Medicaid Frequently Asked Questions

1. What types of Medicaid data files are available from CMS(previously HCFA)?
2. How can I acquire these Medicaid data files?
3. Which 30 states have SMRFs, and what years are available?
4. What about data for the other 20 states?
5. What if I want more recent data?
6. What types of files make up the SMRFs?
7. What fields are in each of the file types?
8. Can I link 2 or more of the file types?
9. What if I want to study people who could be on Medicaid but aren’t?
10. What if I want to study the health care utilization of Medicaid beneficiaries prior to their Medicaid enrollment?
11. What if I want to study the health care utilization of Medicaid beneficiaries after they get off Medicaid?
12. How are SMRFs different from the claims files I can obtain from individual states?
13. Can I do state-to-state comparisons with SMRFs?
14. Can I use SMRFs to do longitudinal analysis for a particular state?
15. Can I easily link Medicaid claims with Medicare claims to study the dually eligible?
16. For the dually eligible, do the SMRFs contain information on all medical claims, including those covered by Medicare?
17. If a dually eligible beneficiary is hospitalized, what information appears in the SMRF for that hospitalization?
18. If a dually eligible beneficiary has an ambulatory physician visit, what information appears in the SMRF   Outpatient File for that visit?
19. How many diagnosis and procedure codes are contained in SMRF claim records?
20. Can I use the SMRFs to study Medicaid managed care utilization?
21.  Can I identify managed care beneficiaries using the SMRFs?
22.  What is the Tape-to-Tape Project?

1. What types of Medicaid data files are available from CMS?

CMS produces several sets of publicly available aggregate and individual-level Medicaid data files.

AGGREGATE FILES: The Medicaid Statistical File contains state, regional, and national level data on Medicaid enrollment and expenditures on a fiscal year (FY) basis. 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. Medicaid State Profile Data System contains a composite profile of Medicaid program characteristics from each state plan.

INDIVIDUAL-LEVEL FILES: State Medicaid Research Files (SMRFs) contain beneficiary-level enrollment, utilization, and expenditure data on a calendar year (CY) basis. The Medicaid Provider Data File contains descriptive information about Medicaid providers.

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 2. How can I acquire these Medicaid data files?

AGGREGATE FILES: Data from the Medicaid Statistical File is available in a publication titled Medicaid Statistics; FY 1996 is the most current edition. You can find this publication at many medical school or government publications libraries; you can also order a copy from the National Technical Information Service (703-605-6000; ask for publication number PB98117997). National summary statistics from the Medicaid Statistical File can also be found on CMS' website at http://www.cms.hhs.gov/. The Medicaid Drug Rebate Product Description File and the Medicaid Drug Rebate Utilization File can be purchased from CMS. Ordering and price information can be found in the Public Use Files Catalog on CMS’ website at http://www.cms.hhs.gov/researchers/statsdata.asp.

INDIVIDUAL-LEVEL FILES: SMRFs, which require a signed data use agreement prior to release, can be purchased from CMS. SMRFs are available for 30 states for varying years; FY 1995 is the most recently available year of data. The Medicaid Provider Data File is available for 13 states for 1993 only, and can also be purchased from CMS. ResDAC can help you obtain prices and with ordering these files.

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3. Which 30 states have SMRFs, and what years are available?

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4. What about data for the other 20 states?

Through 1998, beneficiary-level Medicaid data for the other 20 states is only available from those individual states. Starting with 1999, all states will be required to submit beneficiary-level enrollment, utilization, and expenditure data to CMS; CMS intends to have SMRFs available for all states beginning in 2002.

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5. What if I want more recent data?

Contact the individual states; contact information is available on CMS' website at http://www.cms.hhs.gov/

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6. What types of files make up the SMRFs?

There are five SMRF types: Personal Summary File, Inpatient File, Long Term Care File, Drug File, and Other Claims File.

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7. What fields are in each of the file types?

