www.medicaid.gov: Accessibility — week 2026-W31

Automated Accessibility Conformance Report (OpenACR): Download ACR. Machine-readable; compatible with GSA OpenACR tooling. Automated tools find ~⅓ of real barriers — supplement with manual AT testing.

Training priorities

Top WCAG success criteria by pages affected this week. Use these to focus team training on the highest-impact issues.

SC	Criterion	Pages	Rules
1.4.6	WCAG 1.4.6	3319	1
2.5.5	WCAG 2.5.5	3319	1
1.4.8	WCAG 1.4.8	2191	2
4.1.2	Name, Role, Value (ARIA)	925	4
1.3.1	Info and Relationships (semantic structure)	848	2

Next 10 actions

Clusters are fingerprinted by normalized selector path + rule id + snippet shape. Rank score = (severity weight × pages affected) / distinct components for the rule. This supersedes the template threshold heuristic while still surfacing it as a validation signal.

Top 10 clustered component fixes for this week.
Cluster	Severity	Pages	Who it affects	How to fix	Evidence	Decision
Page should contain a level-one heading · unattributed component Fix one place, resolve ~2278 finding(s) on 2278 page(s). XPath / selector: `html` `<html class="no-js" lang="en">`	Moderate	2278	Requires manual testing.	See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/page-has-heading-one?application=axeAPI	pages (CSV)	Decision Assigned to Notes
Document should have one main landmark · unattributed component Fix one place, resolve ~2274 finding(s) on 2274 page(s). XPath / selector: `html` `<html class="no-js" lang="en">`	Moderate	2274	Requires manual testing.	Each page should have exactly one <main> landmark.	pages (CSV)	Decision Assigned to Notes
First focusable element is link to main content · unattributed component Fix one place, resolve ~1142 finding(s) on 1142 page(s). XPath / selector: `{"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys`	Moderate	1142	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r87	pages (CSV)	Decision Assigned to Notes
Form field label is visible · unattributed component Fix one place, resolve ~1136 finding(s) on 1136 page(s). XPath / selector: `{"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys`	Moderate	1136	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r61	pages (CSV)	Decision Assigned to Notes
Certain ARIA roles must contain particular children · unattributed component Fix one place, resolve ~465 finding(s) on 465 page(s). XPath / selector: `.nav` `<div class="nav nav-tabs nav-justified" role="tablist">`	Critical	465	Without vision, Limited vision, Limited cognitive, language, or learning ability	Add the child roles this container role requires (e.g. a list needs listitem children).	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~2279 finding(s) on 2279 page(s). XPath / selector: `.small` `<div class="small p-1">`	Moderate	2279	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~2276 finding(s) on 2276 page(s). XPath / selector: `.justify-content-between` `<div class="d-flex justify-content-between m-2 mb-2">`	Moderate	2276	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~2275 finding(s) on 2275 page(s). XPath / selector: `.font-weight-bold` `<p class="font-weight-bold m-0 mr-1">Version:</p>`	Moderate	2275	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes
Scrolling content can be accessed by keyboard · unattributed component Fix one place, resolve ~2180 finding(s) on 2180 page(s). XPath / selector: `text: " Feedback "`	Moderate	2180	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r57	pages (CSV)	Decision Assigned to Notes
Text has minimum contrast ratio of 4.5:1 · unattributed component Fix one place, resolve ~2177 finding(s) on 2177 page(s). XPath / selector: `<p class="usa-footer__contact-info margin-bottom-0">`	Moderate	2177	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r73	pages (CSV)	Decision Assigned to Notes

Bug reports

9 issue type(s) are shown by default out of 31 total. Prioritized by severity, key pages, WCAG level, and prevalence; use the toggle to show everything.

Overall severity mix: 2 critical, 3 serious, 25 moderate, 1 minor. By WCAG category: 7 WCAG 2.0 A, 1 WCAG 2.1 A, 1 WCAG 2.2 AA, 4 WCAG 2.x AAA, 9 Best Practice, 9 Undetermined. Ordered by severity, key-page impact, WCAG level, and prevalence. Following accessibility bug-reporting best practices. Download: Markdown · JSON (full archive) · JSON (AI diagnostic) · CSV (all findings) · Priority pages CSV · Priority pages JSON.

Automated testing does not establish full WCAG conformance. Findings in the verification lane require manual testing before they are treated as confirmed failures.

Default view shows 9 prioritized issue type(s); 22 more are available if you switch to "Show everything".

1 finding(s) marked "possible duplicate" — Alfa and axe-core both flagged the same WCAG SC on overlapping pages. If they target the same element, the axe-core report is authoritative. Filter the CSV by possible_duplicate_of to see these. Two engines flagging the same barrier reduces the chance of a false positive.

Findings needing review

These findings need manual verification before they can be treated as confirmed failures. Obligation remains visible for each finding.

