# Accessibility bug reports — www.medicaid.gov, week 2026-W31

31 issue type(s) from 7478 pages scanned. Generated 2026-08-02 by [vital-scans](https://github.com/mgifford/vital-core), following [accessibility bug-reporting best practices](https://mgifford.github.io/ACCESSIBILITY.md/examples/ACCESSIBILITY_BUG_REPORTING_BEST_PRACTICES.html).

> Automated checks find roughly a third of accessibility barriers. Fields marked "requires manual testing" cannot be observed by an automated scan and need a human with assistive technology.

---
## Target size is at least 24×24 CSS pixels or has spacing (Minimum) (WCAG 2.5.8)

**Bug ID:** `VS-d0ed674e`  
**Pattern ID:** `VS-179ad9b3`  
**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">`  
**WCAG SC:** 2.5.8 — Target Size (Minimum) (Level AA)  
**Rule:** Siteimprove Alfa — `sia-r113` ([reference](https://alfa.siteimprove.com/rules/sia-r113))  
**Severity:** Moderate  
**Frequency:** 315 instances; 149 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
2. Locate the element: <textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off">
3. 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
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=2&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=9&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=28&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=941&page=6&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=31&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=736&page=16&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=25&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=796&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=866&page=24&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=29&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=24&q=
- http://medicaid.gov/chip/state-program-information/chip-spa?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=2&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=891&page=18&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B%5D=861&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=811&page=35&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=786&page=10&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_approval_date%5D%5Bgte%5D=&filter%5Bfield_approval_date%5D%5Blte%5D=&filter%5Bfield_effective_date%5D%5Bgte%5D=&filter%5Bfield_effective_date%5D%5Blte%5D=&filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1041&limit=10&page=1&q=&sort=field_approval_date%3Adesc
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=786&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=831&page=7&q=

…and more — 149 pages total ([download CSV](csv/alfa__sia-r113.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

### Example pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=

---

## Accessible name of link or button matches visible label (WCAG 2.5.3)

**Bug ID:** `VS-0e6a4bec`  
**Pattern ID:** `VS-f7dba940`  
**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">`  
**WCAG SC:** 2.5.3 — Label in Name (Level A)  
**Rule:** Siteimprove Alfa — `sia-r14` ([reference](https://alfa.siteimprove.com/rules/sia-r14))  
**Severity:** Moderate  
**Frequency:** 594 instances; 589 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50.
2. Locate the element: <a alt="View Changelog, select to access the version history" href="#" class="text-primary btn p-0" data-target="#modalChangelogHistory">
3. 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
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-83-006-6
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7912
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1658
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7257
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/mis-79-008-8
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-2-010-10
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/rule-7313
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7350
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-17-003-3
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002118
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002163
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-26-013-13
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-8-032-32
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/rule-8659
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-8-030-30
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/el-17-003-3
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/el-14-009-9
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7897

…and more — 589 pages total ([download CSV](csv/alfa__sia-r14.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156

---

## Certain ARIA roles must contain particular children (WCAG 1.3.1)

**Bug ID:** `VS-6fbb414e`  
**Pattern ID:** `VS-9429bb8d`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095  
**XPath / selector:** `.nav`  
**WCAG SC:** 1.3.1 — Info and Relationships (Level A)  
**Rule:** axe-core — `aria-required-children` ([reference](https://dequeuniversity.com/rules/axe/4.12/aria-required-children?application=axeAPI))  
**Severity:** Critical  
**Frequency:** 465 instances; 465 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
2. Locate the element: .nav
3. 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
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx004124
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002115
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002163
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/crx003191
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx003119
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/elg001010
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002118
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002163
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002117
- https://www.medicaid.gov/tmsis/dataguide/v4/file-segment-layouts/prv-provider/prov-affiliated-programs
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002162
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx002042
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002190
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv009116
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl003047
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002148
- https://www.medicaid.gov/tmsis/dataguide/v3/file-segment-layouts/mcr-managed-care-plan-information/managed-care-service-area

…and more — 465 pages total ([download CSV](csv/axe-core__aria-required-children.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008

---

## Presentational children of an element are not focusable (WCAG 1.3.1)

**Bug ID:** `VS-a74c4b51`  
**Pattern ID:** `VS-d6097011`  
**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">`  
**WCAG SC:** 1.3.1 — Info and Relationships (Level A)  
**Rule:** Siteimprove Alfa — `sia-r68` ([reference](https://alfa.siteimprove.com/rules/sia-r68))  
**Severity:** Moderate  
**Frequency:** 400 instances; 383 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
2. Locate the element: <ul class="select2-selection__rendered" id="select2-edit-field-topics-container">
3. 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
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=2&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=9&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=28&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=941&page=6&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=31&q=
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002118
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002163
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002190
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl003047
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002148
- https://www.medicaid.gov/tmsis/dataguide/v3/file-segment-layouts/mcr-managed-care-plan-information/managed-care-service-area
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003074
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/prv003057
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl004056
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cot003225
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=736&page=16&q=

…and more — 383 pages total ([download CSV](csv/alfa__sia-r68.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

### Example pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035

---

## Link in text block is visually distinguishable without color (WCAG 1.4.1)

**Bug ID:** `VS-4989edbf`  
**Pattern ID:** `VS-efd91fdd`  
**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="">`  
**WCAG SC:** 1.4.1 — Use of Color (Level A)  
**Rule:** Siteimprove Alfa — `sia-r62` ([reference](https://alfa.siteimprove.com/rules/sia-r62))  
**Severity:** Moderate  
**Frequency:** 8 instances; 3 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (5 weeks)

