www.medicaid.gov: Accessibility — week 2026-W40

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

Training priorities

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

SC	Criterion	Pages	Rules	Notes
1.4.6	WCAG 1.4.6	1273	1
2.5.5	WCAG 2.5.5	1273	1
1.4.8	WCAG 1.4.8	1051	2
4.1.2	Name, Role, Value (ARIA)	183	3	Component inconsistency
1.3.1	Info and Relationships (semantic structure)	168	2

Next 10 actions

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

Top 10 clustered component fixes for this week.
Cluster	Severity	Pages	Who it affects	How to fix	Evidence	Decision
Text has minimum contrast ratio of 4.5:1 · unattributed component Fix one place, resolve ~1049 finding(s) on 1049 page(s). XPath / selector: `<p class="usa-footer__contact-info margin-bottom-0">`	Moderate	1049	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r73	pages (CSV)	Decision Assigned to Notes
Document should have one main landmark · unattributed component Fix one place, resolve ~441 finding(s) on 441 page(s). XPath / selector: `html` `<html class="no-js" lang="en">`	Moderate	441	Requires manual testing.	Each page should have exactly one <main> landmark.	pages (CSV)	Decision Assigned to Notes
Page should contain a level-one heading · unattributed component Fix one place, resolve ~441 finding(s) on 441 page(s). XPath / selector: `html` `<html class="no-js" lang="en">`	Moderate	441	Requires manual testing.	See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/page-has-heading-one?application=axeAPI	pages (CSV)	Decision Assigned to Notes
Scrolling content can be accessed by keyboard · unattributed component Fix one place, resolve ~1049 finding(s) on 1049 page(s). XPath / selector: `text: " Feedback "`	Moderate	1049	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r57	pages (CSV)	Decision Assigned to Notes
First focusable element is link to main content · unattributed component Fix one place, resolve ~224 finding(s) on 224 page(s). XPath / selector: `{"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys`	Moderate	224	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r87	pages (CSV)	Decision Assigned to Notes
Certain ARIA roles must contain particular children · unattributed component Fix one place, resolve ~93 finding(s) on 93 page(s). XPath / selector: `.nav` `<div class="nav nav-tabs nav-justified" role="tablist">`	Critical	93	Without vision, Limited vision, Limited cognitive, language, or learning ability	Add the child roles this container role requires (e.g. a list needs listitem children).	pages (CSV)	Decision Assigned to Notes
Form field label is visible · unattributed component Fix one place, resolve ~222 finding(s) on 222 page(s). XPath / selector: `{"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys`	Moderate	222	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r61	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~442 finding(s) on 442 page(s). XPath / selector: `.small` `<div class="small p-1">`	Moderate	442	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~442 finding(s) on 442 page(s). XPath / selector: `.justify-content-between` `<div class="d-flex justify-content-between m-2 mb-2">`	Moderate	442	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes
All page content should be contained by landmarks · unattributed component Fix one place, resolve ~442 finding(s) on 442 page(s). XPath / selector: `.font-weight-bold` `<p class="font-weight-bold m-0 mr-1">Version:</p>`	Moderate	442	Requires manual testing.	Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.	pages (CSV)	Decision Assigned to Notes

Bug reports

8 issue type(s) are shown by default out of 24 total. Prioritized by severity, key pages, WCAG level, and prevalence; use the toggle to show everything.

Overall severity mix: 2 critical, 2 serious, 19 moderate, 1 minor. By WCAG category: 5 WCAG 2.0 A, 1 WCAG 2.1 A, 1 WCAG 2.2 AA, 4 WCAG 2.x AAA, 7 Best Practice, 6 Undetermined. Ordered by severity, key-page impact, WCAG level, and prevalence. Following accessibility bug-reporting best practices. Download: Markdown · JSON (full archive) · JSON (AI diagnostic) · CSV (all findings) · Priority pages CSV · Priority pages JSON.

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

Default view shows 8 prioritized issue type(s); 16 more are available if you switch to "Show everything".

