MEDICAID DATA

INTRODUCTION

The Medicaid program became part of Federal law in 1965 under Title XIX of the Social Security Act. Title XIX provides for a program of medical assistance to individuals with low incomes, financed by both Federal and state funds. Federal contributions to each state are based on a formula established by statute. The formula is designed to provide higher federal matching funds for states with relatively low per capita income.

States are required to report annual Medicaid program statistics to HCFA. These statistics include state-level summary utilization data on Medicaid recipients and services, and Medicaid recipient drug utilization data. The CMS Medicaid files described in this chapter contain the statistics, data, and state plan information submitted to CMS by states.

The Medicaid Data chapter contains three file groups:

1. Medicaid Eligibles, Claims, and Utilization Files
2. Medicaid Drug Rebate Files
3. Medicaid Budget and Expenditure Files

The Medicaid Eligibles, Claims, and Utilization Files group consists of files that provide CMS with detailed Medicaid claims information for more than half of the states participating in the Medicaid program, and summarized utilization information for all participating states.

The Medicaid Drug Rebate Files group consists of data files developed in response to a Congressionally mandated drug rebate program. These data are gathered by CMS to track the cost of drugs in each state Medicaid program and to monitor implementation of the rebate program.

The Medicaid Budget and Expenditure Files group consists of data files that contain information on Medicaid-related expenditures and budget projections for each state Medicaid program.

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