| Label | Type | Description | Mandatory |
| Eligibility Result Date | CURAM_DATE | The date on which the eligibility for Medical Assistance was determined. | No |
|
| Retroactive Month 1 |
| Label | Type | Description | Mandatory |
| Coverage Type | PRODUCT_NAME_CODE | Medical Assistance coverage type the household is eligible for, but is not currently receiving. | No |
| Household Member | ISP_HHOLDMEMBER_LIST | Household member(s) eligible for the Medical Assistance program. The abbreviations (m) and (o)are used to denote mandatory and optional members for Low Income Families with Children. | No |
| Primary Client | CONCERN_ROLE_NAME | Individual determined to be the primary client of the product delivery case for the eligible Retroactive Medical Assistance program. | No |
| From | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
| To | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
|
| Retroactive Month 2 |
| Label | Type | Description | Mandatory |
| Coverage Type | PRODUCT_NAME_CODE | Medical Assistance coverage type the household is eligible for, but is not currently receiving. | No |
| Household Member | ISP_HHOLDMEMBER_LIST | Household member(s) eligible for the Medical Assistance program. The abbreviations (m) and (o)are used to denote mandatory and optional members for Low Income Families with Children. | No |
| Primary Client | CONCERN_ROLE_NAME | Individual determined to be the primary client of the product delivery case for the eligible Retroactive Medical Assistance program. | No |
| From | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
| To | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
|
| Retroactive Month 3 |
| Label | Type | Description | Mandatory |
| Coverage Type | PRODUCT_NAME_CODE | Medical Assistance coverage type the household is eligible for, but is not currently receiving. | No |
| Household Member | ISP_HHOLDMEMBER_LIST | Household member(s) eligible for the Medical Assistance program. The abbreviations (m) and (o)are used to denote mandatory and optional members for Low Income Families with Children. | No |
| Primary Client | CONCERN_ROLE_NAME | Individual determined to be the primary client of the product delivery case for the eligible Retroactive Medical Assistance program. | No |
| From | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
| To | CURAM_DATE | From Date for the eligible Retroactive Medical Assistance program. | No |
|
