CMS releases research-ready Medicaid and CHIP datasets

Researchers now will have access to Medicaid and Children’s Health Insurance Program data from a national repository meant to identify and prevent fraud, waste and abuse.

Researchers now will have access to Medicaid and Children's Health Insurance Program data from a national repository meant to identify and prevent fraud, waste and abuse.

This is the first time that the Centers for Medicare and Medicaid Services has released research-ready datasets from the Transformed Medicaid Statistical Information System (T-MSIS), a joint effort by CMS and states to improve the quality of data for better oversight of the Medicaid and CHIP programs.

“Because of the size and complexity of T-MSIS files and the frequency of updates, the raw T-MSIS data are challenging to use directly for analytic purposes,” the agency announced. “Therefore, CMS has created a series of datasets optimized for analytics, known as the T-MSIS Analytic Files (TAF) consisting of research identifiable files (RIFs).”

The TAF RIFs include annual files that contain demographic and eligibility information for all Medicaid and CHIP eligible beneficiaries, as well as claims files that contain service use and payment records.

“A total of five file types are being released for Calendar Years 2014, 2015 and 2016 at this time,” according to CMS. “Additional research-ready TAF RIFs with data for 2017 and 2018, are expected to be released sometime in 2020.”

According to the agency, researchers can now use the T-MSIS data to better analyze what states and the federal government are paying for Medicaid and CHIP, programs which cover nearly 73 million Americans.

“These data provide key information, including information on utilization and spending under Medicaid managed care, and are needed to enable research and analysis to improve quality of care, assess beneficiary care costs, and enrollment and improve program integrity,” states the CMS announcement. “Ongoing availability of T-MSIS data is essential to allow monitoring and oversight of Medicaid and CHIP programs, to enable evaluation of demonstrations under section 1115 of the Social Security Act, and to calculate quality measures and other metrics.”

However, the Government Accountability Office reported last year that the level of completeness, comparability and utility of states' T-MSIS data varies. “While recognizing the progress that has been made, more work needs to be done before CMS or states can use these data for program oversight,” concluded the GAO in a 2018 report.

Nonetheless, CMS contends that it has worked “diligently” with states to improve the quality and integrity of T-MSIS data.

“The lack of access to high quality, timely Medicaid and CHIP data is a concern of CMS, the Government Accountability Office and other oversight entities that routinely highlight this issue in their reports,” according to the agency. “To address this problem, CMS has been working with states since 2011 to implement changes to the data collected about beneficiaries and providers, fee-for-service and managed care claims, and managed care plans and liable third parties, better enabling data-driven decision-making for Medicaid and CHIP.”

As a result of these efforts, CMS says it now has “more timely” beneficiary-level data on the Medicaid and CHIP program than ever before and that the agency is “continuing to work with states to improve reporting to ensure that future data releases will be even better.”

Researchers interested in getting access to T-MSIS data must submit a request to the CMS Research Data Assistance Center and sign a data use agreement that includes beneficiary privacy and data security requirements.

“Data shared with researchers will not include beneficiary names, addresses, or phone numbers, in order to protect beneficiary privacy, and proprietary managed care payment information will be redacted,” according to CMS.

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