Medicaid and Children’s Health Insurance Budget and Expenditure Files

Title XIX and XXI of the Social Security Act authorizes federal funding of the Medicaid and Children’s Health Insurance Program (CHIP). To ensure that states receive an adequate amount of money to properly administer their programs, states are required to report budget estimates prior to the beginning of each quarter. They must also track and report Medicaid and CHIP related expenditures quarterly.

Title XXI of the Social Security Act authorizes federal funding of CHIP. The purpose of CHIP, enacted under the Balanced Budget Act of 1997 (BBA) and technical Amendments made by Public Law 105-100, is to provide federal matching funds to states to enable them to extend coverage to uninsured, low-income children in an effective and efficient manner. Under the BBA and technical amendments made by Public Law 105-100, states are allowed to provide federal matching funds to extend coverage to uninsured, low-income children in an effective and efficient manner through the Medicaid program.

CMS collects state budget and expenditure data through the Medicaid and Children’s Budget and Expenditure System (MBES/CBES). Budget information is reported on Form HCFA-37 and HCFA-21, the Medicaid Program Budget Report. This form provides a statement of the state's funding requirements for the upcoming quarter and certifies the availability of the requisite state and local funds. In addition, it provides both the state's budget estimates and the assumptions that underlie its projections for two fiscal years. This information is needed by CMS to formulate and execute the national Medicaid budget as well as forecast the potential impact of proposed legislation on the Medicaid program. Further, the first quarter submission of the HCFA-37 and HCFA-21 serves as the basis in formulating Medicaid's portion of the President's budget.

Expenditure information is collected on Form HCFA-64, the Quarterly Medicaid Statement of Expenditures for the Medicaid Assistance Program. Form HCFA-64 is a statement of expenditures for which a state is entitled to federal reimbursement. This form also reconciles the monetary advancement made on the basis of the HCFA-37 and HCFA 21B filed previously for the same quarter. It is the vehicle by which states track and adjust overpayments and under payments made by the federal government.

CHIP expenditure information is collected on Form HCFA-21, the Quarterly Statement of Expenditures for the Children’s Health Insurance Program. Form HCFA-21 is the state’s accounting statement of actual recorded expenditures and the disposition of federal funds. It also reconciles the monetary advances made on the basis of the Form HCFA-21B.

The Quarterly Medical Assistance expenditures by Children’s Health Insurance Program (Form HCFA-1) is the state’s accounting statement of actual recorded expenditures and the disposition of federal funds which, in accordance with sections 2105(e) and 2107(b)(1) of the Act, must be submitted each quarter for Medicaid expansion.

MEDICAID BUDGET AND EXPENDITURES FILES

Title XIX of the Social Security Act authorizes federal funding of the Medicaid program. To ensure that states receive an adequate amount of money to properly administer their programs, states are required to report budget estimates prior to the beginning of each quarter. They must also track and report Medicaid-related expenditure quarterly.

CMS collects state budget and expenditure data through the Medicaid Budget and Expenditure System (MBES). Budget information is reported on Form HCFA-37, the Medicaid Program Budget Report. This form provides a statement of the state's funding requirements for the upcoming quarter and certifies the availability of the requisite state and local funds. In addition, it provides both the state's budget estimates and the assumptions that underlie its projections for two fiscal years. This information is needed by CMS to formulate and execute the national Medicaid budget as well as forecast the potential impact of proposed legislation on the Medicaid program. Further, the first quarter submission of the HCFA-37 serves as the basis in formulating Medicaid's portion of the President's budget.

Expenditure information is collected on Form HCFA-64, the Quarterly Medicaid Statement of Expenditures for the Medicaid Assistance Program. Form HCFA-64 is a statement of expenditures for which a state is entitled to federal reimbursement. This form also reconciles the monetary advancement made on the basis of the HCFA-37 filed previously for the same quarter. It is the vehicle by which states track and adjust overpayments and under payments made by the Federal government.

File Creation

The 50 states, District of Columbia, Guam, Northern Mariana Islands, Puerto Rico, American Samoa, and the Virgin Islands submit their Medicaid budget and expenditure data electronically through MBES/CBES directly to the CMS Data Center quarterly. The HCFA-37 and HCFA-21B data is submitted on a November-February-May-August cycle; the HCFA-64 and HCFA 21 is submitted on an October-January-April-July cycle. As these reports are input into MBES/CBES, Quality Assurance edits are performed to verify the field values.