Critical axe aria-allowed-attr WCAG 2.0 A Elements must only use supported ARIA attributes (WCAG 4.1.2) 465/7478 pages · 2247 instances Likely template

Bug ID: VS-1bd49362
Pattern ID: VS-1467ea8a
Combined ID: VS-1bd49362 (pattern VS-1467ea8a) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — Elements must only use supported ARIA attributes [aria-allowed-attr]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: a[href$="#overview"]
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<a class="nav-item nav-link active" href="#overview" role="link" aria-selected="true" aria-controls="overview" data-toggle="tab">Overview</a>

Description

Elements must only use supported ARIA attributes. Detected by axe-core rule aria-allowed-attr on 465 of 7478 scanned pages (2247 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
Locate the element: a[href$="#overview"]
Confirm the axe-core finding for rule aria-allowed-attr against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

…and more — all 465 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Remove ARIA attributes that aren't allowed on this role/element.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-allowed-attr?application=axeAPI

Triage status Notes

Critical axe aria-required-children WCAG 2.0 A Certain ARIA roles must contain particular children (WCAG 1.3.1) 465/7478 pages · 465 instances Likely template

Bug ID: VS-6fbb414e
Pattern ID: VS-9429bb8d
Combined ID: VS-6fbb414e (pattern VS-9429bb8d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: axe-core — Certain ARIA roles must contain particular children [aria-required-children]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: .nav
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<div class="nav nav-tabs nav-justified" role="tablist">

Description

Certain ARIA roles must contain particular children. Detected by axe-core rule aria-required-children on 465 of 7478 scanned pages (465 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
Locate the element: .nav
Confirm the axe-core finding for rule aria-required-children against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 465 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Add the child roles this container role requires (e.g. a list needs listitem children).

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-required-children?application=axeAPI

Triage status Notes

Serious axe aria-input-field-name WCAG 2.0 A ARIA input fields must have an accessible name (WCAG 4.1.2) 308/7478 pages · 648 instances Likely template

Bug ID: VS-5d5de94c
Pattern ID: VS-0841abc2
Combined ID: VS-5d5de94c (pattern VS-0841abc2) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — ARIA input fields must have an accessible name [aria-input-field-name]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
XPath / selector: span[data-select2-id="select2-data-1-zx1c"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"]
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false" tabindex="-1" aria-disabled="false">

Description

ARIA input fields must have an accessible name. Detected by axe-core rule aria-input-field-name on 308 of 7478 scanned pages (648 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
Locate the element: span[data-select2-id="select2-data-1-zx1c"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"]
Confirm the axe-core finding for rule aria-input-field-name against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

…and more — all 308 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-input-field-name?application=axeAPI

Triage status Notes

Serious axe aria-prohibited-attr WCAG 2.0 A Elements must only use permitted ARIA attributes (WCAG 4.1.2) 3/7478 pages · 13 instances

Bug ID: VS-5cfc2d94
Pattern ID: VS-ebb1c464
Combined ID: VS-5cfc2d94 (pattern VS-ebb1c464) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — Elements must only use permitted ARIA attributes [aria-prohibited-attr]
Example URL: http://medicaid.gov/eligibility
XPath / selector: #map-svg-map-1749492555669
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<div id="map-svg-map-1749492555669" class="map-container" aria-disabled="true" aria-label="State Map Image. Keyboard navigating users can use dropdown to select state." style="position: relative; widt

Description

Elements must only use permitted ARIA attributes. Detected by axe-core rule aria-prohibited-attr on 3 of 7478 scanned pages (13 instances).

Steps to reproduce

Open http://medicaid.gov/eligibility.
Locate the element: #map-svg-map-1749492555669
Confirm the axe-core finding for rule aria-prohibited-attr against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-prohibited-attr?application=axeAPI

Triage status Notes

Serious axe label-title-only Best Practice Form elements should have a visible label (WCAG criterion undetermined) 3/7478 pages · 10 instances

Bug ID: VS-08625ac5
Pattern ID: VS-33841929
Combined ID: VS-08625ac5 (pattern VS-33841929) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Form elements should have a visible label [label-title-only]
Example URL: http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices
XPath / selector: select[aria-labelledby="filter-th-87376-0"]
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<select aria-labelledby="filter-th-87376-0" class="usa-select height-1" data-col-index="0" title="Filter by Year">

Description

Form elements should have a visible label. Detected by axe-core rule label-title-only on 3 of 7478 scanned pages (10 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices.
Locate the element: select[aria-labelledby="filter-th-87376-0"]
Confirm the axe-core finding for rule label-title-only.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/label-title-only?application=axeAPI

Triage status Notes

Moderate alfa sia-r14 WCAG 2.1 A Accessible name of link or button matches visible label (WCAG 2.5.3) 589/7478 pages · 594 instances Likely template

Bug ID: VS-0e6a4bec
Pattern ID: VS-f7dba940
Combined ID: VS-0e6a4bec (pattern VS-f7dba940) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.1 A
Obligation: required
Handling: review
WCAG SC: 2.5.3 Label in Name (Level A, WCAG 2.1)
Rule: Siteimprove Alfa — Accessible name of link or button matches visible label [sia-r14]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
XPath / selector: <a alt="View Changelog, select to access the version history" href="#" class="text-primary btn p-0" data-target="#modalChangelogHistory">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Accessible name of link or button matches visible label. Detected by Siteimprove Alfa rule sia-r14 on 589 of 7478 scanned pages (594 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50.
Locate the element: <a alt="View Changelog, select to access the version history" href="#" class="text-primary btn p-0" data-target="#modalChangelogHistory">
Confirm the Siteimprove Alfa finding for rule sia-r14 against WCAG 2.5.3 Label in Name.