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

Findings needing review

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

Critical axe aria-allowed-attr WCAG 2.0 A Elements must only use supported ARIA attributes (WCAG 4.1.2) 93/2696 pages · 453 instances Likely template

Bug ID: VS-1bd49362
Pattern ID: VS-1467ea8a
Combined ID: VS-1bd49362 (pattern VS-1467ea8a) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — Elements must only use supported ARIA attributes [aria-allowed-attr]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: a[href$="#overview"]
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Elements must only use supported ARIA attributes. Detected by axe-core rule aria-allowed-attr on 93 of 2696 scanned pages (453 instances).

Steps to reproduce

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

Impact

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

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

Affected pages

…and more — all 93 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Critical axe aria-required-children WCAG 2.0 A Certain ARIA roles must contain particular children (WCAG 1.3.1) 93/2696 pages · 93 instances Likely template

Bug ID: VS-6fbb414e
Pattern ID: VS-9429bb8d
Combined ID: VS-6fbb414e (pattern VS-9429bb8d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: axe-core — Certain ARIA roles must contain particular children [aria-required-children]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: .nav
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Certain ARIA roles must contain particular children. Detected by axe-core rule aria-required-children on 93 of 2696 scanned pages (93 instances).

Steps to reproduce

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

Impact

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

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

Affected pages

…and more — all 93 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Serious axe aria-input-field-name WCAG 2.0 A ARIA input fields must have an accessible name (WCAG 4.1.2) 60/2696 pages · 129 instances Likely template

Bug ID: VS-49a24127
Pattern ID: VS-0841abc2
Combined ID: VS-49a24127 (pattern VS-0841abc2) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — ARIA input fields must have an accessible name [aria-input-field-name]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=781&page=0&q=
XPath / selector: span[data-select2-id="select2-data-1-qmha"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"]
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

ARIA input fields must have an accessible name. Detected by axe-core rule aria-input-field-name on 60 of 2696 scanned pages (129 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=781&page=0&q=.
Locate the element: span[data-select2-id="select2-data-1-qmha"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"]
Confirm the axe-core finding for rule aria-input-field-name against WCAG 4.1.2 Name, Role, Value.

Impact

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

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

Affected pages

…and more — all 60 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Serious axe label-title-only Best Practice Form elements should have a visible label (WCAG criterion undetermined) 1/2696 pages · 2 instances Likely content

Bug ID: VS-eacc0e48
Pattern ID: VS-33841929
Combined ID: VS-eacc0e48 (pattern VS-33841929) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Form elements should have a visible label [label-title-only]
Example URL: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data
XPath / selector: select[aria-labelledby="filter-th-87371-1"]
History: first seen 2026-W24, last seen 2026-W40 (15 wk)

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

<select aria-labelledby="filter-th-87371-1" class="usa-select height-1" data-col-index="1" title="Filter by Year">

Description

Form elements should have a visible label. Detected by axe-core rule label-title-only on 1 of 2696 scanned pages (2 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data.
Locate the element: select[aria-labelledby="filter-th-87371-1"]
Confirm the axe-core finding for rule label-title-only.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

/medicaid/prescription-drugs/state-drug-utilization-data

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r14 WCAG 2.1 A Accessible name of link or button matches visible label (WCAG 2.5.3) 120/2696 pages · 120 instances Likely template

Bug ID: VS-033ea34d
Pattern ID: VS-f7dba940
Combined ID: VS-033ea34d (pattern VS-f7dba940) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.1 A
Obligation: required
Handling: review
WCAG SC: 2.5.3 Label in Name (Level A, WCAG 2.1)
Rule: Siteimprove Alfa — Accessible name of link or button matches visible label [sia-r14]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/ffs-9-019-16
XPath / selector: <a alt="View Changelog, select to access the version history" href="#" class="text-primary btn p-0" data-target="#modalChangelogHistory">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Accessible name of link or button matches visible label. Detected by Siteimprove Alfa rule sia-r14 on 120 of 2696 scanned pages (120 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-quality-measures/ffs-9-019-16.
Locate the element: <a alt="View Changelog, select to access the version history" href="#" class="text-primary btn p-0" data-target="#modalChangelogHistory">
Confirm the Siteimprove Alfa finding for rule sia-r14 against WCAG 2.5.3 Label in Name.

