Medicaid

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

TAF Annual Managed Care Plan (APL)

The TAF APL file contains information about managed care organizations serving Medicaid enrollees. By linking the information in the APL to other TAFs, users can enhance their analyses focused on plans and providers. For example, users can describe their results by plan name. Users can also identify whether the plan serves Medicaid, CHIP, or both; whether the plan operates under a waiver or state plan authority; how the plan reimburses its providers; and whether the plan is for profit.

What does this file include (variable highlights)

  • Managed Care Plan type
  • Waivers such as 1115
  • Eligible population indicators such as CHIP coverage

Special considerations

  • This file does not contain individual service records but contains information about plans that can be linked to individual enrollment information and may help put utilization into context.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. Please see this page on CMS fee information for TAF data pricing.
  • 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.

TAF Annual Provider (APR)

The TAF APR file contains information about providers of Medicaid services—both facilities and individual providers. By linking the information in the APR to other TAFs by provider ID, users can enhance their analyses focused of providers. For example, users can identify whether the provider is a facility, group or individual; whether the provider’s specialty is primary care, obstetrics, or something else; how the provider is affiliated with other providers in a group practice; where the provider is located; and many other characteristics.

What does this file include (variable highlights)

  • Provider taxonomy indicators such as eye or vision, behavioral health, speech language or hearing services
  • Residential treatment facility indicator
  • Substance Use Disorder Service provider indicator

Special considerations

  • This file does not contain individual service records but contains information about providers that can be linked to individual service records.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. Please see this page on CMS fee information for TAF data pricing.
  • 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.

Home Health Outcome and Assessment Information Set (OASIS)

The Home Health Outcome and Assessment Information Set (OASIS) contains data items developed to measure patient outcomes and for improve home health care. The OASIS assessments are required of all home health agencies certified to accept Medicare and Medicaid payments.

What does this file include? (variable highlights)

  • HIPPS code
  • Socio-demographic variables
  • Information on patient home environment and informal caregivers
  • Health status, including diagnosis codes
  • Functional status
  • Psychosocial status
  • Health service utilization
    • Emergent care
    • Hospital admission

Special considerations

  • The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) suspended required completion for non-Medicare and non-Medicaid patients.

Long Term Care Minimum Data Set (MDS) 2.0

The Long Term Care Minimum Data Set (MDS) is a health status screening and assessment tool used for all residents of long term care nursing facilities certified to participate in Medicare or Medicaid, regardless of payer. The assessment is also required for Medicare payment of skilled nursing facility stays. Assessment data for Skilled Nursing Swing Beds 2.0 is included in a separate file. Version 2.0 was replaced by MDS version 3.0 on October 1, 2010.

What does this file include? (variable highlights)

  • Resource Utilization Group (RUG) code
  • Clinical status measures
  • Physical functioning assessment
  • Psychological status measures
  • Psycho-social functioning measure
  • End-of-life care decisions

Long Term Care Minimum Data Set (MDS) 3.0

The Long Term Care Minimum Data Set (MDS) is a health status screening and assessment tool used for all residents of long term care nursing facilities certified to participate in Medicare or Medicaid, regardless of payer. The assessment is also required for Medicare payment of skilled nursing facility stays. Assessment data for Skilled Nursing Swing Beds 3.0 is included in a separate file, MDS version 3.0 was implemented on October 1, 2010, replacing version 2.0.

What does this file include? (variable highlights)

  • Resource Utilization Group (RUG) code
  • Clinical status measures
  • Physical functioning assessment
  • Psychological status measures
  • Psycho-social functioning measure
  • End-of-life care decisions

Long Term Care Minimum Data Set (MDS) - Swing-Bed 3.0

The Long Term Care Minimum Data Set (MDS)-Swing Bed is a health status screening and assessment tool. It is required for Medicare payment of hospital-based skilled nursing care. Swing-bed providers are hospitals that can use their beds, as needed, to provide either acute or post-acute skilled nursing care.  The swing-bed assessment includes a subset of the skilled nursing facility (SNF) assessment items. The MDS 3.0 was implemented in October, 2010, replacing version 2.0.

What does this file include? (variable highlights)

  • Resource Utilization Group (RUG) code
  • Clinical status measures
  • Physical functioning assessment
  • Psychological status measures
  • Psycho-social functioning measure

MAX Personal Summary File

Medicaid MAX (Medicaid Analytic Extract) Personal Summary (PS) file contains one record for every individual eligible for and enrolled in Medicaid for at least one month or who had a Medicaid-paid service within the file year.

What does this file include? (variable highlights)

  • Bene_ID (links to all other CMS Research Identifiable Files (RIF))
  • State, county, zipcode
  • Date of birth, gender, race
  • Eligibility category
  • Dual Medicare-Medicaid eligibility
  • Medicaid managed care enrollment
  • Summary utilization, Medicaid payments

Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0

The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0 suite of files combines Medicare and Medicaid enrollment and claims data into four annual beneficiary-level files. The files include beneficiaries who are Medicare-only, Medicare-Medicaid dually enrolled and Medicaid-only blind and disabled.

Source data

  • Medicare: FFS, PDE and MA
  • Medicaid: MAX data

What does this file include? (variable highlights)

  • Eligibility, enrollment variables
  • Aggregated cost and use
    • Medicare: FFS, PDE includes FFS and MA
    • Medicaid: FFS, managed care encounter where available
  • Prescription Drug service utilization reported for classes of drugs
  • Chronic Condition flags - 27 CCW Chronic Conditions plus an additional 25 other condition flags
  • All four files are released for approved MMLEADS data requests
    • Beneficiary file
    • Medicare Services file
    • Medicaid Services file
    • Conditions file

Special considerations

TAF Pharmacy File

The Medicaid and CHIP TAF (T-MSIS Analytic File) Pharmacy (RX) file includes records of filled prescriptions. Records include fee-for-service (FFS) claims, managed care encounters and supplemental payments for Medicaid, Medicaid-expansion CHIP and separate CHIP.

What does this file include? (variable highlights)

Special considerations

  • Encounter data reporting may vary by state, year and eligibility group.
  • Information on the drug name, dosage and format is not recorded in the TAF RX file. An external source of NDC data will be required if that information is needed.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. CMS has fee information for TAF data pricing.
  • 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.

TAF Other Services File

The Medicaid and CHIP TAF (T-MSIS Analytic File) Other Services (OT) file contains records for a variety of Medicaid services, including physician services, outpatient hospital institutional utilization, lab/X-ray, clinic services, home health, hospice and premium payments. Records include fee-for-service (FFS) claims, managed care encounters and supplemental payments for Medicaid, Medicaid-expansion CHIP and separate CHIP.

What does this file include? (variable highlights)

  • As appropriate for the type of service on the record:
    • Diagnosis codes
    • Procedure code
  • Charges and payments
  • Provider identifiers

Special considerations

  • Encounter data reporting may vary by state, year and eligibility group.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. CMS has fee information for TAF data pricing.
  • 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.