Impact

Affects Without vision (1.0%), Without speech (0.5%).

Without vision — 1.0% of population
Without speech — 0.5% of population

Affected pages

…and more — all 589 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r14

Triage status Notes

Moderate alfa sia-r68 WCAG 2.0 A Presentational children of an element are not focusable (WCAG 1.3.1) 383/7478 pages · 400 instances · possible duplicate Likely template

Bug ID: VS-a74c4b51
Pattern ID: VS-d6097011
Combined ID: VS-a74c4b51 (pattern VS-d6097011) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Presentational children of an element are not focusable [sia-r68]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
XPath / selector: <ul class="select2-selection__rendered" id="select2-edit-field-topics-container">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-6fbb414e (pattern VS-9429bb8d). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

Presentational children of an element are not focusable. Detected by Siteimprove Alfa rule sia-r68 on 383 of 7478 scanned pages (400 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
Locate the element: <ul class="select2-selection__rendered" id="select2-edit-field-topics-container">
Confirm the Siteimprove Alfa finding for rule sia-r68 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 383 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r68

Triage status Notes

Moderate alfa sia-r8 WCAG 2.0 A Form field has accessible name (WCAG 4.1.2) 149/7478 pages · 315 instances Likely template

Bug ID: VS-5ad4482c
Pattern ID: VS-a48e6078
Combined ID: VS-5ad4482c (pattern VS-a48e6078) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Form field has accessible name [sia-r8]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
XPath / selector: <span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Form field has accessible name. Detected by Siteimprove Alfa rule sia-r8 on 149 of 7478 scanned pages (315 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
Locate the element: <span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false">
Confirm the Siteimprove Alfa finding for rule sia-r8 against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

…and more — all 149 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Associate the form field with a label.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r8

Triage status Notes

Moderate alfa sia-r113 WCAG 2.2 AA Target size is at least 24×24 CSS pixels or has spacing (Minimum) (WCAG 2.5.8) 149/7478 pages · 315 instances Likely template

Bug ID: VS-d0ed674e
Pattern ID: VS-179ad9b3
Combined ID: VS-d0ed674e (pattern VS-179ad9b3) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.2 AA
Obligation: required
Handling: review
WCAG SC: 2.5.8 Target Size (Minimum) (Level AA, WCAG 2.2)
Rule: Siteimprove Alfa — Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
XPath / selector: <textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Target size is at least 24×24 CSS pixels or has spacing (Minimum). Detected by Siteimprove Alfa rule sia-r113 on 149 of 7478 scanned pages (315 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
Locate the element: <textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off">
Confirm the Siteimprove Alfa finding for rule sia-r113 against WCAG 2.5.8 Target Size (Minimum).

Impact

Affects Limited manipulation/strength (13.0%), Limited reach (2.0%), Limited vision (2.4%).

Limited manipulation/strength — 13.0% of population
Limited reach — 2.0% of population
Limited vision — 2.4% of population

Affected pages

…and more — all 149 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r113

Triage status Notes

Moderate alfa sia-r66 WCAG 2.x AAA Text has enhanced contrast (WCAG 1.4.6) 3319/7478 pages · 114340 instances Likely template

Bug ID: VS-1fd14477
Pattern ID: VS-646b1e0b
Combined ID: VS-1fd14477 (pattern VS-646b1e0b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.6 Contrast (Enhanced) (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has enhanced contrast [sia-r66]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
XPath / selector: text: "Here’s how you know"
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Text has enhanced contrast. Detected by Siteimprove Alfa rule sia-r66 on 3319 of 7478 scanned pages (114340 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
Locate the element: text: "Here’s how you know"
Confirm the Siteimprove Alfa finding for rule sia-r66 against WCAG 1.4.6 Contrast (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 3319 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Increase text contrast to meet WCAG AAA (7:1).

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r66

Triage status Notes

Moderate alfa sia-r111 WCAG 2.x AAA Target size is at least 44×44 CSS pixels (Enhanced) (WCAG 2.5.5) 3319/7478 pages · 67902 instances Likely template

Bug ID: VS-2de7b1f8
Pattern ID: VS-cb53cc4d
Combined ID: VS-2de7b1f8 (pattern VS-cb53cc4d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 2.5.5 Target Size (Enhanced) (Level AAA, WCAG 2.1)
Rule: Siteimprove Alfa — Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
XPath / selector: <button class="usa-button" type="submit">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Target size is at least 44×44 CSS pixels (Enhanced). Detected by Siteimprove Alfa rule sia-r111 on 3319 of 7478 scanned pages (67902 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
Locate the element: <button class="usa-button" type="submit">
Confirm the Siteimprove Alfa finding for rule sia-r111 against WCAG 2.5.5 Target Size (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 3319 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r111

