This variable is contained in the following files:
SAS Name
MDCD_NON_CAPTD_SPEND_02
This variable is the sum of the Medicaid payment amounts from the inpatient (IP), long-term care (LT), pharmacy (RX) and other services (OT) (header) claims for the beneficiary for the month – after removing the Medicaid managed care capitated payments. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.
CCW creates this variable as the sum of all MDCD_PD_AMT from all claims for the month, however we identify and remove the OT header claims that are for managed care capitated payments. These are header claims where the claim type code (T-MSIS variable called CLM_TYPE_CD) is equal to '2' (Medicaid or expansion claim) 'B' (S-CHIP claim) or 'V' (Other Services claim). These capitated payment claims are captured in MMLEADS in the monthly MDCD_MC_CAPTD_SPEND_01–12 variables.
Note that the Center for Medicaid and CHIP Services (CMCS) at CMS has required redaction of the MDCD_PD_AMT field for managed care claims due to the proprietary and confidential nature of this information. Therefore, this total does not reflect the redacted managed care expenditures. MMLEADS counts all claims in the monthly MDCD_TOTAL_USE_01–12 variables. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Values: $
Source: T-MSIS Claims file (derived)