Medicare Data Available

CMS-MMCO has established a free-of-charge process for state Medicaid agencies to request timely access to certain Medicare data to coordinate the care of the dually eligible population and help ensure the integrity of the state’s Medicaid program.

A state Medicaid agency may request the following data, subject to procedural limitations:

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Claims Data

Medicare Parts A and B claims and Part D prescription drug event data

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Enrollment Data

Medicare Parts A, B, C, and D eligibility and enrollment data

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Assessments Data

  • Minimum Data Set (MDS)
  • Outcome and Assessment Information Set (OASIS)
  • Swing Bed
  • Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)
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Provider Data

  • Medicare Provider and Analysis Review (MedPAR)
  • Medicaid Enrollee Supplemental File (MESF) data

These data include summary files, which contain summary-level information on Medicare beneficiary demographics and claims data, and claims/event/eligibility files, which contain information on the services paid for by Medicare as well as demographic and service-level identifiers. State Medicaid agencies can find additional information on Medicare data options for care coordination and program integrity in the document entitled Requesting and Using Medicare Data for Medicare-Medicaid Care Coordination and Program Integrity: An Overview.

In addition to the document referenced above, there are a number of data resources available to state Medicaid agencies that explain the variables and layouts of these data.

Additional Information

Additional information on coordinating care for the dually eligible population can be found on the About Care Coordination page.

Care Coordination

More information about CMS support of state program integrity activities can be found on the About Program Integrity page.

Program Integrity