### 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
1. Open https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality.
2. Locate the element: <a style="text-decoration:none;" href="#one" title="">
3. 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
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
- http://medicaid.gov/medicaid/quality-of-care/quality-improvement/oral-health-quality-improvement-resources/advancing-oral-health-prevention-in-primary-care
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/addressing-childhood-obesity

### 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

### Example pages
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
- http://medicaid.gov/medicaid/quality-of-care/quality-improvement/oral-health-quality-improvement-resources/advancing-oral-health-prevention-in-primary-care
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/addressing-childhood-obesity

---

## Elements must only use supported ARIA attributes (WCAG 4.1.2)

**Bug ID:** `VS-1bd49362`  
**Pattern ID:** `VS-1467ea8a`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095  
**XPath / selector:** `a[href$="#overview"]`  
**WCAG SC:** 4.1.2 — Name, Role, Value (Level A)  
**Rule:** axe-core — `aria-allowed-attr` ([reference](https://dequeuniversity.com/rules/axe/4.12/aria-allowed-attr?application=axeAPI))  
**Severity:** Critical  
**Frequency:** 2247 instances; 465 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
2. Locate the element: a[href$="#overview"]
3. 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
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx004124
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002115
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002163
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/crx003191
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx003119
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/elg001010
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002118
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002163
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002117
- https://www.medicaid.gov/tmsis/dataguide/v4/file-segment-layouts/prv-provider/prov-affiliated-programs
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002162
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx002042
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002190
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv009116
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl003047
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002148
- https://www.medicaid.gov/tmsis/dataguide/v3/file-segment-layouts/mcr-managed-care-plan-information/managed-care-service-area

…and more — 465 pages total ([download CSV](csv/axe-core__aria-allowed-attr.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008

---

## ARIA input fields must have an accessible name (WCAG 4.1.2)

**Bug ID:** `VS-5d5de94c`  
**Pattern ID:** `VS-0841abc2`  
**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"]`  
**WCAG SC:** 4.1.2 — Name, Role, Value (Level A)  
**Rule:** axe-core — `aria-input-field-name` ([reference](https://dequeuniversity.com/rules/axe/4.12/aria-input-field-name?application=axeAPI))  
**Severity:** Serious  
**Frequency:** 648 instances; 308 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
2. Locate the element: span[data-select2-id="select2-data-1-zx1c"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"]
3. 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
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=10&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=2&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=9&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=4&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=28&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=941&page=6&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=31&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=986&page=7&q=
- https://www.medicaid.gov/chip/state-program-information/chip-spa?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=811&page=0&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=826&page=20&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=716&page=25&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=711&page=41&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=9&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=32&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=926&page=53&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=736&page=16&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=1&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=25&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=841&page=0&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=5&q=

…and more — 308 pages total ([download CSV](csv/axe-core__aria-input-field-name.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

### Example pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=10&q=

---

## Elements must only use permitted ARIA attributes (WCAG 4.1.2)

**Bug ID:** `VS-5cfc2d94`  
**Pattern ID:** `VS-ebb1c464`  
**URL:** http://medicaid.gov/eligibility  
**XPath / selector:** `#map-svg-map-1749492555669`  
**WCAG SC:** 4.1.2 — Name, Role, Value (Level A)  
**Rule:** axe-core — `aria-prohibited-attr` ([reference](https://dequeuniversity.com/rules/axe/4.12/aria-prohibited-attr?application=axeAPI))  
**Severity:** Serious  
**Frequency:** 13 instances; 3 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open http://medicaid.gov/eligibility.
2. Locate the element: #map-svg-map-1749492555669
3. 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
- http://medicaid.gov/eligibility
- https://www.medicaid.gov/
- https://www.medicaid.gov/homepage

### 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

### Example pages
- http://medicaid.gov/eligibility
- https://www.medicaid.gov/
- https://www.medicaid.gov/homepage

---

## Form field has accessible name (WCAG 4.1.2)

**Bug ID:** `VS-5ad4482c`  
**Pattern ID:** `VS-a48e6078`  
**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">`  
**WCAG SC:** 4.1.2 — Name, Role, Value (Level A)  
**Rule:** Siteimprove Alfa — `sia-r8` ([reference](https://alfa.siteimprove.com/rules/sia-r8))  
**Severity:** Moderate  
**Frequency:** 315 instances; 149 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Steps to reproduce
1. Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
2. Locate the element: <span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false">
3. 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
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=2&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=9&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=28&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=941&page=6&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=31&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=736&page=16&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=25&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=796&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=866&page=24&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=29&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=24&q=
- http://medicaid.gov/chip/state-program-information/chip-spa?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=2&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=891&page=18&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B%5D=861&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=811&page=35&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=786&page=10&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_approval_date%5D%5Bgte%5D=&filter%5Bfield_approval_date%5D%5Blte%5D=&filter%5Bfield_effective_date%5D%5Bgte%5D=&filter%5Bfield_effective_date%5D%5Blte%5D=&filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1041&limit=10&page=1&q=&sort=field_approval_date%3Adesc
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=786&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=831&page=7&q=

…and more — 149 pages total ([download CSV](csv/alfa__sia-r8.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