Triage status Notes

Moderate alfa sia-r57 Undetermined Scrolling content can be accessed by keyboard (WCAG criterion undetermined) 3317/7478 pages · 54363 instances Likely template

Bug ID: VS-3adb53e6
Pattern ID: VS-c18be945
Combined ID: VS-3adb53e6 (pattern VS-c18be945) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Scrolling content can be accessed by keyboard [sia-r57]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
XPath / selector: text: " Feedback "
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Scrolling content can be accessed by keyboard. Detected by Siteimprove Alfa rule sia-r57 on 3317 of 7478 scanned pages (54363 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
Locate the element: text: " Feedback "
Confirm the Siteimprove Alfa finding for rule sia-r57.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 3317 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r57

Triage status Notes

Moderate axe region Best Practice All page content should be contained by landmarks (WCAG criterion undetermined) 2279/7478 pages · 10132 instances Likely template

Bug ID: VS-f7200168
Pattern ID: VS-f18df681
Combined ID: VS-f7200168 (pattern VS-f18df681) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — All page content should be contained by landmarks [region]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
XPath / selector: .small
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<div class="small p-1">

Description

All page content should be contained by landmarks. Detected by axe-core rule region on 2279 of 7478 scanned pages (10132 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
Locate the element: .small
Confirm the axe-core finding for rule region.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 2279 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.

Drupal tip: Use Drupal's region system (header, navigation, main, sidebar, footer) and map each to an HTML5 landmark element in your theme's page.html.twig.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/region?application=axeAPI

Triage status Notes

Moderate axe page-has-heading-one Best Practice Page should contain a level-one heading (WCAG criterion undetermined) 2278/7478 pages · 2278 instances Likely template

Bug ID: VS-bc01ba9b
Pattern ID: VS-fa44f293
Combined ID: VS-bc01ba9b (pattern VS-fa44f293) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Page should contain a level-one heading [page-has-heading-one]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<html class="no-js" lang="en">

Description

Page should contain a level-one heading. Detected by axe-core rule page-has-heading-one on 2278 of 7478 scanned pages (2278 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
Locate the element: html
Confirm the axe-core finding for rule page-has-heading-one.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 2278 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/page-has-heading-one?application=axeAPI

Triage status Notes

Moderate axe landmark-one-main Best Practice Document should have one main landmark (WCAG criterion undetermined) 2274/7478 pages · 2274 instances Likely template

Bug ID: VS-8241b526
Pattern ID: VS-d5d82446
Combined ID: VS-8241b526 (pattern VS-d5d82446) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Document should have one main landmark [landmark-one-main]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<html class="no-js" lang="en">

Description

Document should have one main landmark. Detected by axe-core rule landmark-one-main on 2274 of 7478 scanned pages (2274 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
Locate the element: html
Confirm the axe-core finding for rule landmark-one-main.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 2274 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Each page should have exactly one <main> landmark.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-one-main?application=axeAPI

Triage status Notes

Moderate alfa sia-r73 WCAG 2.x AAA Text has minimum contrast ratio of 4.5:1 (WCAG 1.4.8) 2182/7478 pages · 6316 instances Likely template

Bug ID: VS-7e56ae53
Pattern ID: VS-2208081b
Combined ID: VS-7e56ae53 (pattern VS-2208081b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.8 Visual Presentation (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has minimum contrast ratio of 4.5:1 [sia-r73]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
XPath / selector: <p class="usa-footer__contact-info margin-bottom-0">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Text has minimum contrast ratio of 4.5:1. Detected by Siteimprove Alfa rule sia-r73 on 2182 of 7478 scanned pages (6316 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
Locate the element: <p class="usa-footer__contact-info margin-bottom-0">
Confirm the Siteimprove Alfa finding for rule sia-r73 against WCAG 1.4.8 Visual Presentation.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 2182 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r73

Triage status Notes

Moderate alfa sia-r87 Undetermined First focusable element is link to main content (WCAG criterion undetermined) 1142/7478 pages · 1142 instances Likely template

Bug ID: VS-b762c651
Pattern ID: VS-aa242c2d
Combined ID: VS-b762c651 (pattern VS-aa242c2d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — First focusable element is link to main content [sia-r87]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
XPath / selector: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

First focusable element is link to main content. Detected by Siteimprove Alfa rule sia-r87 on 1142 of 7478 scanned pages (1142 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50.
Locate the element: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
Confirm the Siteimprove Alfa finding for rule sia-r87.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1142 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r87

Triage status Notes

Moderate alfa sia-r61 Undetermined Form field label is visible (WCAG criterion undetermined) 1136/7478 pages · 1136 instances Likely template

Bug ID: VS-ceb71760
Pattern ID: VS-7118fead
Combined ID: VS-ceb71760 (pattern VS-7118fead) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Form field label is visible [sia-r61]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
XPath / selector: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Form field label is visible. Detected by Siteimprove Alfa rule sia-r61 on 1136 of 7478 scanned pages (1136 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50.
Locate the element: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
Confirm the Siteimprove Alfa finding for rule sia-r61.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1136 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r61