Impact

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

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

Affected pages

…and more — all 120 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r68 WCAG 2.0 A Presentational children of an element are not focusable (WCAG 1.3.1) 75/2696 pages · 79 instances · possible duplicate Likely template

Bug ID: VS-46db8702
Pattern ID: VS-d6097011
Combined ID: VS-46db8702 (pattern VS-d6097011) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Presentational children of an element are not focusable [sia-r68]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
XPath / selector: <div class="nav nav-tabs nav-justified" role="tablist">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-6fbb414e (pattern VS-9429bb8d). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

Presentational children of an element are not focusable. Detected by Siteimprove Alfa rule sia-r68 on 75 of 2696 scanned pages (79 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008.
Locate the element: <div class="nav nav-tabs nav-justified" role="tablist">
Confirm the Siteimprove Alfa finding for rule sia-r68 against WCAG 1.3.1 Info and Relationships.

Impact

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

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

Affected pages

…and more — all 75 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r8 WCAG 2.0 A Form field has accessible name (WCAG 4.1.2) 30/2696 pages · 64 instances · possible duplicate Likely template

Bug ID: VS-d55b93cc
Pattern ID: VS-a48e6078
Combined ID: VS-d55b93cc (pattern VS-a48e6078) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Form field has accessible name [sia-r8]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=41&q=
XPath / selector: <span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-49a24127 (pattern VS-0841abc2). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

Form field has accessible name. Detected by Siteimprove Alfa rule sia-r8 on 30 of 2696 scanned pages (64 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=41&q=.
Locate the element: <span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false">
Confirm the Siteimprove Alfa finding for rule sia-r8 against WCAG 4.1.2 Name, Role, Value.

Impact

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

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

Affected pages

…and more — all 30 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate alfa sia-r113 WCAG 2.2 AA Target size is at least 24×24 CSS pixels or has spacing (Minimum) (WCAG 2.5.8) 30/2696 pages · 64 instances Likely template

Bug ID: VS-00350601
Pattern ID: VS-179ad9b3
Combined ID: VS-00350601 (pattern VS-179ad9b3) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.2 AA
Obligation: required
Handling: review
WCAG SC: 2.5.8 Target Size (Minimum) (Level AA, WCAG 2.2)
Rule: Siteimprove Alfa — Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=41&q=
XPath / selector: <textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Target size is at least 24×24 CSS pixels or has spacing (Minimum). Detected by Siteimprove Alfa rule sia-r113 on 30 of 2696 scanned pages (64 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=681&page=41&q=.
Locate the element: <textarea class="select2-search__field" type="search" tabindex="0" autocorrect="off">
Confirm the Siteimprove Alfa finding for rule sia-r113 against WCAG 2.5.8 Target Size (Minimum).

Impact

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

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

Affected pages

…and more — all 30 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r66 WCAG 2.x AAA Text has enhanced contrast (WCAG 1.4.6) 1273/2696 pages · 52687 instances Likely template

Bug ID: VS-c691c18c
Pattern ID: VS-646b1e0b
Combined ID: VS-c691c18c (pattern VS-646b1e0b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.6 Contrast (Enhanced) (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has enhanced contrast [sia-r66]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656
XPath / selector: text: "Here’s how you know"
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Text has enhanced contrast. Detected by Siteimprove Alfa rule sia-r66 on 1273 of 2696 scanned pages (52687 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656.
Locate the element: text: "Here’s how you know"
Confirm the Siteimprove Alfa finding for rule sia-r66 against WCAG 1.4.6 Contrast (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1273 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate alfa sia-r111 WCAG 2.x AAA Target size is at least 44×44 CSS pixels (Enhanced) (WCAG 2.5.5) 1273/2696 pages · 31073 instances Likely template

Bug ID: VS-899f8753
Pattern ID: VS-cb53cc4d
Combined ID: VS-899f8753 (pattern VS-cb53cc4d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 2.5.5 Target Size (Enhanced) (Level AAA, WCAG 2.1)
Rule: Siteimprove Alfa — Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656
XPath / selector: <button class="usa-button" type="submit">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Target size is at least 44×44 CSS pixels (Enhanced). Detected by Siteimprove Alfa rule sia-r111 on 1273 of 2696 scanned pages (31073 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656.
Locate the element: <button class="usa-button" type="submit">
Confirm the Siteimprove Alfa finding for rule sia-r111 against WCAG 2.5.5 Target Size (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1273 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r57 Undetermined Scrolling content can be accessed by keyboard (WCAG criterion undetermined) 1273/2696 pages · 10728 instances Likely template

