Medical Assistance |
FFM Application in the VaCMS (Field Mapping) |
About
Customers applying for medical coverage through the Federally Facilitated Marketplace (FFM) complete an application that looks substantially different than the one provided by Virginia. Pages, fields, and response options do not always correlate exactly to those contained in the VaCMS.
When electronic applications arrive from the FFM, the VaCMS, through a backend process, automatically converts many of the FFM responses to their appropriate VaCMS option. However, the FFM fields remain in the PDF copy of the application.
The chart below lists each FFM field in the first column, the corresponding VaCMS field in the second, and the VaCMS page where the field is located in the third.
FFM Field |
VaCMS Field |
VaCMS Page |
| Transfer Details | ||
| Application Transfer Date / Time | ||
| Transfer ID | ||
| Insurance Application Details | ||
| Application ID | ||
| Application Signature Date | ||
| Applying for Financial Assistance Indicator | ||
| Attested Non Perjury Indicator | ||
| Tax Return Access | ||
| Privacy Policy Agreement Indicator | ||
| Primary Contact Details | ||
| First Name | First Name | Household Address |
| Middle Name | Middle Name | Household Address |
| Last Name | Last name | Household Address |
| Suffix Name | Suffix Name | Household Address |
| Address Type Code | Address Type Code | Household Address |
| Street Name 1 | Street name 1 | Household Address |
| Street name 2 | Street Name 2 | Household Address |
| City Name | City Name | Household Address |
| State Code | State Code | Household Address |
| Zip Code | Zip Code | Household Address |
| County Code | See Understanding FFM Applications in the VaCMS (Reference Codes) | Household Address |
| Phone Number | Phone Number | Household Address |
| Extension | Phone #2 Extension | Household Address |
| Notification Email Address | Household Address | |
| Spoken Language | Preferred Language | Client Information |
| Written Language | Written Language | Client Information |
| Application Signature | Not Collected in VaCMS | N/A |
| Application Details | ||
| First Name | First Name | Client Information |
| Middle Name | Middle | Client Information |
| Last name | last name | Client Information |
| Suffix name | Suffix | Client Information |
| Address Type Code | If addressed received is home address then it would be populated as the Physical Address. | Household Address |
| Street Name 1 | Street # | Household Address |
| Street Name 2 | Address Line 2 / PO Box | Household Address |
| City Name | City | Household Address |
| State Code | State | Household Address |
| Zip Code | Zip Code | Household Address |
| County Code | See Understanding FFM Applications in the VaCMS (Reference Codes) | Household Address |
| Birth Date | DOB | Client Information |
| Sex Male | Gender | Client Information |
| Social Security Number | SSN | Client Information |
| US Citizen Indicator | Citizenship | Client Information |
| Person American Indian Alaska Native Status | Primary Race | Client Information |
| Wife | Relationship | |
| Son | Relationship | |
| Daughter | Relationship | |
| Related to another way | Relationship | |
| Father | Relationship | |
| Relationship to Tax Filer Code | Relationship | |
| Fixed Address Indicator | Not Collected in VaCMS | N/A |
| Medical Bills Within 90 Days | Not Collected in VaCMS | N/A |
| Other Coverage Within 6 Months Indicator | Not Collected in VaCMS | N/A |
| Age Left Foster Care | Not Collected in VaCMS | N/A |
| Had Medicaid During Foster Care Indicator | Not Collected in VaCMS | N/A |
| Applicant Attest Disabled | Is anyone in the household disabled? | Individual Information - Questions |
| Applicant Attest Long Term Care | Living Arrangement Type | Living Arrangement |
| Reason Coverage Ended Code | Not Collected in VaCMS | N/A |
| Other Coverage Type Code | Not Collected in VaCMS | N/A |
| Other Coverage Insurance name | Not Collected in VaCMS | N/A |
| Other Coverage Insurance Policy Number | Not Collected in VaCMS | N/A |
| Identification Number | Alien | Alien |
| Identification Number Type | Alien Status Verification Source | Alien |
| Foreign Passport Country of Issuance Code | Foreign Passport Country of Issuance | Alien |
| Document Expiration Date | Passport Expiration Date | Alien |
| Document Name | Passport Number | Alien |
| Document Type Code | Use if Identification Number Type is blank. | Alien |
| Document Type Other Code | Not Collected in VaCMS | N / A |
| Received Indian Health Services Indicator | Indian Health Services | Client Demographics |
| Access to State Employee Benefit Plan | State Employee Health Insurance | Client Demographics |
| Student Indicator | School Enrollment Status | Education |
| Maps to Indian Tribe State Code | Tribal State | Client Demographics |
| Veteran Status Indicator | Veteran or dependent of a veteran? | Client Demographics |
| Employer EIN | Employer EIN | Employer Health Insurance |
| Employer Name | Employer Name | Employment |
| Employee Status Code | Not collected in VaCMS | N/A |
| COBRA Coverage Available Indicator | Is coverage from employer COBRA coverage? | Employer Health Insurance |
| Employee Indicator | Is anyone in the household covered by Employment Health Insurance? | Non-Financial Questions |
| Coverage Offered Through This Job | Is anyone in the household covered by medical insurance? | Non-Financial Questions |
| Retiree Plan Coverage Indicator | Is employer coverage a retiree health plan? | Employer Health Insurance |
| Date LCSOP Will End | What will be the last day this employer offers coverage? | Employer Health Insurance |
| Date LCSOP Premium Will Change | When will employer make change? | Employer Health Insurance |
| Date ESI Coverage Will End | What will be the last day this employer offers coverage? | Employer Health Insurance |
| Date ESI Coverage Will Start | Date Health Coverage started. | Employer Health Insurance |
| Employer Offers Minimum Value Standard Plan | Plan meet "Minimum value standard?" | Employer Health Insurance |
| Most Recent Hire Date | Not collected in VaCMS | N/A |
| Referral Details
This section shows who is applying for coverage. This will correspond to the individuals requesting assistance on the Program Request page. |
||
| Person Name | Not collected in VaCMS | N/A |
| Referral ID | Not collected in VaCMS | N/A |
| Referral Activity Status Code | INITIATED: An initial referral to the FFM from
the VaCMS OR to the VaCMS from the FFM.