Triage status Notes

Minor axe aria-allowed-role Best Practice ARIA role should be appropriate for the element (WCAG criterion undetermined) 311/7478 pages · 653 instances Likely template

Bug ID: VS-7c21ade5
Pattern ID: VS-4fac2f41
Combined ID: VS-7c21ade5 (pattern VS-4fac2f41) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — ARIA role should be appropriate for the element [aria-allowed-role]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
XPath / selector: span[data-select2-id="select2-data-1-zx1c"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"] > .select2-search.select2-search--inline > textarea
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off" autocapitalize="none" spellcheck="false" role="searchbox" aria-autocomplete="list" autocomplete="off" aria-label="S

Description

ARIA role should be appropriate for the element. Detected by axe-core rule aria-allowed-role on 311 of 7478 scanned pages (653 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
Locate the element: span[data-select2-id="select2-data-1-zx1c"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"] > .select2-search.select2-search--inline > textarea
Confirm the axe-core finding for rule aria-allowed-role.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 311 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Remove or change the ARIA role — it isn't allowed on this element type.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-allowed-role?application=axeAPI

Triage status Notes

Moderate alfa sia-r18 Undetermined aria attribute is permitted for element role (WCAG criterion undetermined) 241/7478 pages · 1163 instances Likely template

Bug ID: VS-4bb4de80
Pattern ID: VS-e05344b9
Combined ID: VS-4bb4de80 (pattern VS-e05344b9) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — aria attribute is permitted for element role [sia-r18]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
XPath / selector: @aria-selected="true"
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

aria attribute is permitted for element role. Detected by Siteimprove Alfa rule sia-r18 on 241 of 7478 scanned pages (1163 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035.
Locate the element: @aria-selected="true"
Confirm the Siteimprove Alfa finding for rule sia-r18.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 241 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Only use ARIA states/properties that are allowed on this element/role.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r18

Triage status Notes

Moderate axe heading-order Best Practice Heading levels should only increase by one (WCAG criterion undetermined) 191/7478 pages · 211 instances Likely template

Bug ID: VS-7c8f0191
Pattern ID: VS-d25f622d
Combined ID: VS-7c8f0191 (pattern VS-d25f622d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Heading levels should only increase by one [heading-order]
Example URL: https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
XPath / selector: .region-footer-first > .usa-footer__primary-content.usa-footer__primary-content--collapsible > h4
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<h4 class="usa-footer__primary-link">Related Sites</h4>

Description

Heading levels should only increase by one. Detected by axe-core rule heading-order on 191 of 7478 scanned pages (211 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments.
Locate the element: .region-footer-first > .usa-footer__primary-content.usa-footer__primary-content--collapsible > h4
Confirm the axe-core finding for rule heading-order.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 191 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Use heading levels in order (h1 → h2 → h3) without skipping; structure, not size.

Drupal tip: Drupal Views and blocks can insert headings at arbitrary levels. In the Views UI, set "Title tag" for each display. For block titles, configure the heading level in the block's layout settings.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/heading-order?application=axeAPI

Triage status Notes

Moderate deprecated-html presentational-attr Undetermined Presentational attribute (use CSS) (WCAG criterion undetermined) 132/7478 pages · 163 instances Likely template

Bug ID: VS-fd47ab5d
Pattern ID: VS-04a9d28c
Combined ID: VS-fd47ab5d (pattern VS-04a9d28c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: deprecated-html — Presentational attribute (use CSS) [presentational-attr]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
XPath / selector: td
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<td valign="top" colspan="6" class="dataTables_empty">No data available in table</td>

Description

Presentational attribute (use CSS). Detected by deprecated-html rule presentational-attr on 132 of 7478 scanned pages (163 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023.
Locate the element: td
Confirm the deprecated-html finding for rule presentational-attr.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 132 pages (CSV).

Testing environment

Automated: deprecated-html, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

Not captured by automated scan — requires manual testing.

Triage status Notes

Moderate alfa sia-r53 Undetermined Headings are structured hierarchically (WCAG criterion undetermined) 108/7478 pages · 119 instances Likely template

Bug ID: VS-445ff332
Pattern ID: VS-f054f4a4
Combined ID: VS-445ff332 (pattern VS-f054f4a4) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Headings are structured hierarchically [sia-r53]
Example URL: https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
XPath / selector: <h4 class="usa-footer__primary-link">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Headings are structured hierarchically. Detected by Siteimprove Alfa rule sia-r53 on 108 of 7478 scanned pages (119 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments.
Locate the element: <h4 class="usa-footer__primary-link">
Confirm the Siteimprove Alfa finding for rule sia-r53.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 108 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Use headings in a logical, non-skipping order.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r53

Triage status Notes

Moderate axe landmark-unique Best Practice Landmarks should have a unique role or role/label/title (i.e. accessible name) c (WCAG criterion undetermined) 39/7478 pages · 39 instances Likely template

Bug ID: VS-01f01755
Pattern ID: VS-8806389c
Combined ID: VS-01f01755 (pattern VS-8806389c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Landmarks should have a unique role or role/label/title (i.e. accessible name) c [landmark-unique]
Example URL: https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
XPath / selector: .section
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