Bug ID: VS-e61eb469
Pattern ID: VS-c18be945
Combined ID: VS-e61eb469 (pattern VS-c18be945) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Scrolling content can be accessed by keyboard [sia-r57]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656
XPath / selector: text: " Feedback "
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Scrolling content can be accessed by keyboard. Detected by Siteimprove Alfa rule sia-r57 on 1273 of 2696 scanned pages (10728 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656.
Locate the element: text: " Feedback "
Confirm the Siteimprove Alfa finding for rule sia-r57.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1273 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r73 WCAG 2.x AAA Text has minimum contrast ratio of 4.5:1 (WCAG 1.4.8) 1049/2696 pages · 1049 instances Likely template

Bug ID: VS-9f176a22
Pattern ID: VS-2208081b
Combined ID: VS-9f176a22 (pattern VS-2208081b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.8 Visual Presentation (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has minimum contrast ratio of 4.5:1 [sia-r73]
Example URL: https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656
XPath / selector: <p class="usa-footer__contact-info margin-bottom-0">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Text has minimum contrast ratio of 4.5:1. Detected by Siteimprove Alfa rule sia-r73 on 1049 of 2696 scanned pages (1049 instances).

Steps to reproduce

Open https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments?f%5B0%5D=topics%3A3046&f%5B1%5D=topics%3A7426&page=1656.
Locate the element: <p class="usa-footer__contact-info margin-bottom-0">
Confirm the Siteimprove Alfa finding for rule sia-r73 against WCAG 1.4.8 Visual Presentation.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 1049 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate axe region Best Practice All page content should be contained by landmarks (WCAG criterion undetermined) 442/2696 pages · 1964 instances Likely template

Bug ID: VS-25bf460e
Pattern ID: VS-f18df681
Combined ID: VS-25bf460e (pattern VS-f18df681) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — All page content should be contained by landmarks [region]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: .small
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

<div class="small p-1">

Description

All page content should be contained by landmarks. Detected by axe-core rule region on 442 of 2696 scanned pages (1964 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
Locate the element: .small
Confirm the axe-core finding for rule region.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 442 pages (CSV).

Testing environment

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

Suggested fix

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

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

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

Triage status Notes

Moderate axe landmark-one-main Best Practice Document should have one main landmark (WCAG criterion undetermined) 441/2696 pages · 441 instances Likely template

Bug ID: VS-51b851fa
Pattern ID: VS-d5d82446
Combined ID: VS-51b851fa (pattern VS-d5d82446) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Document should have one main landmark [landmark-one-main]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Document should have one main landmark. Detected by axe-core rule landmark-one-main on 441 of 2696 scanned pages (441 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
Locate the element: html
Confirm the axe-core finding for rule landmark-one-main.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 441 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate axe page-has-heading-one Best Practice Page should contain a level-one heading (WCAG criterion undetermined) 441/2696 pages · 441 instances Likely template

Bug ID: VS-22b482cc
Pattern ID: VS-fa44f293
Combined ID: VS-22b482cc (pattern VS-fa44f293) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Page should contain a level-one heading [page-has-heading-one]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Page should contain a level-one heading. Detected by axe-core rule page-has-heading-one on 441 of 2696 scanned pages (441 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/cot002095.
Locate the element: html
Confirm the axe-core finding for rule page-has-heading-one.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 441 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r87 Undetermined First focusable element is link to main content (WCAG criterion undetermined) 224/2696 pages · 224 instances Likely template

Bug ID: VS-7233315f
Pattern ID: VS-aa242c2d
Combined ID: VS-7233315f (pattern VS-aa242c2d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — First focusable element is link to main content [sia-r87]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806
XPath / selector: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

First focusable element is link to main content. Detected by Siteimprove Alfa rule sia-r87 on 224 of 2696 scanned pages (224 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806.
Locate the element: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
Confirm the Siteimprove Alfa finding for rule sia-r87.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 224 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Moderate alfa sia-r61 Undetermined Form field label is visible (WCAG criterion undetermined) 222/2696 pages · 222 instances Likely template

Bug ID: VS-ead0f39f
Pattern ID: VS-7118fead
Combined ID: VS-ead0f39f (pattern VS-7118fead) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Form field label is visible [sia-r61]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806
XPath / selector: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Form field label is visible. Detected by Siteimprove Alfa rule sia-r61 on 222 of 2696 scanned pages (222 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/validation-rules/rule-2806.
Locate the element: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
Confirm the Siteimprove Alfa finding for rule sia-r61.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 222 pages (CSV).