### Example pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=

---

## Text has enhanced contrast (WCAG 1.4.6)

**Bug ID:** `VS-1fd14477`  
**Pattern ID:** `VS-646b1e0b`  
**URL:** http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0  
**XPath / selector:** `text: "Here’s how you know"`  
**WCAG SC:** 1.4.6 — Contrast (Enhanced) (Level AAA)  
**Rule:** Siteimprove Alfa — `sia-r66` ([reference](https://alfa.siteimprove.com/rules/sia-r66))  
**Severity:** Moderate  
**Frequency:** 114340 instances; 3319 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Steps to reproduce
1. Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
2. Locate the element: text: "Here’s how you know"
3. 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
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A891&f%5B1%5D=waiver_state_facet%3A901&page=69
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A711&f%5B1%5D=state%3A796&f%5B2%5D=state%3A816&f%5B3%5D=state%3A866&f%5B4%5D=state%3A976&f%5B5%5D=state%3A1036&f%5B6%5D=state%3A1046&f%5B7%5D=topics%3A3046&f%5B8%5D=topics%3A7406&page=1660
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?entry=8383&page=61
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1516&f%5B1%5D=fpg_topics_facet%3A8601&f%5B2%5D=fpg_topics_facet%3A8716&f%5B3%5D=fpg_topics_facet%3A8861&page=4
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments/approved-state-directed-payment-preprints?items_per_page=50&page=5
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A796&f%5B1%5D=state%3A831&page=1663
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1856&f%5B1%5D=sub_topic_faq_library_facet%3A2091&f%5B2%5D=sub_topic_faq_library_facet%3A2096&f%5B3%5D=sub_topic_faq_library_facet%3A2371&f%5B4%5D=sub_topic_faq_library_facet%3A2436&page=0
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1976&f%5B1%5D=sub_topic_faq_library_facet%3A1986&f%5B2%5D=sub_topic_faq_library_facet%3A2091&f%5B3%5D=sub_topic_faq_library_facet%3A2431&f%5B4%5D=sub_topic_faq_library_facet%3A2531&page=0
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1971&fcf=41230&page=0&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A716&f%5B1%5D=waiver_state_facet%3A991&items_per_page=10&page=5
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A2826&page=109
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A2451&fcf=40870&page=4&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/110976
- http://medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A856&f%5B1%5D=fpg_topics_facet%3A906&f%5B2%5D=fpg_topics_facet%3A1016&f%5B3%5D=fpg_topics_facet%3A1491&f%5B4%5D=fpg_topics_facet%3A8711&f%5B5%5D=fpg_topics_facet%3A8716&f%5B6%5D=fpg_topics_facet%3A8861&page=110
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1471&f%5B1%5D=fpg_topics_facet%3A1501&f%5B2%5D=fpg_topics_facet%3A1516&f%5B3%5D=fpg_topics_facet%3A8406&page=106
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1881&f%5B1%5D=sub_topic_faq_library_facet%3A1911&f%5B2%5D=sub_topic_faq_library_facet%3A2501&page=82
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729

…and more — 3319 pages total ([download CSV](csv/alfa__sia-r66.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

### Example pages
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6

---

## Text has minimum contrast ratio of 4.5:1 (WCAG 1.4.8)

**Bug ID:** `VS-7e56ae53`  
**Pattern ID:** `VS-2208081b`  
**URL:** http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0  
**XPath / selector:** `<p class="usa-footer__contact-info margin-bottom-0">`  
**WCAG SC:** 1.4.8 — Visual Presentation (Level AAA)  
**Rule:** Siteimprove Alfa — `sia-r73` ([reference](https://alfa.siteimprove.com/rules/sia-r73))  
**Severity:** Moderate  
**Frequency:** 6316 instances; 2182 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
2. Locate the element: <p class="usa-footer__contact-info margin-bottom-0">
3. 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
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A891&f%5B1%5D=waiver_state_facet%3A901&page=69
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A711&f%5B1%5D=state%3A796&f%5B2%5D=state%3A816&f%5B3%5D=state%3A866&f%5B4%5D=state%3A976&f%5B5%5D=state%3A1036&f%5B6%5D=state%3A1046&f%5B7%5D=topics%3A3046&f%5B8%5D=topics%3A7406&page=1660
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?entry=8383&page=61
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1516&f%5B1%5D=fpg_topics_facet%3A8601&f%5B2%5D=fpg_topics_facet%3A8716&f%5B3%5D=fpg_topics_facet%3A8861&page=4
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments/approved-state-directed-payment-preprints?items_per_page=50&page=5
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A796&f%5B1%5D=state%3A831&page=1663
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1856&f%5B1%5D=sub_topic_faq_library_facet%3A2091&f%5B2%5D=sub_topic_faq_library_facet%3A2096&f%5B3%5D=sub_topic_faq_library_facet%3A2371&f%5B4%5D=sub_topic_faq_library_facet%3A2436&page=0
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1976&f%5B1%5D=sub_topic_faq_library_facet%3A1986&f%5B2%5D=sub_topic_faq_library_facet%3A2091&f%5B3%5D=sub_topic_faq_library_facet%3A2431&f%5B4%5D=sub_topic_faq_library_facet%3A2531&page=0
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1971&fcf=41230&page=0&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A716&f%5B1%5D=waiver_state_facet%3A991&items_per_page=10&page=5
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A2826&page=109
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A2451&fcf=40870&page=4&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/110976
- http://medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A856&f%5B1%5D=fpg_topics_facet%3A906&f%5B2%5D=fpg_topics_facet%3A1016&f%5B3%5D=fpg_topics_facet%3A1491&f%5B4%5D=fpg_topics_facet%3A8711&f%5B5%5D=fpg_topics_facet%3A8716&f%5B6%5D=fpg_topics_facet%3A8861&page=110
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1471&f%5B1%5D=fpg_topics_facet%3A1501&f%5B2%5D=fpg_topics_facet%3A1516&f%5B3%5D=fpg_topics_facet%3A8406&page=106
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1881&f%5B1%5D=sub_topic_faq_library_facet%3A1911&f%5B2%5D=sub_topic_faq_library_facet%3A2501&page=82
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A836&f%5B1%5D=state%3A846&f%5B2%5D=state%3A851&f%5B3%5D=state%3A971&f%5B4%5D=topics%3A856&page=1
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A771&f%5B10%5D=fpg_topics_facet%3A6481&f%5B11%5D=fpg_topics_facet%3A6486&f%5B12%5D=fpg_topics_facet%3A8411&f%5B13%5D=fpg_topics_facet%3A8601&f%5B14%5D=fpg_type_facet%3A1486&f%5B2%5D=fpg_topics_facet%3A906&f%5B3%5D=fpg_topics_facet%3A1021&f%5B4%5D=fpg_topics_facet%3A1491&f%5B5%5D=fpg_topics_facet%3A1516&f%5B6%5D=fpg_topics_facet%3A1521&f%5B7%5D=fpg_topics_facet%3A1531&f%5B8%5D=fpg_topics_facet%3A2826&f%5B9%5D=fpg_topics_facet%3A3261&page=1