HTML snippet — use this to validate the finding without re-running the tool

<aside class="section" role="complementary">

Description

Landmarks should have a unique role or role/label/title (i.e. accessible name) c. Detected by axe-core rule landmark-unique on 39 of 7478 scanned pages (39 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments.
Locate the element: .section
Confirm the axe-core finding for rule landmark-unique.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 39 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: When a landmark role/type repeats (e.g. two <nav>s), give each a distinct accessible name with aria-label or aria-labelledby (e.g. "Primary" and "Footer" navigation) so screen-reader users can tell them apart.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-unique?application=axeAPI

Triage status Notes

Moderate alfa sia-r74 WCAG 2.x AAA Link is distinguishable without relying on color (WCAG 1.4.8) 9/7478 pages · 30 instances

Bug ID: VS-1a0e9aff
Pattern ID: VS-fbf54eba
Combined ID: VS-1a0e9aff (pattern VS-fbf54eba) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.8 Visual Presentation (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Link is distinguishable without relying on color [sia-r74]
Example URL: https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality
XPath / selector: <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);box-sizing:inherit;color:rgb(27, 27, 27);font-family:"Source Sans Pro Web", "Helvetica Neue", Helvetica, Roboto, Arial, sans
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Link is distinguishable without relying on color. Detected by Siteimprove Alfa rule sia-r74 on 9 of 7478 scanned pages (30 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality.
Locate the element: <p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);box-sizing:inherit;color:rgb(27, 27, 27);font-family:"Source Sans Pro Web", "Helvetica Neue", Helvetica, Roboto, Arial, sans
Confirm the Siteimprove Alfa finding for rule sia-r74 against WCAG 1.4.8 Visual Presentation.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r74

Triage status Notes

Moderate alfa sia-r72 Undetermined Element role is consistent with ARIA landmark (WCAG criterion undetermined) 5/7478 pages · 900 instances

Bug ID: VS-6d53d87f
Pattern ID: VS-e5ec42f0
Combined ID: VS-6d53d87f (pattern VS-e5ec42f0) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Element role is consistent with ARIA landmark [sia-r72]
Example URL: https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
XPath / selector: <p _ngcontent-ng-c2822395467="" class="title core-set">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Element role is consistent with ARIA landmark. Detected by Siteimprove Alfa rule sia-r72 on 5 of 7478 scanned pages (900 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D.
Locate the element: <p _ngcontent-ng-c2822395467="" class="title core-set">
Confirm the Siteimprove Alfa finding for rule sia-r72.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r72

Triage status Notes

Moderate alfa sia-r78 Undetermined Table header has scope (WCAG criterion undetermined) 5/7478 pages · 5 instances

Bug ID: VS-ea01f8e9
Pattern ID: VS-2cd767ca
Combined ID: VS-ea01f8e9 (pattern VS-2cd767ca) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Table header has scope [sia-r78]
Example URL: https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
XPath / selector: <h3 _ngcontent-ng-c1329502141="" class="view-measures-related-to-header core-set ng-star-inserted">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Table header has scope. Detected by Siteimprove Alfa rule sia-r78 on 5 of 7478 scanned pages (5 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D.
Locate the element: <h3 _ngcontent-ng-c1329502141="" class="view-measures-related-to-header core-set ng-star-inserted">
Confirm the Siteimprove Alfa finding for rule sia-r78.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r78

Triage status Notes

Moderate alfa sia-r85 Undetermined Keyboard trap does not exist (WCAG criterion undetermined) 4/7478 pages · 247 instances

Bug ID: VS-a381b0d4
Pattern ID: VS-4c341c77
Combined ID: VS-a381b0d4 (pattern VS-4c341c77) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Keyboard trap does not exist [sia-r85]
Example URL: https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
XPath / selector: <p class="selected-states-header">
History: first seen 2026-W24, last seen 2026-W31 (8 wk)

Description

Keyboard trap does not exist. Detected by Siteimprove Alfa rule sia-r85 on 4 of 7478 scanned pages (247 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D.
Locate the element: <p class="selected-states-header">
Confirm the Siteimprove Alfa finding for rule sia-r85.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r85

Triage status Notes

Moderate alfa sia-r62 WCAG 2.0 A Link in text block is visually distinguishable without color (WCAG 1.4.1) 3/7478 pages · 8 instances

Bug ID: VS-4989edbf
Pattern ID: VS-efd91fdd
Combined ID: VS-4989edbf (pattern VS-efd91fdd) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.4.1 Use of Color (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Link in text block is visually distinguishable without color [sia-r62]
Example URL: https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
XPath / selector: <a style="text-decoration:none;" href="#one" title="">
History: first seen 2026-W24, last seen 2026-W31 (5 wk)

Description

Link in text block is visually distinguishable without color. Detected by Siteimprove Alfa rule sia-r62 on 3 of 7478 scanned pages (8 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality.
Locate the element: <a style="text-decoration:none;" href="#one" title="">
Confirm the Siteimprove Alfa finding for rule sia-r62 against WCAG 1.4.1 Use of Color.