ACCEPTED: An FFM referral with Approved eligibility results in the VaCMS sent to the FFM. REJECTED: An FFM referral with Denied eligibility results in the VaCMS sent to the FFM. |
N/A |
| Tax Return Details | ||
| Married Filing Jointly Code | If Yes, then mark Tax Filing Status as Joint Payer | Client Demographics |
| Dependent Indicator | If Yes, then mark Tax Filing Status as Tax Dependent | Client Demographics |
| Tax Filer Indicator | If Yes, then mark Tax Filing Status as Tax Payer | Client Demographics |
| Attested Annual Income This Year | Yearly Details | |
| Verification Details | ||
| Persons Verified | Not collected in VaCMS | N/A |
| SSN Verification Indicator | Verified by Federal Hub (Y / N) | Client |
| Lawful Presence Verified Code | Verified by Federal Hub (Y / N) | Alien |
| US Citizen Code | Verified by Federal Hub (Y / N) | Client Demographics |
| Qualified Non-Citizen Code | Verified by Federal Hub (Y / N) | Alien |
| Verification Authority | See Understanding FFM Applications in the VaCMS (Reference Codes) | |
| Verification Type Code | SSN: Verified by Federal Hub (Y / N)
Citizenship: Verified by Federal Hub (Y / N) Eligible Immigration Status: Lawful Presence Verified by Federal Hub (Y / N) Incarceration Status: Incarceration Verified by Federal Hub (Y / N) Current Income: N / A |
SSN: Client
Citizenship: Client Demographics Eligible Immigration Status: Client Demographics Incarceration Status: Client Demographics |
| Household Member Details | ||
| First Name | First Name | Client |
| Last Name | Last Name | Client |
| Middle name | Middle Name | Client |
| Suffix Name | Suffix | Client |
| Person Race Name | Race | Client |
| Person Ethnicity Name | Ethnicity | Client |
| Income Type Code | See Understanding FFM Applications in the VaCMS (Reference Codes) | Employment Self Employment Unearned Income |
| Income Type Amount | Unearned
Income Amount Earned Income Amount Self-Employment Income Amount |
Employment Self Employment Unearned Income |
| Income Frequency Code | See Understanding FFM Applications in the VaCMS (Reference Codes) | Employment Self Employment Unearned Income |
| Hours Per Week | No. of Hours expected to work per week | Employment Self Employment |
| Type of Work | Self-Employment Type | Self-Employment Details |
| Date Unemployment Will End | Effective End Date | Unearned Income |
| Data Source Income Frequency Code | See Understanding FFM Applications in the VaCMS (Reference Codes) | Employment - Pay Details |
| Pay Period End Date | Pay Period End Date | Employment - Employer |
| Hours Worked in Pay Period | Actual Pay Period Hours | Employment - Pay Details |
| Employer Identifier | EIN | Employment Health Insurance Details |
| Employer Street 1 | Street # | Employment Health Insurance Details |
| Employer City | City | Employment Health Insurance Details |
| Employer State Code | State | Employment Health Insurance Details |
| Employer Zip Code | Zip Code | `Employment Health Insurance Details |
| Pregnant Indicator | Is anyone in the household currently pregnant? | Individual Information - Questions |
| Member of Applicant's Medicaid Household | Household Status | Client - Household Status |
| Assister Details | ||
| Navigator / Assister First Name | First | Certified Application Counselor |
| Navigator / Assister Middle Name | Middle | Certified Application Counselor |
| Navigator / Assister Last Name | Last | Certified Application Counselor |
| Navigator / Assister Suffix | Suffix | Certified Application Counselor |
| Name of Assister Organization | Organization Name | Certified Application Counselor |
| Assister Organization Identification Number | ID Number | Certified Application Counselor |
| Assister Designation Date | Date Change Occurred | Certified Application Counselor |
| Authorized Representative Details | ||
| Authorized Representative First Name | First Name | Authorized Representative |
| Authorized Representative Middle Name | Middle Name | Authorized Representative |
| Authorized Representative Last Name | Last Name | Authorized Representative |
| Authorized Representative Suffix | Suffix | Authorized Representative |
| Name of Organization Authorized Rep | Organization Name | Authorized Representative |
| Authorized Rep Designation date | Not collected in VaCMS | Authorized Representative |
Updated 06/30/2017