Medicaid Frequently Asked Questions (FAQ)
- What population is included in CMS Medicaid data files?
- What types of data files are available from CMS? For which states and years?
- MAX Medicaid Analytic Extract 1999 forward
- Years, states available for CMS MAX data
- What media is used for CMS MAX?
- How many records are there in a MAX file?
- What are some important considerations when working with Medicaid data?
- Can managed care services be studied with the CMS Medicaid claims data files?
- Can Medicaid claims and enrollment records be linked to other data?
- How can the dually eligible for Medicare and Medicaid be studied using CMS Medicaid claims and enrollment data?
- What files are part of MAX? What types of data elements are in each file?
- Is file documentation available for the MAX files?
- How can CMS Medicaid data be obtained?
- Where are the documents required to submit a CMS Data Request?
- Is there an LDS version of Medicaid (MAX) data?
- Are non-CMS Medicaid data files available?
- Where is assistance with CMS Medicaid data available?
CMS also has an FAQ document for their Medicaid data files. Some of the topics addressed include detailed information on eligibility codes, waiver program data, dually eligible data, M-SCHIP and S-SCHIP, managed care data, file records, MSIS versus MAX data files, the identification of long term care residents and data quality of the MAX files.
The CMS Medicaid enrollment and claim files, State Medicaid Research Files (SMRFs), contain data for Medicaid eligibles who actually enroll. SMRF or MAX cannot, therefore, be used to study individuals who are eligible but not enrolled. The National Health Interview Study or the National Medical Expenditure Survey both collect data that may enable study of persons eligible for Medicaid.
Since the CMS SMRFs document enrollment and utilization of Medicaid-paid services, it is not possible to study the health care utilization of Medicaid enrollees prior to enrollment or during periods when enrollment or eligibility lapses.
- Aggregated statistics data from the CMS web site
AGGREGATE FILES: The Medicaid Statistical Files contain state, regional, and national level data on Medicaid enrollment and expenditures on a federal fiscal year basis.
- Drug utilization files, downloadable from CMS web site
The Medicaid Drug Rebate Product Description File contains descriptive information for individual drug products that qualify for Medicaid reimbursement and/or a manufacturer rebate.
The Medicaid Drug Rebate Utilization File contains National Drug Code (NDC) level Medicaid drug utilization data for each state on a quarterly basis. Record layout and data definitions are available
- MAX Medicaid Analytic Extract 1999 forward
Data validation tables are now available from the CMS web site for 1996-98 SMRF files and the 1999 and later MAX files.
Years, States available for CMS MAX data
Starting with 1999, all states will be required to submit beneficiary-level enrollment, utilization, and expenditure data to CMS. CMS now has MAX 1999 and later data available (Look for the document in the ZIP archive that addresses current availability).
CMS MAX files can be released on CD, DVD or USB hard drive, dependent on the size of the files.
Record counts for the 1999 and later MAX files can be as part of the file downloaded here, as they are made available from CMS.
The Medicaid program is essentially an insurance program with federal oversight and state administration. Since states have latitude in program coverage decisions, it may be difficulty to complete some analyses across states and/or across years. Eligibility rules and program benefits can vary across states and across years.
Historically, the states have not been required to report managed care encounters to CMS.
There are 2 approaches to identifying Medicaid beneficiaries who were covered under a managed care plan. The Personal Summary File indicates if a beneficiary was in a managed care plan with coverage purchased by the state, and this information is indicated for each month. Primary Care Case Management plans are not included in the indicator since these services are paid fee for service. It may be necessary for other types of plans to determine if the managed care is medical, dental, transportation or some other form. This information can be obtained by examining claims in the Other Therapeutic Claims file. Claims with a Type of Service = '20' (premium payment) indicate beneficiaries covered by a managed care plan, and the corresponding managed care plan number can be found in the Provider Number field. Details on the specific type of service could then be obtained from a state listing of provider numbers.
Records for one individual can be linked between file types and across years within a state, using the MSIS Identification Number, which appears in all five files. When considering longitudinal analysis, remember that that eligibility rules and program benefits change frequently.
You may be able to link files for one individual across states by using the eligible's SSN. Prior to 1999 states were not required to report SSN. Washington and Michigan files will not have SSN until the 1999 MAX files.
Beginning with 1999, information is available in the MAX files on Medicare eligibility, including the details of Medicaid program payment of Medicare co-insurance, premiums and deductibles. Eg: QMB or SLMB programs.
In terms of utilization data, the MAX files contain little information regarding claims for Medicare-covered services. Most states would treat the Medicare payment as payment-in-full. Claims will exist in the Medicaid files for services not covered by Medicare, eg: prescription drug claims.
There are five MAX file types: Personal Summary File, Inpatient File, Long Term Care File, Drug File, and Other Therapy File.
The Personal Summary File contains one record for every individual enrolled for at least one day during the year. The file contains demographic data (e.g. date of birth, gender, race), basis of eligibility, maintenance assistance status, monthly enrollment status, and a utilization summary. The Inpatient File contains complete stay records for enrollees who used inpatient services including diagnoses, procedures, discharge status, length of stay, and payment amount. The Long Term Care File contains claims for long term care services provided by Skilled Nursing Facilities (SNFs), Intermediate Care Facilities (ICFs), and independent psychiatric facilities. Fields include facility type, dates of service, and discharge status. The Drug File contains final action paid drug which beginning with 1996 data required an NDC. The Other Therapy File contains claim records for all non-institutional Medicaid services, including physician services, lab/X-ray, clinic services and premium payments. As appropriate the claims include diagnosis, procedure and date of service.
For MAX files, 1999 and forward the number of procedure and/or diagnosis fields has generally increased: Inpatient, 10 diagnoses and 7 procedure; Other Therapy, 2 diagnosis codes and 1 procedure; Long Term Care, 5 diagnosis codes.
Record layouts are available for the MAX files.
Inpatient | Long-Term Care | Other Services | Personal Summary | Drug Record
Data validation tables and anomalies reports are now available from the CMS web site for Medicaid Analytic Extract Files.
Aggregated statistics and data is available from the CMS web site. Data on both the Medicare and Medicaid programs is included in the Data Compendium. The Medicaid Drug Rebate Product Description File and the Medicaid Drug Rebate Utilization File can be downloaded from CMS. Individual level, state specific MAX files require completion of a CMS Data Request packet and payment of data processing and file creation fees. Documents for the data request packet are available through links at www.resdac.umn.edu/medicare/requesting_data.asp. You can contact ResDAC for assistance with your packet via the web, resdac@umn.edu or by phone (1-888-973-7322). All MAX data request packets must be reviewed by ResDAC prior to submission to CMS.
Documents required for submit a CMS Data Request are here
No, beneficiary-level Medicaid data is only available as a RIF. Highly aggregated Medicaid data is available in the form of several Public Use Files. Please visit our Medicaid Data Available page under the subheading “Public Use Files” for more information.
You may be able to obtain more recent claims data directly from a state. Files available from states may be in the form of MSIS data tapes or other state specific file formats. MSIS tapes will be organized by the year that the claim was paid, not the year of service, as is true for MAX files. MSIS files also are not in the format of final action claims, meaning the researcher will need to apply algorithms or otherwise determine which claims were finally paid and settled. It may be more difficult to do comparisons across years and states since the files will not have a uniform format. MSIS files obtained from states will not have gone through CMS validation and editing procedures.
Questions regarding the content of files, data limitations or how to acquire CMS Medicaid data can be directed to ResDAC at 1-888-973-7322 or resdac@umn.edu.
Training workshops on Medicaid data are also offered by ResDAC.
Last Modified October 5, 2011