…and more — 2182 pages total ([download CSV](csv/alfa__sia-r73.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

### Example pages
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6

---

## Link is distinguishable without relying on color (WCAG 1.4.8)

**Bug ID:** `VS-1a0e9aff`  
**Pattern ID:** `VS-fbf54eba`  
**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`  
**WCAG SC:** 1.4.8 — Visual Presentation (Level AAA)  
**Rule:** Siteimprove Alfa — `sia-r74` ([reference](https://alfa.siteimprove.com/rules/sia-r74))  
**Severity:** Moderate  
**Frequency:** 30 instances; 9 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality.
2. 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
3. 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
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality
- http://medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=3
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/eligibility-policy/medicaid-eligibility-quality-control-program
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22NY%22%5D
- http://medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=5
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22AZ%22%5D

### 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

### Example pages
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality
- http://medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=3
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D

---

## Target size is at least 44×44 CSS pixels (Enhanced) (WCAG 2.5.5)

**Bug ID:** `VS-2de7b1f8`  
**Pattern ID:** `VS-cb53cc4d`  
**URL:** http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0  
**XPath / selector:** `<button class="usa-button" type="submit">`  
**WCAG SC:** 2.5.5 — Target Size (Enhanced) (Level AAA)  
**Rule:** Siteimprove Alfa — `sia-r111` ([reference](https://alfa.siteimprove.com/rules/sia-r111))  
**Severity:** Moderate  
**Frequency:** 67902 instances; 3319 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### 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
1. Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0.
2. Locate the element: <button class="usa-button" type="submit">
3. 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
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A891&f%5B1%5D=waiver_state_facet%3A901&page=69
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A711&f%5B1%5D=state%3A796&f%5B2%5D=state%3A816&f%5B3%5D=state%3A866&f%5B4%5D=state%3A976&f%5B5%5D=state%3A1036&f%5B6%5D=state%3A1046&f%5B7%5D=topics%3A3046&f%5B8%5D=topics%3A7406&page=1660
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?entry=8383&page=61
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1516&f%5B1%5D=fpg_topics_facet%3A8601&f%5B2%5D=fpg_topics_facet%3A8716&f%5B3%5D=fpg_topics_facet%3A8861&page=4
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments/approved-state-directed-payment-preprints?items_per_page=50&page=5
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A796&f%5B1%5D=state%3A831&page=1663
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1856&f%5B1%5D=sub_topic_faq_library_facet%3A2091&f%5B2%5D=sub_topic_faq_library_facet%3A2096&f%5B3%5D=sub_topic_faq_library_facet%3A2371&f%5B4%5D=sub_topic_faq_library_facet%3A2436&page=0
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1976&f%5B1%5D=sub_topic_faq_library_facet%3A1986&f%5B2%5D=sub_topic_faq_library_facet%3A2091&f%5B3%5D=sub_topic_faq_library_facet%3A2431&f%5B4%5D=sub_topic_faq_library_facet%3A2531&page=0
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1971&fcf=41230&page=0&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A716&f%5B1%5D=waiver_state_facet%3A991&items_per_page=10&page=5
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A2826&page=109
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A2451&fcf=40870&page=4&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/110976
- http://medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A856&f%5B1%5D=fpg_topics_facet%3A906&f%5B2%5D=fpg_topics_facet%3A1016&f%5B3%5D=fpg_topics_facet%3A1491&f%5B4%5D=fpg_topics_facet%3A8711&f%5B5%5D=fpg_topics_facet%3A8716&f%5B6%5D=fpg_topics_facet%3A8861&page=110
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1471&f%5B1%5D=fpg_topics_facet%3A1501&f%5B2%5D=fpg_topics_facet%3A1516&f%5B3%5D=fpg_topics_facet%3A8406&page=106
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1881&f%5B1%5D=sub_topic_faq_library_facet%3A1911&f%5B2%5D=sub_topic_faq_library_facet%3A2501&page=82
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729

…and more — 3319 pages total ([download CSV](csv/alfa__sia-r111.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