Testing environment

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

Suggested fix

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

Triage status Notes

Minor axe aria-allowed-role Best Practice ARIA role should be appropriate for the element (WCAG criterion undetermined) 60/2696 pages · 129 instances Likely template

Bug ID: VS-af061246
Pattern ID: VS-4fac2f41
Combined ID: VS-af061246 (pattern VS-4fac2f41) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — ARIA role should be appropriate for the element [aria-allowed-role]
Example URL: http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=781&page=0&q=
XPath / selector: span[data-select2-id="select2-data-1-qmha"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"] > .select2-search.select2-search--inline > textarea
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

ARIA role should be appropriate for the element. Detected by axe-core rule aria-allowed-role on 60 of 2696 scanned pages (129 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/medicaid-state-plan-amendments?filter%5Bfield_state%5D%5Bin%5D%5B0%5D=781&page=0&q=.
Locate the element: span[data-select2-id="select2-data-1-qmha"] > .selection > .select2-selection.select2-selection--multiple[role="combobox"] > .select2-search.select2-search--inline > textarea
Confirm the axe-core finding for rule aria-allowed-role.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 60 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate alfa sia-r18 Undetermined aria attribute is permitted for element role (WCAG criterion undetermined) 46/2696 pages · 223 instances Likely template

Bug ID: VS-52dc8da7
Pattern ID: VS-e05344b9
Combined ID: VS-52dc8da7 (pattern VS-e05344b9) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — aria attribute is permitted for element role [sia-r18]
Example URL: https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008
XPath / selector: @aria-selected="true"
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

aria attribute is permitted for element role. Detected by Siteimprove Alfa rule sia-r18 on 46 of 2696 scanned pages (223 instances).

Steps to reproduce

Open https://www.medicaid.gov/tmsis/dataguide/v4/data-elements/prv001008.
Locate the element: @aria-selected="true"
Confirm the Siteimprove Alfa finding for rule sia-r18.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 46 pages (CSV).

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate axe heading-order Best Practice Heading levels should only increase by one (WCAG criterion undetermined) 43/2696 pages · 49 instances Likely template

Bug ID: VS-eed0d6cd
Pattern ID: VS-d25f622d
Combined ID: VS-eed0d6cd (pattern VS-d25f622d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Heading levels should only increase by one [heading-order]
Example URL: http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification
XPath / selector: .field--name-field-resources-list > h3
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

<h3>Related Links</h3>

Description

Heading levels should only increase by one. Detected by axe-core rule heading-order on 43 of 2696 scanned pages (49 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification.
Locate the element: .field--name-field-resources-list > h3
Confirm the axe-core finding for rule heading-order.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 43 pages (CSV).

Testing environment

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

Suggested fix

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

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

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

Triage status Notes

Moderate deprecated-html presentational-attr Undetermined Presentational attribute (use CSS) (WCAG criterion undetermined) 29/2696 pages · 36 instances Likely template

Bug ID: VS-55739e10
Pattern ID: VS-04a9d28c
Combined ID: VS-55739e10 (pattern VS-04a9d28c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: deprecated-html — Presentational attribute (use CSS) [presentational-attr]
Example URL: https://medicaid.gov/tmsis/dataguide/v4/data-elements/tpl003050
XPath / selector: td
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Presentational attribute (use CSS). Detected by deprecated-html rule presentational-attr on 29 of 2696 scanned pages (36 instances).

Steps to reproduce

Open https://medicaid.gov/tmsis/dataguide/v4/data-elements/tpl003050.
Locate the element: td
Confirm the deprecated-html finding for rule presentational-attr.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 29 pages (CSV).

