (Informational)
State: Florida
Quarter:4/2018
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Type of Eligible: U2
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 64.21EI
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida
Transaction File
Quarter:4/2018
Age Range: 0 - 1
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida
Transaction File
Quarter:4/2018
Age Range: 1 - 5
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida
Transaction File
Quarter:4/2018
Age Range: 6 - 12
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
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0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
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0
0
0
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0
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0
0
0
0
0
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0
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0
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0
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0
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0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida
Transaction File
Quarter:4/2018
Age Range: 13 - 18
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
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0
0
0
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0
0
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0
0
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0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
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0
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0
0
0
0
0
0
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0
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0
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0
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0
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0
0
0
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0
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0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program
State: Florida
Transaction File
Quarter:4/2018
Age Range: 19 - 20
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 64.EC
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 0 - 1
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 1 - 5
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 6 - 12
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 13 - 18
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 20
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Children Served in Medicaid Program (Informational)
State: Florida
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 20
Percentage of FPL
0-133
134-200
201-250
251-300
301
(A)
(B)
(C)
(D)
(E)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 64.ECI
Transaction File
Quarter:4/2018
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction file
CHIP Statistical Enrollment Data System
State: Florida
Gender, Race, Ethnicity
1 - Female
2 - Male
3 - Unspecified Gender
1 - White
2 - Black or African American
3 - American Indian or Alaska Native
4 - Asian Indian
5 - Chinese
6 - Filipino
7 - Japanese
8 - Korean
9 - Vietnamese
10 - Other Asian
11 - Asian Unknown
12 - Native Hawaiian
13 - Guamanian or Chamorro
14 - Samoan
15 - Other Pacific Islander
16 - Native Hawaiian or Other Pacific Islander Unknown
17 - Some other race
18 - Two or more races (regardless of ethnicity)
19 - Unspecified Race
1 - Not of Hispanic, Latino/a, or Spanish origin
2 - Mexican, Mexican American, Chicano/a
3 - Puerto Rican
4 - Cuban
5 - Another Hispanic, Latino, or Spanish Origin
6 - Hispanic or Latino Unknown
7 - Unspecified Ethnicity
Form: Gndr./Race/Ethn.
21E Enrolled
64.21E Enrolled
Gender
0
0
0
Race
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Ethnicity
0
0
0
0
0
0
0
Total CHIP Enrolled
Quarter: 4/2018
21PW Enrolled
64.EC Enrolled
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:35 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served
State: Colorado
Program Code: CO
Quarter:4/2018
Age Range: 19 - 64
Percentage of FPL
134-200
201-250
251-300
(B)
(C)
(D)
0-133
(A)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
1B - Man Care Arngmt
0
1C - Pri Care CA Mgt
0
Total
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
2B - Man Care Arngmt
0
2C - Pri Care CA Mgt
0
Total
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
3B - Man Care Arngmt
0
3C - Pri Care CA Mgt
0
Total
0
4. # Member Months Enrollment
4A - Fee For Service
0
4B - Man Care Arngmt
0
4C - Pri Care CA Mgt
0
Total
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
5B - Man Care Arngmt
0.0
5C - Pri Care CA Mgt
0.0
Total
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
6B - Man Care Arngmt
0
6C - Pri Care CA Mgt
0
Total
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
7B - Man Care Arngmt
0
7C - Pri Care CA Mgt
0
Total
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
8B - Man Care Arngmt
0
8C - Pri Care CA Mgt
0
Total
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
9B - Man Care Arngmt
0
9C - Pri Care CA Mgt
0
Total
0
Form: CMS 21PW
Transaction File
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served (Informational)
State: Colorado
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 64
Program Code: CO
Percentage of FPL
0-133
134-200
201-250
251-300
(A)
(B)
(C)
(D)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 21PWI
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Pregnant Women served (Informational)
State: Colorado
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 64
Program Code: CO
Percentage of FPL
0-133
134-200
201-250
251-300