### Example pages
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6

---

## Form elements should have a visible label (WCAG criterion undetermined)

**Bug ID:** `VS-08625ac5`  
**Pattern ID:** `VS-33841929`  
**URL:** http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices  
**XPath / selector:** `select[aria-labelledby="filter-th-87376-0"]`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `label-title-only` ([reference](https://dequeuniversity.com/rules/axe/4.12/label-title-only?application=axeAPI))  
**Severity:** Serious  
**Frequency:** 10 instances; 3 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices
- https://www.medicaid.gov/prior-annual-medicaid-hospice-rate-letters
- https://www.medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/drug-utilization-review-annual-report

### 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

### Example pages
- http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices
- https://www.medicaid.gov/prior-annual-medicaid-hospice-rate-letters
- https://www.medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/drug-utilization-review-annual-report

---

## All page content should be contained by landmarks (WCAG criterion undetermined)

**Bug ID:** `VS-f7200168`  
**Pattern ID:** `VS-f18df681`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953  
**XPath / selector:** `.small`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `region` ([reference](https://dequeuniversity.com/rules/axe/4.12/region?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 10132 instances; 2279 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
2. Locate the element: .small
3. Confirm the axe-core finding for rule region.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-2003
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7663
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-81-007-7
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7394
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-8-015-15
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-083-126
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7125
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7441
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-648
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx004124
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8417
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-937

…and more — 2279 pages total ([download CSV](csv/axe-core__region.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.

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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095

---

## Page should contain a level-one heading (WCAG criterion undetermined)

**Bug ID:** `VS-bc01ba9b`  
**Pattern ID:** `VS-fa44f293`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953  
**XPath / selector:** `html`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `page-has-heading-one` ([reference](https://dequeuniversity.com/rules/axe/4.12/page-has-heading-one?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 2278 instances; 2278 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
2. Locate the element: html
3. Confirm the axe-core finding for rule page-has-heading-one.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-2003
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7663
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-81-007-7
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7394
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-8-015-15
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-083-126
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7125
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7441
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-648
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx004124
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8417
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-937

…and more — 2278 pages total ([download CSV](csv/axe-core__page-has-heading-one.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095

---

## Document should have one main landmark (WCAG criterion undetermined)

**Bug ID:** `VS-8241b526`  
**Pattern ID:** `VS-d5d82446`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953  
**XPath / selector:** `html`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `landmark-one-main` ([reference](https://dequeuniversity.com/rules/axe/4.12/landmark-one-main?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 2274 instances; 2274 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953.
2. Locate the element: html
3. Confirm the axe-core finding for rule landmark-one-main.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-2003
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003068
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7663
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-81-007-7
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7394
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-8-015-15
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-083-126
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7125
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7441
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-648
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx004124
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8417
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-937

…and more — 2274 pages total ([download CSV](csv/axe-core__landmark-one-main.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7953
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/all-21-007-7
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095

---

## Heading levels should only increase by one (WCAG criterion undetermined)

**Bug ID:** `VS-7c8f0191`  
**Pattern ID:** `VS-d25f622d`  
**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`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `heading-order` ([reference](https://dequeuniversity.com/rules/axe/4.12/heading-order?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 211 instances; 191 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments.
2. Locate the element: .region-footer-first > .usa-footer__primary-content.usa-footer__primary-content--collapsible > h4
3. Confirm the axe-core finding for rule heading-order.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- http://medicaid.gov/medicaid/data-systems/health-information-exchange/federal-financial-participation-for-hit-and-hie
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22GU%22%5D
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations
- http://medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106876
- http://medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106701
- http://medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming
- https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/entry/54063
- https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/program-areas/reducing-substance-use-disorders/collaborative-learning
- https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/request-health-home-planning-funds
- https://www.medicaid.gov/new-notable?page=92
- https://www.medicaid.gov/medicaid/data-systems/medicaid-and-chip-business-information-solution/macbis-financial/medicaid-budget-and-expenditure-system-mbes/cms-37-medicaid-program-budget-report
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
- http://medicaid.gov/about-us/organization/jeremy-silanskis
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/improving-asthma-control
- http://medicaid.gov/eligibility
- https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/other-agency-guidance/medicare-and-other-coverage-guidance
- https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/functional-areas
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality
- http://medicaid.gov/resources-for-states
- http://medicaid.gov/medicaid/benefits/telehealth/office-of-civil-rights-hipaa-guidance
- https://www.medicaid.gov/medicaid/managed-care/managed-care-entities
- http://medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/innovative-practices
- https://www.medicaid.gov/new-notable?page=4
- http://medicaid.gov/medicaid/quality-of-care/quality-improvement/oral-health-quality-improvement-resources/advancing-oral-health-prevention-in-primary-care

…and more — 191 pages total ([download CSV](csv/axe-core__heading-order.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.