Impact

Affects Without color perception (4.5%), Limited vision (2.4%).

Without color perception — 4.5% of population
Limited vision — 2.4% of population

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Make links visually distinguishable from surrounding text (not by color alone).

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r62

Triage status Notes

Moderate axe landmark-no-duplicate-main Best Practice Document should not have more than one main landmark (WCAG criterion undetermined) 3/7478 pages · 3 instances

Bug ID: VS-eb8eb499
Pattern ID: VS-cd69be3a
Combined ID: VS-eb8eb499 (pattern VS-cd69be3a) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Document should not have more than one main landmark [landmark-no-duplicate-main]
Example URL: https://www.medicaid.gov/style-guide/components/button
XPath / selector: .main-content
History: first seen 2026-W28, last seen 2026-W31 (4 wk)

HTML snippet — use this to validate the finding without re-running the tool

<main id="content" class="main-content grid-col-12" role="main">

Description

Document should not have more than one main landmark. Detected by axe-core rule landmark-no-duplicate-main on 3 of 7478 scanned pages (3 instances).

Steps to reproduce

Open https://www.medicaid.gov/style-guide/components/button.
Locate the element: .main-content
Confirm the axe-core finding for rule landmark-no-duplicate-main.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-no-duplicate-main?application=axeAPI

Triage status Notes

Moderate axe landmark-main-is-top-level Best Practice Main landmark should not be contained in another landmark (WCAG criterion undetermined) 3/7478 pages · 3 instances

Bug ID: VS-3614bc86
Pattern ID: VS-ff3ceb19
Combined ID: VS-3614bc86 (pattern VS-ff3ceb19) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Main landmark should not be contained in another landmark [landmark-main-is-top-level]
Example URL: https://www.medicaid.gov/style-guide/components/button
XPath / selector: .style-guide-page > .grid-gap-sm.grid-row > main
History: first seen 2026-W28, last seen 2026-W31 (4 wk)

HTML snippet — use this to validate the finding without re-running the tool

<main id="content" class="grid-col-12 desktop:grid-col-9" role="main">

Description

Main landmark should not be contained in another landmark. Detected by axe-core rule landmark-main-is-top-level on 3 of 7478 scanned pages (3 instances).

Steps to reproduce

Open https://www.medicaid.gov/style-guide/components/button.
Locate the element: .style-guide-page > .grid-gap-sm.grid-row > main
Confirm the axe-core finding for rule landmark-main-is-top-level.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-main-is-top-level?application=axeAPI

Triage status Notes

Deque axe-core findings

Rule-level axe-core summary (13 rule type(s))

Each failing rule links out to the axe-core documentation. For full element-level detail including HTML snippets and XPaths, see the bug reports above.

axe-core rules failing in 2026-W31, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
All page content should be contained by landmarks [region]	moderate	2279	10132	/tmsis/dataguide/v3/validation-rules/rule-7953 /tmsis/dataguide/v4/data-quality-measures/all-21-007-7 /tmsis/dataguide/v4/data-elements/cot002095	all 2279 pages (CSV)
Page should contain a level-one heading [page-has-heading-one]	moderate	2278	2278	/tmsis/dataguide/v3/validation-rules/rule-7953 /tmsis/dataguide/v4/data-quality-measures/all-21-007-7 /tmsis/dataguide/v4/data-elements/cot002095	all 2278 pages (CSV)
Document should have one main landmark [landmark-one-main]	moderate	2274	2274	/tmsis/dataguide/v3/validation-rules/rule-7953 /tmsis/dataguide/v4/data-quality-measures/all-21-007-7 /tmsis/dataguide/v4/data-elements/cot002095	all 2274 pages (CSV)
Elements must only use supported ARIA attributes [aria-allowed-attr]	critical	465	2247	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/data-elements/ftx003068 /tmsis/dataguide/v4/data-elements/prv001008	all 465 pages (CSV)
Certain ARIA roles must contain particular children [aria-required-children]	critical	465	465	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/data-elements/ftx003068 /tmsis/dataguide/v4/data-elements/prv001008	all 465 pages (CSV)
ARIA role should be appropriate for the element [aria-allowed-role]	minor	311	653	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments	all 311 pages (CSV)
ARIA input fields must have an accessible name [aria-input-field-name]	serious	308	648	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments	all 308 pages (CSV)
Heading levels should only increase by one [heading-order]	moderate	191	211	/medicaid/managed-care/guidance/state-directed-payments /medicaid/data-systems/health-information-exchange/federal-financial-participation-for-hit-and-hie /medicaid/quality-of-care/core-set-data-dashboard/main	all 191 pages (CSV)
Landmarks should have a unique role or role/label/title (i.e. accessible name) combination [landmark-unique]	moderate	39	39	/medicaid/managed-care/guidance/state-directed-payments /medicaid/financial-management/medicaid-administrative-claiming /medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality	all 39 pages (CSV)
Elements must only use permitted ARIA attributes [aria-prohibited-attr]	serious	3	13	/eligibility / /homepage	all 3 pages (CSV)
Form elements should have a visible label [label-title-only]	serious	3	10	/medicaid/prescription-drugs/drug-utilization-review/innovative-practices /prior-annual-medicaid-hospice-rate-letters /medicaid/prescription-drugs/drug-utilization-review/drug-utilization-review-annual-report	all 3 pages (CSV)
Main landmark should not be contained in another landmark [landmark-main-is-top-level]	moderate	3	3	/style-guide/components/button /style-guide/components/back-to-top /style-guide/components	all 3 pages (CSV)
Document should not have more than one main landmark [landmark-no-duplicate-main]	moderate	3	3	/style-guide/components/button /style-guide/components/back-to-top /style-guide/components	all 3 pages (CSV)

