Use Case 46: Medicaid MCO Data

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Requirements

Use case summary

Description

Initial request:

  • Information for Medicaid Managed Care Organizations (MCO) are currently published only in pdf format.
  • Managed Care Profiles are available for individual states, but it would be preferable to have this information aggregated. A Managed Care Enrollment Report was published in 2012, but nothing more recent is available.

Value

  • Value to customer: Identify geographies where needs of the public are not being met.
  • Value to industry/public: Resource referral and social service organizations can more accurately and easily update their databases with enrollment data. They can also better prioritize which geographies to focus on, depending on where their services are needed most.

Customer


Current data and limitation

  • Data source: Managed Care Enrollment Report
    • How it's used: Identify geographies where the public might be underserved. Input benefits available and populations served into their database for providing referral services to the public and support organizations.
    • Limitations: Last published in 2012; pdf format
Update: As of Sept 2015, file is available in Excel format for 2013 data, with a separate tab for each state.
  • Data source: Managed Care Profiles
    • How it's used: Identify geographies where the public might be underserved. Input benefits available and populations served into their database for providing referral services to the public and support organizations.
    • Limitations: Non-aggregated pdfs (individual pdfs for each state)


Specifications

  • Fields:
Program type
Statewide or region-specific
Federal operating authority
Program start date 
Waiver expiration date (if applicable)
Program end date (if applicable)
Populations enrolled
Benefits covered
Quality assurance and improvement
Participating plans and regions served
Notes
  • Update frequency: Ideally quarterly. No need to wait to compile data from all providers before publishing.
  • Joins between datasets: 2-letter state abbreviation
  • Lag time: Ideally, less than a year. (Currently, it's 2-3 years behind.)
  • History: Keep all history online
  • Delivery mechanism: Excel or CSV download


Solution

Location: The Medicaid Managed Care Enrollment Report is published on a yearly basis by the Data Systems Group (DSG) of the Centers for Medicare and Medicaid. As of September 2015, the 2013 pdf report as well as a zip file of Excel files containing the underlying data are available on: http://www.medicaid.gov/medicaid-chip-program-information/by-topics/data-and-systems/medicaid-managed-care/medicaid-managed-care-enrollment-report.html

2013 Files

Files: Summary of the files available in the 2013 download "2013 Enrollment Data by Program and Population" (Zip file):

  • 1_Enrollment by program type (all) -- single row per state; columns of total all eligibles Medicaid enrollment and breakdown of enrollment by plan type (MCO, PCCM, MLTSS, etc)
  • 3_Comprehensive MCO penetration -- single row per state; column of total Medicaid enrollees and breakdown by all medicaid managed care and comprehensive managed care
  • 4_Enrollment by program and plan -- multiple rows per state; columns of program name (type), plan, geographic region, total Medicaid only enrollment, dual enrollment, total enrollment
  • 5_MLTSS enrollment -- single row per state; columns of total managed care enrollees and broken down by comprehensive managee care, managed LTSS, and other MLTSS
  • 6_features by enrollment population -- single row per "feature" (population type); columns of number of managed care programs by type and mandatory/voluntary
  • 7_Features by QA and performance incentive -- single row per "feature" (either QA or performance metric); columns of total number of programs by program type
  • 2013 MMCDCS state tables -- one tab per state; seems to contain the data in the state profile pdfs
  • zip file of individual state table pdfs




2014 Files

Files: Summary of the files available in the 2014 download "2014 Enrollment Data by Program and Population" (Zip file):

  • 1_2014 MMCDCS summary.xlsx
  • 2_Enrollment by program type (all).xlsx
  • 3_Enrollment by program type (duals).xlsx
  • 4_Comprehensive MCO penetration.xlsx
  • 5_Enrollment by program and plan.xlsx
  • 6_MLTSS enrollment.xlsx
  • 7_Features by enrollment population.xlsx
  • 8_Features by QA and performance incentive.xlsx
  • 9_State tables.xlsx




2015 Files

From the program owner of this data on 4/25/2016:

..."keep an eye out for the 2015 data…maybe by the end of the summer" [2016]

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