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Child & Teen Checkups Program

CMS 416 Reports

State of Minnesota
CHB/Tribe

CHB/Tribe Line 10

Racial/Ethnic Groups
Fee-for-Service and Health Plan

CHB/Tribe Dental Services


Participation Reports
The CMS – 416 Report is a federal requirement for Minnesota’s annual reporting to the federal Centers for Medicare and Medicaid Services (CMS) on the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) or Child and Teen Checkups Program (C&TC) as it is called in Minnesota.

Individual county breakdown reports are created from the annual state report. The same methods are used to calculate all 14 line items for both state and county reports. The report line items include both Medical Assistance (MA) and MinnesotaCare enrolled children for both state and county reports.

Read the “Total” line when reviewing either the state or county reports. (CN or Categorically Needy, and MN or Medically Needy, are federal reporting categories, based on certain kinds of eligibility factors.)


State of Minnesota Participation Reports


CHB/Tribe Participation Reports

CHB/Tribe Line 10 Participation Reports
County/Tribe Comparison – C&TC Federal 416 Calculation Method of Line 10 Participation Rates for:


Racial/Ethnic Groups Participation Reports
This report is generated using the same methodology as the statewide, county and tribal CMS-416 C&TC participation reports. This report breaks the data out by racial/ethnic groups as reported on the Minnesota Health Care Programs application. The category of “Unknown/Other” represents applications received by mail where the race/ethnicity information was not completed.

• CMS-416 by Racial/Ethnic Groups FFY 2009 C&TC Participation Report, for the period of 10/01/2008 through 9/30/2009
• CMS-416 by Racial/Ethnic Groups FFY 2008 C&TC Participation Report, for the period of 10/01/2007 through 9/30/2008
• CMS-416 By Racial/Ethnic Groups FFY 2007 C&TC Participation Report, for the period of 10/01/2006 through 09/30/2007
• CMS-416 by Racial/Ethnic Groups FFY 2006 C&TC Participation Report, for the period of 10/01/2005 through 9/30/2006
• CMS-416 By Racial/Ethnic Groups FFY 2005 C&TC Participation Report, for the period of 10/01/2004 through 09/30/2005

Fee-for-Service and Health Plan Participation Reports

CHB/Tribe Dental Services Participation Report

The CMS Web site
provides additional information about the CMS 416 Report, including line item definitions.

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