Medicaid

A joint federal and state program that helps provide health care coverage for people with low incomes and limited resources.

Accountable Health Communities Model

In 2017, the Innovation Center launched the Accountable Health Communities (AHC) Model to assess whether identifying and addressing Medicare and Medicaid beneficiaries’ health-related social needs (HRSNs) would reduce health care use and costs. The Innovation Center funded entities called bridge organizations to convene a coalition of clinical delivery sites (CDSs) and community service providers (CSPs) to implement the AHC Model in communities across the country. Under the AHC Model, Medicare and Medicaid beneficiaries were screened by participating entities for five core HRSNs, and up to 8 supplemental HRSNs.

The AHC Research Identifiable File (RIF) contains beneficiary-level screening and navigation information about individuals participating in the AHC model. Participants included Medicare and Medicaid enrollees, 94% of whom can be linked to other CMS research files. The remaining 6% cannot be linked to Medicaid or Medicaid claims, since their Medicare and/or Medicaid ID was either missing or incomplete.

The file contains data for the entire AHC Model performance period, which began on May 1, 2017 and concluded on April 30, 2023. Screenings were conducted between May 1, 2018, and January 31, 2023, and navigation services were provided to those with at least one health-related social need (HRSN) and two or more emergency department (ED) visits between May 3, 2018, and April 30, 2023.

The file includes one record per beneficiary screening, with some beneficiaries having more than one screening. For each beneficiary, screening outcomes across domains (e.g. food, housing, safety, transportation, utilities) are reported. Some beneficiaries also have supplemental indicators related to disabilities, education, employment, family and community support, mental health, physical activity, and substance use. For screened items where a need is identified, the file contains information about services offered and their outcomes.

What does this file include? (variable highlights)

  • Person level identifiers (i.e., BENE_ID, MSIS_ID) that researchers can use to link to other CMS research files
  • Sociodemographic variables (e.g., date of birth, race and ethnicity, education, income)
  • HRSN screening results (e.g., HRSNs reported, number of ED visits in the 12 months prior to screening)
  • Navigation case information for those who were eligible and opted in to receive navigation (e.g., navigation case start and end dates)
  • Contacts between navigator and beneficiary who received navigation services (e.g., total number of successful contacts during the navigation period)
  • Navigation outcomes (e.g., beneficiary reported connection with a community service provider, beneficiary had their HRSN(s) resolved)

Special Considerations

Most beneficiaries (94%) in the file have been linked to an identifier (BENE_ID and/or MSIS_ID) that researchers can use to link to other CMS research files. For more information on how to use the data, please refer to the Accountable Health Communities (AHC) Model Data File User Guide.

EPPE Code
AHCMD

TAF Research Considerations: Data Quality, Program Variation, and Disenrollment

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicaid and CHIP TAF (T-MSIS Analytic File) Data for Research.

In this presentation, Dr. Shippee discusses common issues that come up when using TAF data for research, including (1) how benefit design influences what is observed in the data (2) data quality and data availability, and (3) disenrollment.

Acute Hospital Care at Home - Patient

The Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020 in response to the COVID-19 Public Health Emergency (PHE), allows Medicare-certified hospitals to treat patients with inpatient-level care at home. Data contained within the AHCAH data set was collected by CMS directly from individual hospitals on either a weekly or monthly basis depending on their participation tier, which is based on the level of experience the facility has with providing hospital at-home services.

The AHCAH data file set contains two files, a Hospital file and a Patient file, both of which are provided as a set with an approved research request and signed data use agreement. The Patient file contains a record for each AHCAH admission for the patient and includes other beneficiary-specific data such as the beneficiary’s program eligibility status (Medicare, Medicaid, Dual) and the state Medicaid identifier, if applicable. The file also contains the facility submission date for the data represented in the file record. The submission date represents the data submitted by the facility for the previous month.

The AHCAH file set is organized by release, and each release contains two files (a hospital and a patient file). Researchers should request files by release, as opposed to individual years or months.

There have been two AHCAH releases to date:

  • First release data submission period: November 2020 - March 2023 (29 months)
  • Second release data submission period: April 2023 - September 2025 (30 months)

What does this file include? (variable highlights)

  • CCW Beneficiary Identifier
  • Beneficiary Program Identifier (Medicare, Medicaid, Dual)
  • Admission Date for In-Home Care Episode
  • Beneficiary State Medicaid Identifier
  • CMS Certifications Number (CCN), also known as the Facility Identifier
  • Facility Waiver Participation Tier (based on the level of experience the facility has with providing hospital at-home services)
  • Facility Waiver Submission Identifier
  • Data Submission Date
  • Facility Location Information

Special Considerations

  • AHCAH data may need to be requested in conjunction with Part A claims, beneficiary demographic and eligibility data to fully understand the information in the AHCAH dataset.

T-MSIS Analytic File Demographic and Eligibility

The Medicaid and CHIP T-MSIS Analytic File (TAF) Demographic and Eligibility (DE) file contains one record for every individual eligible for and enrolled in Medicaid or CHIP for at least one day during the file calendar year.

What does this file include? (variable highlights)

  • Eligibility dates
  • Managed care enrollment
  • Waiver enrollment
  • Money Follows the Person program enrollment
  • Health Home information, including State Plan Option participants, chronic Home Health condition
  • Long-Term Services and Supports eligiblity
  • Conception-to-Birth Option eligibility
  • Disability information
  • Government Assistance program participation
  • Third Party Liability coverage

Special considerations

  • ResDAC provides resources on Medicaid TAF data quality.
  • A bridge file will be provided to assist researchers that are conducting longitudinal analysis involving 2020 TAF research files along with earlier service years. For additional information, please see the CCW T-MSIS Analytic Files (TAF) User Guide posted on CCW’s User Documentation page.

Project Design and Data Request Process

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicaid and CHIP TAF (T-MSIS Analytic File) Data for Research.

Topics include:

  • Considerations before submitting a request for TAF RIF (T-MSIS Analytic File, Research Identifiable Files)
  • Cohort selection options and considerations
  • RIF request process and timeline

Application to Research Studies

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicaid and CHIP TAF (T-MSIS Analytic File) Data for Research.

This presentation contains a discussion of Dr. Shippee’s work using Medicaid data with an emphasis on approaches to Medicaid data challenges.