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, sex, 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; the file contains information about diagnoses, procedures performed, 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, days of care, and discharge status. The Drug File contains final action paid drug claims; most records contain a National Drug Code (NDC). The Other Claims File contains claims records for all non-institutional Medicaid services, including physician services, lab/X-ray, and clinic services; the file contains information about diagnosis, procedures performed, and payment amount.

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8. Can I link 2 or more of the file types?

Yes, by using the Eligible Identification Number, which appears in all five files.

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9. What if I want to study people who could be on Medicaid but aren’t?

Because the SMRFs only contain data for Medicaid eligibles who actually enroll, you cannot use SMRFs to study individuals who are eligible but not enrolled. You might look into the National Health Interview Study or the National Medical Expenditure Survey, which both collect data that may enable you to ascertain Medicaid eligibility.

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 10. What if I want to study the health care utilization of Medicaid beneficiaries prior to their Medicaid enrollment?

This is not possible with SMRFs because they only contain data about services used after an individual enrolls.

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 11. What if I want to study the health care utilization of Medicaid beneficiaries after they get off Medicaid?

This is also not possible with SMRFs because they only contain data about services used while an individual is enrolled.

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 12. How are SMRFs different from the claims files I can obtain from individual states?

SMRFs contain final action claims, which are claims for which all adjustments and errors have been resolved, whereas most states do not provide files with final action claims. SMRFs also require far less data cleaning than Medicaid files obtained from individual states because SMRFs have been edited extensively.

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13. Can I do state-to-state comparisons with SMRFs?

State-to-state comparisons are possible with these data, but keep in mind that eligibility rules and program benefits vary across states.

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14. Can I use SMRFs to do longitudinal analysis for a particular state?

Longitudinal analysis is possible for states with more than 1 year of SMRFs available, but keep in mind that eligibility rules and program benefits change frequently.

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 15. Can I easily link Medicaid claims with Medicare claims to study the dually eligible?

Not at this time. CMS(previously HCFA) is working on an initiative that will eventually allow researchers to link Medicare and Medicaid claims.

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 16. For the dually eligible, do the SMRFs contain information on all medical claims, including those covered by Medicare?

No, SMRFs only contain data for claims that were paid for by Medicaid.

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 17. If a dually eligible beneficiary is hospitalized, what information appears in the SMRF for that hospitalization?

None. For dually-eligible beneficiaries, Medicare is the primary payer so inpatient claims will appear in the Medicare Inpatient File and in MedPAR.

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 18. If a dually eligible beneficiary has an ambulatory physician visit, what information appears in the SMRF Outpatient File for that visit?

None. The claim information will appear in the Medicare Physician/Supplier Standard Analytic File if the beneficiary received services from a non-institutional provider (e.g. a community physician in his own office) and in the Medicare Outpatient File for services received from an institutional provider (e.g. a hospital outpatient clinic).

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19. How many diagnosis and procedure codes are contained in SMRF claim records?

The Inpatient File contains 2 diagnostic fields and 2 procedure fields. The Outpatient File contains 1 diagnostic field and 1 procedure field. The Drug File contains 1 procedure field but no diagnostic fields. The Long Term Care File contains 1 diagnostic field but no procedure fields.

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 20. Can I use the SMRFs to study Medicaid managed care utilization?

Not with the currently available SMRFs. Historically, the SMRF states have not been required to report managed care encounters. Beginning in 1999, all states will be required to report managed care encounters to CMS(previously HCFA).

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 21. Can I identify managed care beneficiaries using the SMRFs?

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. It isn’t possible to distinguish which plan a beneficiary is covered under, but this information may become available in future SMRFs.

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 22. What is the Tape-to-Tape Project?

The Medicaid Analysis Project for States, or the Tape-to-Tape Project, was a late 1980s-early 1990s CMS initiative to construct uniform, beneficiary-level data sets from individual claims data in 4 states (California, Georgia, Michigan, and Tennessee). The success of the Tape-to-Tape Project led to the development of SMRFs on a more widespread basis.