For a program that provides health insurance to more than 67 million Americans—including low-income children and parents, elderly individuals, individuals with disabilities, and adults without dependent children—having complete, accurate and useable data about the Medicaid program is crucial. The issue of states and health data will be front and center at AcademyHealth’s upcoming Health Data Policy and Strategy Orientation (September 26-27), which will feature a session on “The Role of States in the Data Ecosystem.”

A similar theme was highlighted in August at this year’s Medicaid Enterprise Systems Conference (MESC) by Julie Boughn, Director of the Data Systems Group (DSG) within the Centers for Medicaid and CHIP Services (CMCS) at CMS. At the MESC, Boughn declared this the “Year of Data Quality” and emphasized the CMS priority to improve the quality and utility of data captured by the Transformed Medicaid Statistical Information System (T-MSIS) over the next year. She expressed hope that at next year’s MESC she will be talking about all the positive ways T-MSIS has been used that will have a real impact on beneficiary health and wellness, for example with maternal and child health.

As every state Medicaid program is different, it can be challenging to collect timely and accurate data that can be effectively digested and compared to answer fundamental questions about coverage, delivery systems, and cost, as well as to evaluate policies and ensure program integrity. CMS transitioned the Medicaid Statistical Information System (MSIS) to the T-MSIS after the passage of the Affordable Care Act (ACA), which strengthened the existing requirements for data collected from Medicaid agencies to include data related to program integrity, program oversight, and administration. All states (including the District of Columbia and Puerto Rico) are reporting the following data to CMS:

  • enhanced information about beneficiary eligibility,
  • beneficiary and provider enrollment,
  • service utilization,
  • claims and managed care data, and
  • expenditure data for Medicaid and CHIP.

On August 10, CMS released a State Health Official Letter (SHO #18-008) that outlined CMS’ approach to further improve T-MSIS data. The agency is prioritizing sharing, using, and enhancing T-MSIS data. CMS discussed the following plans to enhance the value of T-MSIS data:

  1. Share T-MSIS analytic files with external researchers for feedback on quality and usability.
  2. Develop canned reports (e.g., beneficiary enrollment, managed care, expenditures, etc.) accessible to CMS staff and leadership, state staff and leadership, researchers, oversight agencies, and the public at large. 
  3. Increase data transparency and crowdsource the data so more researchers and analysts can help identify issues and ways to use T-MSIS data.

Additionally, on June 26, CMS Administrator Seema Verma announced a number of initiatives to strengthen Medicaid program integrity efforts, including the use of T-MSIS data. One of the initiatives is to optimize state-provided claims and provider data. CMS will validate the quality and completeness of T-MSIS data and use advanced analytics and other innovative solutions to both improve T-MSIS data and maximize the potential for program integrity purposes.

T-MSIS is part of the larger Medicaid and CHIP Business Information Solution (MACBIS) that was initiated by CMS in 2010 and is still under development. MACBIS is an enterprise-wide initiative to ensure the Medicaid and CHIP data infrastructure and technology further the programs’ role in health care delivery reforms, access to coverage, and proper monitoring and oversight. CMS will use MACBIS data for such things as program integrity, evaluation of demonstrations, and actuarial and quality of care analysis.[1]

Once MACBIS is fully implemented and CMS can collect and consolidate robust, clean, higher quality data from states and internal components, the research community will have access to very rich Medicaid data to conduct studies with meaningful results to inform social policy and clinical practice.

As health data policy experts prepare to participate in the upcoming Health Data Policy and Strategy Orientation, one opportunity for discussion is the generation of ideas for how to advance efforts to put Medicaid data into action for better management of Medicaid dollars and better care for Medicaid recipients.

The opinions expressed in this blog post are the author's own and do not necessarily reflect the view of AcademyHealth.

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Rebecca Bruno

Principal Health Systems Analyst - MITRE

Rebecca Bruno is the Principle Health Systems Analyst at MITRE. Read Bio