Siteimprove Alfa findings

Rule-level Alfa summary (17 rule type(s))

Rule-level summary from Siteimprove Alfa (W3C ACT-based). Findings that overlap with axe-core on the same WCAG success criterion are noted as possible duplicates in the bug reports above.

Alfa rules failing in 2026-W31, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
Text has enhanced contrast [sia-r66]	n/a	3319	114340	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /federal-policy-guidance	all 3319 pages (CSV)
Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]	n/a	3319	67902	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /federal-policy-guidance	all 3319 pages (CSV)
Scrolling content can be accessed by keyboard [sia-r57]	n/a	3317	54363	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /federal-policy-guidance	all 3317 pages (CSV)
Text has minimum contrast ratio of 4.5:1 [sia-r73]	n/a	2182	6316	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /federal-policy-guidance	all 2182 pages (CSV)
First focusable element is link to main content [sia-r87]	n/a	1142	1142	/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50 /tmsis/dataguide/v3/validation-rules/rule-1789 /tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5	all 1142 pages (CSV)
Form field label is visible [sia-r61]	n/a	1136	1136	/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50 /tmsis/dataguide/v3/validation-rules/rule-1789 /tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5	all 1136 pages (CSV)
Accessible name of link or button matches visible label [sia-r14]	n/a	589	594	/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50 /tmsis/dataguide/v3/validation-rules/rule-1789 /tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156	all 589 pages (CSV)
Presentational children of an element are not focusable [sia-r68]	n/a	383	400	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /tmsis/dataguide/v3/data-elements/crx002035	all 383 pages (CSV)
aria attribute is permitted for element role [sia-r18]	n/a	241	1163	/tmsis/dataguide/v3/data-elements/crx002035 /tmsis/dataguide/v4/data-elements/ftx009326 /tmsis/dataguide/v4/data-elements/prv002023	all 241 pages (CSV)
Form field has accessible name [sia-r8]	n/a	149	315	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments	all 149 pages (CSV)
Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]	n/a	149	315	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments	all 149 pages (CSV)
Headings are structured hierarchically [sia-r53]	n/a	108	119	/medicaid/managed-care/guidance/state-directed-payments /medicaid/section-1115-demonstrations/about-section-1115-demonstrations /state-resource-center/disaster-response-toolkit/federal-disaster-resources/106876	all 108 pages (CSV)
Link is distinguishable without relying on color [sia-r74]	n/a	9	30	/medicaid/section-1115-demonstrations/budget-neutrality /resources-for-states/disaster-response-toolkit/federal-disaster-resources /medicaid/quality-of-care/core-set-data-dashboard/main	all 9 pages (CSV)
Element role is consistent with ARIA landmark [sia-r72]	n/a	5	900	/medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main	all 5 pages (CSV)
Table header has scope [sia-r78]	n/a	5	5	/medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main	all 5 pages (CSV)
Keyboard trap does not exist [sia-r85]	n/a	4	247	/medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main /medicaid/quality-of-care/core-set-data-dashboard/main	all 4 pages (CSV)
Link in text block is visually distinguishable without color [sia-r62]	n/a	3	8	/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality /medicaid/quality-of-care/quality-improvement/oral-health-quality-improvement-resources/advancing-oral-health-prevention-in-primary-care /medicaid/quality-of-care/quality-improvement/addressing-childhood-obesity	all 3 pages (CSV)

Unique accessibility issues (axe + Alfa consolidated)

axe and Alfa both implement W3C ACT rules, so the same issue is often caught by both. These are deduplicated by ACT rule and page, so a shared finding counts once (24682 raw engine findings → 24297 unique).

Unique issues (rule × page): 24297
Caught by both engines: 385 highest confidence
axe only: 8237
Alfa only: 15675

2 rule type(s) caught by both engines — highest confidence

Two independent ACT-rule implementations (Deque axe-core and Siteimprove Alfa) flagged the same issue on the same pages. Agreement between separate engines is strong evidence the barrier is real, not a single-tool false positive — the best place to start.

Rules flagged by both axe-core and Alfa in 2026-W31, by pages affected.
Issue	Pages	Rule references
Elements must only use supported ARIA attributes	473	axe aria-allowed-attr · Alfa sia-r18 · ACT 5c01ea
ARIA input fields must have an accessible name	308	axe aria-input-field-name · Alfa sia-r8 · ACT e086e5