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

### Example pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- http://medicaid.gov/medicaid/data-systems/health-information-exchange/federal-financial-participation-for-hit-and-hie
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22GU%22%5D

---

## Landmarks should have a unique role or role/label/title (i.e. accessible name) c (WCAG criterion undetermined)

**Bug ID:** `VS-01f01755`  
**Pattern ID:** `VS-8806389c`  
**URL:** https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments  
**XPath / selector:** `.section`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `landmark-unique` ([reference](https://dequeuniversity.com/rules/axe/4.12/landmark-unique?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 39 instances; 39 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments.
2. Locate the element: .section
3. Confirm the axe-core finding for rule landmark-unique.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- http://medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
- https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/functional-areas
- http://medicaid.gov/resources-for-states
- https://www.medicaid.gov/medicaid/benefits/prevention
- http://medicaid.gov/resources-for-states/spa-and-1915-waiver-processing
- https://www.medicaid.gov/medicaid/prescription-drugs/drug-utilization-review/drug-utilization-review-annual-report
- http://medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=3
- https://www.medicaid.gov/medicaid/long-term-services-supports/real-choice-systems-change/state-profile-tool-grant-program
- https://www.medicaid.gov/medicaid/managed-care/guidance
- https://www.medicaid.gov/
- https://www.medicaid.gov/style-guide/components/button
- https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?items_per_page=10&page=18
- http://medicaid.gov/resources-for-states/innovation-accelerator-program/functional-areas
- https://www.medicaid.gov/medicaid/prescription-drugs/medicaid-drug-rebate-program
- http://medicaid.gov/medicaid/benefits/prevention
- http://medicaid.gov/medicaid/long-term-services-supports/balancing-long-term-services-supports
- https://www.medicaid.gov/style-guide/components/back-to-top
- https://www.medicaid.gov/medicaid/quality-of-care/quality-of-care-performance-measurement/chip-quality-of-care-performance-measurement
- https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19
- https://www.medicaid.gov/medicaid/eligibility-policy
- https://www.medicaid.gov/medicaid/benefits/alternative-benefit-plan-coverage
- http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources
- https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/functional-areas/quality-measurement

…and more — 39 pages total ([download CSV](csv/axe-core__landmark-unique.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

### Example pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- http://medicaid.gov/medicaid/financial-management/medicaid-administrative-claiming
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality

---

## Main landmark should not be contained in another landmark (WCAG criterion undetermined)

**Bug ID:** `VS-3614bc86`  
**Pattern ID:** `VS-ff3ceb19`  
**URL:** https://www.medicaid.gov/style-guide/components/button  
**XPath / selector:** `.style-guide-page > .grid-gap-sm.grid-row > main`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `landmark-main-is-top-level` ([reference](https://dequeuniversity.com/rules/axe/4.12/landmark-main-is-top-level?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 3 instances; 3 of 7478 pages affected
  
**History:** first seen 2026-W28, last seen 2026-W31 (4 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/style-guide/components/button.
2. Locate the element: .style-guide-page > .grid-gap-sm.grid-row > main
3. Confirm the axe-core finding for rule landmark-main-is-top-level.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/style-guide/components/button
- https://www.medicaid.gov/style-guide/components/back-to-top
- https://www.medicaid.gov/style-guide/components

### 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

### Example pages
- https://www.medicaid.gov/style-guide/components/button
- https://www.medicaid.gov/style-guide/components/back-to-top
- https://www.medicaid.gov/style-guide/components

---

## Document should not have more than one main landmark (WCAG criterion undetermined)

**Bug ID:** `VS-eb8eb499`  
**Pattern ID:** `VS-cd69be3a`  
**URL:** https://www.medicaid.gov/style-guide/components/button  
**XPath / selector:** `.main-content`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `landmark-no-duplicate-main` ([reference](https://dequeuniversity.com/rules/axe/4.12/landmark-no-duplicate-main?application=axeAPI))  
**Severity:** Moderate  
**Frequency:** 3 instances; 3 of 7478 pages affected
  
**History:** first seen 2026-W28, last seen 2026-W31 (4 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/style-guide/components/button.
2. Locate the element: .main-content
3. Confirm the axe-core finding for rule landmark-no-duplicate-main.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/style-guide/components/button
- https://www.medicaid.gov/style-guide/components/back-to-top
- https://www.medicaid.gov/style-guide/components

### 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

### Example pages
- https://www.medicaid.gov/style-guide/components/button
- https://www.medicaid.gov/style-guide/components/back-to-top
- https://www.medicaid.gov/style-guide/components

---

## ARIA role should be appropriate for the element (WCAG criterion undetermined)

**Bug ID:** `VS-7c21ade5`  
**Pattern ID:** `VS-4fac2f41`  
**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`  
**WCAG SC:** _undetermined_  
**Rule:** axe-core — `aria-allowed-role` ([reference](https://dequeuniversity.com/rules/axe/4.12/aria-allowed-role?application=axeAPI))  
**Severity:** Minor  
**Frequency:** 653 instances; 311 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=.
2. 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
3. Confirm the axe-core finding for rule aria-allowed-role.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=10&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=34&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=2&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=9&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=4&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=756&page=1&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=28&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=941&page=6&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=31&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=986&page=7&q=
- https://www.medicaid.gov/chip/state-program-information/chip-spa?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=811&page=0&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=826&page=20&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=716&page=25&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=711&page=41&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=991&page=9&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=32&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=926&page=53&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=736&page=16&q=
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=1&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=976&page=25&q=
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=841&page=0&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=696&page=5&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=5&q=

…and more — 311 pages total ([download CSV](csv/axe-core__aria-allowed-role.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

### Example pages
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B%5D=786&q=
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=1001&page=10&q=