(A)
(B)
(C)
(D)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
Total
0
0
0
0
Form: CMS 21PWI
Transaction File
Quarter:4/2018
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration
State: Colorado
Transaction File
Quarter:4/2018
Age Range: 19 - 64
Pregnant women
0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21Waiver
Percentage of FPL
201-250
251-300
(C)
(D)
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration (Informational)
State: Colorado
Information Category: DS (Dental-only Supplmental Coverage)
Age Range: 19 - 64
Transaction File
Quarter:4/2018
Sub-Category: Pregnant
women
0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21WaiverI
Percentage of FPL
201-250
251-300
(C)
(D)
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Children's Health Insurance Program
Number of Adults Served, CHIP Demonstration (Informational)
State: Colorado
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 19 - 64
Transaction File
Quarter:4/2018
Sub-Category: Pregnant
women
0-133
134-200
(A)
(B)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
1B - Man Care Arngmt
0
0
1C - Pri Care CA Mgt
0
0
Total
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
2B - Man Care Arngmt
0
0
2C - Pri Care CA Mgt
0
0
Total
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
3B - Man Care Arngmt
0
0
3C - Pri Care CA Mgt
0
0
Total
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
4B - Man Care Arngmt
0
0
4C - Pri Care CA Mgt
0
0
Total
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
Total
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
6B - Man Care Arngmt
0
0
6C - Pri Care CA Mgt
0
0
Total
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
7B - Man Care Arngmt
0
0
7C - Pri Care CA Mgt
0
0
Total
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
8B - Man Care Arngmt
0
0
8C - Pri Care CA Mgt
0
0
Total
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
9B - Man Care Arngmt
0
0
9C - Pri Care CA Mgt
0
0
Total
0
0
Form: CMS 21WaiverI
Percentage of FPL
201-250
251-300
(C)
(D)
301
(E)
Total
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
CHIP Statistical Enrollment Data System
State: Colorado
Waiver Gender, Race, Ethnicity
Transaction file
Quarter: 4/2018
Adults Enrolled
Gender
1 - Female
2 - Male
3 - Unspecified Gender
Race
1 - White
2 - Black or African American
3 - American Indian or Alaska Native
4 - Asian Indian
5 - Chinese
6 - Filipino
7 - Japanese
8 - Korean
9 - Vietnamese
10 - Other Asian
11 - Asian Unknown
12 - Native Hawaiian
13 - Guamanian or Chamorro
14 - Samoan
15 - Other Pacific Islander
16 - Native Hawaiian or Other Pacific Islander Unknown
17 - Some other race
18 - Two or more races (regardless of ethnicity)
19 - Unspecified Race
Ethnicity
1 - Not of Hispanic, Latino/a, or Spanish origin
2 - Mexican, Mexican American, Chicano/a
3 - Puerto Rican
4 - Cuban
5 - Another Hispanic, Latino, or Spanish Origin
6 - Hispanic or Latino Unknown
7 - Unspecified Ethnicity
Form: Waiver Gndr./Race/Ethn.
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Created On: Tuesday, July 17, 2018 12:44 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: Under 0
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI
Created On: Wednesday, July 18, 2018 2:26 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 0 - 1
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI
Created On: Wednesday, July 18, 2018 2:26 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 1 - 5
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI
Created On: Wednesday, July 18, 2018 2:26 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 6 - 12
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI
Created On: Wednesday, July 18, 2018 2:26 PM
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Transaction File
Children's Health Insurance Program
Number of CHIP Children Served, Separate Child Health Program (Informational)
State: Utah
Quarter:4/2017
Information Category: ESI (Employer Sponsored Insurance)
Age Range: 13 - 18
Program Code: UT
Percentage of FPL
0-133
134-200
201-250
251-300
301
Total
(A)
(B)
(C)
(D)
(E)
(F)
1. Unduplicatd # Ever Enrolled
1A - Fee For Service
0
0
0
0
0
0
1B - Man Care Arngmt
0
0
0
0
0
0
1C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
2. Unduplicated # New Enrollees
2A - Fee For Service
0
0
0
0
0
0
2B - Man Care Arngmt
0
0
0
0
0
0
2C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
3. Unduplicated # Disenrollees
3A - Fee For Service
0
0
0
0
0
0
3B - Man Care Arngmt
0
0
0
0
0
0
3C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
4. # Member Months Enrollment
4A - Fee For Service
0
0
0
0
0
0
4B - Man Care Arngmt
0
0
0
0
0
0
4C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
5. Average # Months (Line 4/1)
5A - Fee For Service
0.0
0.0
0.0
0.0
0.0
0.0
5B - Man Care Arngmt
0.0
0.0
0.0
0.0
0.0
0.0
5C - Pri Care CA Mgt
0.0
0.0
0.0
0.0
0.0
0.0
Total
0.0
0.0
0.0
0.0
0.0
0.0
6. # of Children Enrolled at Last Day of Quarter
6A - Fee For Service
0
0
0
0
0
0
6B - Man Care Arngmt
0
0
0
0
0
0
6C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
7. Unduplicated # Ever Enrolled Year
7A - Fee For Service
0
0
0
0
0
0
7B - Man Care Arngmt
0
0
0
0
0
0
7C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
8. Unduplicated # New Enrollees Year
8A - Fee For Service
0
0
0
0
0
0
8B - Man Care Arngmt
0
0
0
0
0
0
8C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
9. Unduplicated # Disenrollees Year
9A - Fee For Service
0
0
0
0
0
0
9B - Man Care Arngmt
0
0
0
0
0
0
9C - Pri Care CA Mgt
0
0
0
0
0
0
Total
0
0
0
0
0
0
Form: CMS 21EI
Created On: Wednesday, July 18, 2018 2:26 PM
| File Type | application/pdf |
| File Modified | 2018-07-19 |
| File Created | 2018-07-18 |