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Medicaid |
Description
Medicaid is a jointly financed state and federal program to
provide health insurance coverage to certain categories of low-income individuals,
including children, pregnant women, parents of eligible children, people with
disabilities, and the elderly. Individual states administer the program under
guidelines established by the federal government. Each state sets its own guidelines
regarding eligibility and covered services. As a result, eligibility rules and
covered services may differ significantly from state to state.
States submit data to the Centers for Medicare and Medicaid Services (CMS)
through the Medicaid Statistical Information System (MSIS). CMS extracts
the Medicaid Analytic eXtract files (MAX) from MSIS to support research and
policy analysis. MAX files contain data on enrollment, healthcare utilization,
charges and payments for all states and the District of Columbia.
| Name |
Description |
| Person Summary (PS) |
Enrollment and claim summary file containing one record
for every individual enrolled in Medicaid in the state during the calendar
year. |
| Other Services (OT) |
Claims for physician services, laboratory, radiology, durable
medical equipment and supplies, and capitated premium payments to managed
care plans |
| Inpatient (IP) |
Claims for inpatient hospital services |
| Prescription Drug (RX) |
Claims for prescription drugs, durable medical equipment
supplies, or services provided by a pharmacy |
| Long Term Care (LT) |
Claims for services provided by long term care institutions,
such as nursing facility services, mental hospital services for the aged,
and intermediate care facility services for the mentally retarded |
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