---

## Scrolling content can be accessed by keyboard (WCAG criterion undetermined)

**Bug ID:** `VS-3adb53e6`  
**Pattern ID:** `VS-c18be945`  
**URL:** http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0  
**XPath / selector:** `text: "  Feedback  "`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r57` ([reference](https://alfa.siteimprove.com/rules/sia-r57))  
**Severity:** Moderate  
**Frequency:** 54363 instances; 3317 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A891&f%5B1%5D=waiver_state_facet%3A901&page=69
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A711&f%5B1%5D=state%3A796&f%5B2%5D=state%3A816&f%5B3%5D=state%3A866&f%5B4%5D=state%3A976&f%5B5%5D=state%3A1036&f%5B6%5D=state%3A1046&f%5B7%5D=topics%3A3046&f%5B8%5D=topics%3A7406&page=1660
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?entry=8383&page=61
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1516&f%5B1%5D=fpg_topics_facet%3A8601&f%5B2%5D=fpg_topics_facet%3A8716&f%5B3%5D=fpg_topics_facet%3A8861&page=4
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments/approved-state-directed-payment-preprints?items_per_page=50&page=5
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=state%3A796&f%5B1%5D=state%3A831&page=1663
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=916&page=8&q=
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1856&f%5B1%5D=sub_topic_faq_library_facet%3A2091&f%5B2%5D=sub_topic_faq_library_facet%3A2096&f%5B3%5D=sub_topic_faq_library_facet%3A2371&f%5B4%5D=sub_topic_faq_library_facet%3A2436&page=0
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1976&f%5B1%5D=sub_topic_faq_library_facet%3A1986&f%5B2%5D=sub_topic_faq_library_facet%3A2091&f%5B3%5D=sub_topic_faq_library_facet%3A2431&f%5B4%5D=sub_topic_faq_library_facet%3A2531&page=0
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1971&fcf=41230&page=0&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list?f%5B0%5D=waiver_state_facet%3A716&f%5B1%5D=waiver_state_facet%3A991&items_per_page=10&page=5
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A2826&page=109
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A2451&fcf=40870&page=4&sl=yes
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/110976
- http://medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A856&f%5B1%5D=fpg_topics_facet%3A906&f%5B2%5D=fpg_topics_facet%3A1016&f%5B3%5D=fpg_topics_facet%3A1491&f%5B4%5D=fpg_topics_facet%3A8711&f%5B5%5D=fpg_topics_facet%3A8716&f%5B6%5D=fpg_topics_facet%3A8861&page=110
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A1471&f%5B1%5D=fpg_topics_facet%3A1501&f%5B2%5D=fpg_topics_facet%3A1516&f%5B3%5D=fpg_topics_facet%3A8406&page=106
- https://www.medicaid.gov/faq?f%5B0%5D=sub_topic_faq_library_facet%3A1881&f%5B1%5D=sub_topic_faq_library_facet%3A1911&f%5B2%5D=sub_topic_faq_library_facet%3A2501&page=82
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729

…and more — 3317 pages total ([download CSV](csv/alfa__sia-r57.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

### Example pages
- http://medicaid.gov/medicaid/medicaid-state-plan-amendments?page=0
- https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A936&f%5B1%5D=topics%3A3001&f%5B2%5D=topics%3A4676&page=1659
- https://www.medicaid.gov/federal-policy-guidance?f%5B0%5D=fpg_topics_facet%3A741&f%5B1%5D=fpg_topics_facet%3A751&f%5B2%5D=fpg_topics_facet%3A936&f%5B3%5D=fpg_topics_facet%3A8716&f%5B4%5D=fpg_topics_facet%3A8861&f%5B5%5D=fpg_topics_facet%3A8901&page=6

---

## First focusable element is link to main content (WCAG criterion undetermined)

**Bug ID:** `VS-b762c651`  
**Pattern ID:** `VS-aa242c2d`  
**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`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r87` ([reference](https://alfa.siteimprove.com/rules/sia-r87))  
**Severity:** Moderate  
**Frequency:** 1142 instances; 1142 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7125
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7441
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-648
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8417
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-444
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2256
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-6586
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-83-006-6
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-6321
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7912
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7023
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1658
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7675
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2460
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7257

…and more — 1142 pages total ([download CSV](csv/alfa__sia-r87.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5

---

## Form field label is visible (WCAG criterion undetermined)

**Bug ID:** `VS-ceb71760`  
**Pattern ID:** `VS-7118fead`  
**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`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r61` ([reference](https://alfa.siteimprove.com/rules/sia-r61))  
**Severity:** Moderate  
**Frequency:** 1136 instances; 1136 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-729
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7125
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7441
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-648
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mcr-12-156-156
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8417
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-444
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2256
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-6586
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-83-006-6
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-6321
- https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/OR
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/rule-7912
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7023
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1658
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7675
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2460

…and more — 1136 pages total ([download CSV](csv/alfa__sia-r61.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/mis-21-050-50
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1789
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/ffs-14-004-5

---

## aria attribute is permitted for element role (WCAG criterion undetermined)

**Bug ID:** `VS-4bb4de80`  
**Pattern ID:** `VS-e05344b9`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035  
**XPath / selector:** `@aria-selected="true"`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r18` ([reference](https://alfa.siteimprove.com/rules/sia-r18))  
**Severity:** Moderate  
**Frequency:** 1163 instances; 241 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg013184
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot001014
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002118
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002163
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cip002190
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl003047
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cip002148
- https://www.medicaid.gov/tmsis/dataguide/v3/file-segment-layouts/mcr-managed-care-plan-information/managed-care-service-area
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx003074
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/prv003057
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl004056
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cot003225
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/mcr004057
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg002020
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/elg015202
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/tpl003089
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/clt002099
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/clt002076
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002084
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cot002147
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx008283
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/tpl003037

…and more — 241 pages total ([download CSV](csv/alfa__sia-r18.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