File Maintenance

The Medicaid and Children's Budget and Expenditure files are updated continually by the states and territories. The files may contain errors that are identified as a result of a verification process. Once verification is passed, the file cannot be altered. It is possible to remove the verified status and alter the data; however, the data must be verified again before being transferred to the Master File.

File Structure and Usage

MBES consists of nine Virtual Storage Access Method (VSAM) files. The following list identifies the VSAM files:

• HCFA-64Transaction File
• HCFA-64Master File. The HCFA-64 Transaction and Master Files contain the Medicaid expenditure data that are derived from source documents such as invoices, cost reports, and eligibility records. These files contain 11 types of records:
  • HCFA-64Summary Data and Certification of the Submission
  • HCFA-649Base Data for Medical Assistance Expenditures by Type of Service
  • HCFA-649Waiver for Medical Assistance Payments (MAP) by Type of Service
  • HCFA-649PMAP Data by Type of Service for Prior Period of Adjustments
  • HCFA-649OMedicaid Overpayment Adjustments
  • HCFA-649AThird Party Liability Collections and Cost Avoidance
  • HCFA-6410Base Data for State and Local Administration Expenditures
  • HCFA-6410PWaiver for Adjustments
  • HCFA-64Narrative Data for Submission
  • HCFA-6421Presumptive eligible Data for M-CHIP by Type of Service
  • HCFA-6421PPresumptive eligible Data for M-CHIP by Type of Service-Prior Period
  • HCFA-6421USec. 1905(u)(2) & (u)(3) Data for M-CHIP by Type of Service
  • HCFA-6421UPSec. 1905(u)(2) & (u)(3) Data for M-CHIP by Type of Service-Prior Period
• HCFA-21Transaction File
• HCFA-21Master File. The HCFA-21 Transaction and Master Files contain the Children's Health Insurance expenditure data that are derived from source documents such as invoices, cost reports, and eligibility records. These files contain six types of records:
  • HCFA-21Summary Data and Certification of the Submission
  • HCFA-21BaseBase Data for Medical Assistance Expenditures by Type of Service
  • HCFA-21PCHIP Data by Type of Service-Prior Period
  • HCFA-21LCalculation 10% Limit for CHIP Expenditures
  • HCFA-21CAllocation of Title XIX and Title XXI Expenditures to CHIP Fiscal Year Allotment
  • HCFA-21BEstimate of Quarterly and Fiscal year CHIP Expenditures
• HCFA-37Transaction File
• HCFA-37Master File. The HCFA-37 Transaction and Master Files contain projected medical assistance payment data. These files contain five types of records:
  • HCFA-37.1Estimate of Quarterly Grant Awards
  • HCFA-37.3Estimated Medical Assistance Payments by Type of Service
  • HCFA-37.7Estimated Average Number of Eligibles During Year
  • HCFA-37.8Quarterly Distribution of Funding Requirements
  • HCFA-37.10State and Local Administration Payments
  • HCFA-37.12Other Narrative Explanations
• Regional Office File contains the Regional Deferral Log and Regional Decision data
• Central Office File contains Deferral, Penalty, Grant Award, Offset, Medicaid Eligibility Quality Control (MEQC) Reduction, Waiver, and Disproportionate Share Hospital (DSH) data
• Federal Security File captures user information including security levels
• DSH Verify File

Data Structure and Usage

The Medicaid and Child Health Budget and Expenditure HCFA-64, HCFA-21, and HCFA-37 files contain approximately 1,200 data elements per state. These elements contain information on total computable and federal share amounts of medical assistance payments and administrative expenditures. Narrative explanations of variances in program expenditures are also captured. There are currently 11 years of data online.

Methods of Access

CMS users may obtain read access to the Medicaid budget and expenditure data through MBES. The system has a reporting capability that will allow users to print a variety of reports that track each state's expenditures and show national trends by comparing across all states in specific expenditure categories.

Data are available to users outside CMS (previously CMS) in the annual publication, Medicaid Statistics, a document that compiles profile data on the Medicaid population and Medicaid expenditures by region, state, and nation.

Migration of Data

MBES has not been affected by the changing CMS (previously HCFA) data processing environment.

List of Data Elements

A list of data elements will be included in the future on the CMS (previously HCFA) web site at www.cms.hhs.gov.

Medicaid Data | Eligibles, Claims, and Utilization Files | Drug Rebate Files |Budget and Expenditure Files