Testing environment

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

Suggested fix

Not captured by automated scan — requires manual testing.

Triage status Notes

Moderate alfa sia-r53 Undetermined Headings are structured hierarchically (WCAG criterion undetermined) 19/2696 pages · 22 instances Likely template

Bug ID: VS-63682834
Pattern ID: VS-f054f4a4
Combined ID: VS-63682834 (pattern VS-f054f4a4) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Headings are structured hierarchically [sia-r53]
Example URL: http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification
XPath / selector: <h3>
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Headings are structured hierarchically. Detected by Siteimprove Alfa rule sia-r53 on 19 of 2696 scanned pages (22 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification.
Locate the element: <h3>
Confirm the Siteimprove Alfa finding for rule sia-r53.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate axe landmark-unique Best Practice Landmarks should have a unique role or role/label/title (i.e. accessible name) c (WCAG criterion undetermined) 12/2696 pages · 12 instances Likely template

Bug ID: VS-eea592cb
Pattern ID: VS-8806389c
Combined ID: VS-eea592cb (pattern VS-8806389c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Landmarks should have a unique role or role/label/title (i.e. accessible name) c [landmark-unique]
Example URL: http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification
XPath / selector: .section
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

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

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

Description

Landmarks should have a unique role or role/label/title (i.e. accessible name) c. Detected by axe-core rule landmark-unique on 12 of 2696 scanned pages (12 instances).

Steps to reproduce

Open http://medicaid.gov/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification.
Locate the element: .section
Confirm the axe-core finding for rule landmark-unique.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

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

Suggested fix

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

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

Triage status Notes

Moderate alfa sia-r74 WCAG 2.x AAA Link is distinguishable without relying on color (WCAG 1.4.8) 2/2696 pages · 20 instances Likely content

Bug ID: VS-4a870020
Pattern ID: VS-fbf54eba
Combined ID: VS-4a870020 (pattern VS-fbf54eba) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.8 Visual Presentation (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Link is distinguishable without relying on color [sia-r74]
Example URL: https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=24
XPath / selector: <p class="field-content">
History: first seen 2026-W24, last seen 2026-W40 (17 wk)

Description

Link is distinguishable without relying on color. Detected by Siteimprove Alfa rule sia-r74 on 2 of 2696 scanned pages (20 instances).

Steps to reproduce

Open https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/federal-disaster-resources?page=24.
Locate the element: <p class="field-content">
Confirm the Siteimprove Alfa finding for rule sia-r74 against WCAG 1.4.8 Visual Presentation.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

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

Suggested fix

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

Triage status Notes

Deque axe-core findings

Rule-level axe-core summary (10 rule type(s))

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

axe-core rules failing in 2026-W40, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
All page content should be contained by landmarks [region]	moderate	442	1964	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 442 pages (CSV)
Document should have one main landmark [landmark-one-main]	moderate	441	441	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 441 pages (CSV)
Page should contain a level-one heading [page-has-heading-one]	moderate	441	441	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 441 pages (CSV)
Elements must only use supported ARIA attributes [aria-allowed-attr]	critical	93	453	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/data-elements/clt002024 /tmsis/dataguide/v4/data-elements/prv001008	all 93 pages (CSV)
Certain ARIA roles must contain particular children [aria-required-children]	critical	93	93	/tmsis/dataguide/v4/data-elements/cot002095 /tmsis/dataguide/v4/data-elements/clt002024 /tmsis/dataguide/v4/data-elements/prv001008	all 93 pages (CSV)
ARIA role should be appropriate for the element [aria-allowed-role]	minor	60	129	/medicaid/medicaid-state-plan-amendments /chip/state-program-information/chip-spa /medicaid/medicaid-state-plan-amendments	all 60 pages (CSV)
ARIA input fields must have an accessible name [aria-input-field-name]	serious	60	129	/medicaid/medicaid-state-plan-amendments /chip/state-program-information/chip-spa /medicaid/medicaid-state-plan-amendments	all 60 pages (CSV)
Heading levels should only increase by one [heading-order]	moderate	43	49	/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification /medicaid/data-systems/health-information-technology/health-disparities /state-resource-center/disaster-response-toolkit/federal-disaster-resources/entry/54038	all 43 pages (CSV)
Landmarks should have a unique role or role/label/title (i.e. accessible name) combination [landmark-unique]	moderate	12	12	/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification /about-us/contact-us /medicaid/data-systems	all 12 pages (CSV)
Form elements should have a visible label [label-title-only]	serious	1	2	/medicaid/prescription-drugs/state-drug-utilization-data	all 1 pages (CSV)