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/crx002035
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx009326
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023

---

## Presentational attribute (use CSS) (WCAG criterion undetermined)

**Bug ID:** `VS-fd47ab5d`  
**Pattern ID:** `VS-04a9d28c`  
**URL:** https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023  
**XPath / selector:** `td`  
**WCAG SC:** _undetermined_  
**Rule:** deprecated-html — `presentational-attr`  
**Severity:** Moderate  
**Frequency:** 163 instances; 132 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

### HTML snippet
```html
<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
1. Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023.
2. Locate the element: td
3. Confirm the deprecated-html finding for rule presentational-attr.

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/mis-21-014-14
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-6379
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002117
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-6214
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/cot003225
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/mcr004057
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8877
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/mis-22-005-5
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-7006
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-8037
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/clt003189
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-7649
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/elg007124
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt004268
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-1392
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/prv-5-001-1
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-3008
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/exp-1-008-22
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt003207
- https://www.medicaid.gov/tmsis/dataguide/v3/data-elements/tpl002023
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/clt002244
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/ftx006201
- https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-608
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/mis-7-014-14

…and more — 132 pages total ([download CSV](csv/deprecated-html__presentational-attr.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.

### Example pages
- https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv002023
- https://www.medicaid.gov/tmsis/dataguide/v3/data-quality-measures/mis-21-014-14
- https://www.medicaid.gov/tmsis/dataguide/v3/validation-rules/rule-6379

---

## Headings are structured hierarchically (WCAG criterion undetermined)

**Bug ID:** `VS-445ff332`  
**Pattern ID:** `VS-f054f4a4`  
**URL:** https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments  
**XPath / selector:** `<h4 class="usa-footer__primary-link">`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r53` ([reference](https://alfa.siteimprove.com/rules/sia-r53))  
**Severity:** Moderate  
**Frequency:** 119 instances; 108 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations
- http://medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106876
- http://medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106701
- https://www.medicaid.gov/new-notable?page=92
- https://www.medicaid.gov/medicaid/data-systems/medicaid-and-chip-business-information-solution/macbis-financial/medicaid-budget-and-expenditure-system-mbes/cms-37-medicaid-program-budget-report
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/maternal-infant-health-care-quality
- http://medicaid.gov/about-us/organization/jeremy-silanskis
- https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement/improving-asthma-control
- http://medicaid.gov/eligibility
- https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/other-agency-guidance/medicare-and-other-coverage-guidance
- https://www.medicaid.gov/resources-for-states/innovation-accelerator-program/functional-areas
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/budget-neutrality
- http://medicaid.gov/resources-for-states
- https://www.medicaid.gov/medicaid/managed-care/managed-care-entities
- http://medicaid.gov/medicaid/quality-of-care/quality-improvement/oral-health-quality-improvement-resources/advancing-oral-health-prevention-in-primary-care
- http://medicaid.gov/resources-for-states/medicaid-state-technical-assistance/health-home-information-resource-center/request-health-home-planning-funds
- http://medicaid.gov/medicaid/program-integrity/affordable-care-act-program-integrity-provisions
- http://medicaid.gov/state-overviews/stateprofile.html?state=New-York
- https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106626
- https://www.medicaid.gov/about-us/organization/todd-jones
- https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/physician-administered-drugs-pad
- https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/entry/192741
- http://medicaid.gov/medicaid/quality-of-care/quality-improvement/improving-tobacco-cessation/state-stories
- https://www.medicaid.gov/medicaid/long-term-services-supports/money-follows-person/money-follows-person-additional-resources

…and more — 108 pages total ([download CSV](csv/alfa__sia-r53.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

### Example pages
- https://www.medicaid.gov/medicaid/managed-care/guidance/state-directed-payments
- https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations
- http://medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-resources/106876

---

## Table header has scope (WCAG criterion undetermined)

**Bug ID:** `VS-ea01f8e9`  
**Pattern ID:** `VS-2cd767ca`  
**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">`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r78` ([reference](https://alfa.siteimprove.com/rules/sia-r78))  
**Severity:** Moderate  
**Frequency:** 5 instances; 5 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22NY%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22AZ%22%5D

### 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

### Example pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main

---

## Element role is consistent with ARIA landmark (WCAG criterion undetermined)

**Bug ID:** `VS-6d53d87f`  
**Pattern ID:** `VS-e5ec42f0`  
**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">`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r72` ([reference](https://alfa.siteimprove.com/rules/sia-r72))  
**Severity:** Moderate  
**Frequency:** 900 instances; 5 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22NY%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22AZ%22%5D

### 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

### Example pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main

---

## Keyboard trap does not exist (WCAG criterion undetermined)

**Bug ID:** `VS-a381b0d4`  
**Pattern ID:** `VS-4c341c77`  
**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">`  
**WCAG SC:** _undetermined_  
**Rule:** Siteimprove Alfa — `sia-r85` ([reference](https://alfa.siteimprove.com/rules/sia-r85))  
**Severity:** Moderate  
**Frequency:** 247 instances; 4 of 7478 pages affected
  
**History:** first seen 2026-W24, last seen 2026-W31 (8 weeks)

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

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

### Impact
Not captured by automated scan — requires manual testing.

### Affected pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22NY%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22AZ%22%5D

### 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

### Example pages
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22KS%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22PA%22%5D
- https://www.medicaid.gov/medicaid/quality-of-care/core-set-data-dashboard/main?focusStates=%5B%22NY%22%5D