Siteimprove Alfa findings

Rule-level Alfa summary (13 rule type(s))

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

Alfa rules failing in 2026-W40, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
Text has enhanced contrast [sia-r66]	n/a	1273	52687	/medicaid/medicaid-state-plan-amendments /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 1273 pages (CSV)
Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]	n/a	1273	31073	/medicaid/medicaid-state-plan-amendments /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 1273 pages (CSV)
Scrolling content can be accessed by keyboard [sia-r57]	n/a	1273	10728	/medicaid/medicaid-state-plan-amendments /tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18	all 1273 pages (CSV)
Text has minimum contrast ratio of 4.5:1 [sia-r73]	n/a	1049	1049	/medicaid/medicaid-state-plan-amendments /faq /medicaid/medicaid-state-plan-amendments	all 1049 pages (CSV)
First focusable element is link to main content [sia-r87]	n/a	224	224	/tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18 /tmsis/dataguide/v4/data-quality-measures/ffs-9-019-16	all 224 pages (CSV)
Form field label is visible [sia-r61]	n/a	222	222	/tmsis/dataguide/v4/validation-rules/rule-2806 /tmsis/dataguide/v3/data-quality-measures/exp-1-004-18 /tmsis/dataguide/v4/data-quality-measures/ffs-9-019-16	all 222 pages (CSV)
Accessible name of link or button matches visible label [sia-r14]	n/a	120	120	/tmsis/dataguide/v4/data-quality-measures/ffs-9-019-16 /tmsis/dataguide/v4/data-elements/prv001008 /tmsis/dataguide/v3/validation-rules/rule-7183	all 120 pages (CSV)
Presentational children of an element are not focusable [sia-r68]	n/a	75	79	/tmsis/dataguide/v4/data-elements/prv001008 /medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments	all 75 pages (CSV)
aria attribute is permitted for element role [sia-r18]	n/a	46	223	/tmsis/dataguide/v4/data-elements/prv001008 /tmsis/dataguide/v3/data-elements/crx002084 /tmsis/dataguide/v4/data-elements/elg016212	all 46 pages (CSV)
Form field has accessible name [sia-r8]	n/a	30	64	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /chip/state-program-information/chip-spa	all 30 pages (CSV)
Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]	n/a	30	64	/medicaid/medicaid-state-plan-amendments /medicaid/medicaid-state-plan-amendments /chip/state-program-information/chip-spa	all 30 pages (CSV)
Headings are structured hierarchically [sia-r53]	n/a	19	22	/medicaid/home-community-based-services/home-community-based-services-guidance-additional-resources/electronic-visit-verification /state-resource-center/disaster-response-toolkit/federal-disaster-resources/entry/54038 /state-overviews/stateprofile.html	all 19 pages (CSV)
Link is distinguishable without relying on color [sia-r74]	n/a	2	20	/resources-for-states/disaster-response-toolkit/federal-disaster-resources /resources-for-states/disaster-response-toolkit/federal-disaster-resources	all 2 pages (CSV)

Unique accessibility issues (axe + Alfa consolidated)

axe and Alfa both implement W3C ACT rules, so the same issue is often caught by both. These are deduplicated by ACT rule and page, so a shared finding counts once (7322 raw engine findings → 7247 unique).

Unique issues (rule × page): 7247
Caught by both engines: 75 highest confidence
axe only: 1611
Alfa only: 5561

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

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

Rules flagged by both axe-core and Alfa in 2026-W40, by pages affected.
Issue	Pages	Rule references
Elements must only use supported ARIA attributes	94	axe aria-allowed-attr · Alfa sia-r18 · ACT 5c01ea
ARIA input fields must have an accessible name	60	axe aria-input-field-name · Alfa sia-r8 · ACT e086e5