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This variable is contained in the following files:
SAS Name
MDCD_TOTAL_SPEND_01
This variable is the sum of Medicaid payment amount from the inpatient (IP), long-term care (LT), pharmacy (RX), and other services (OT) (header) claims for the beneficiary for each month. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.
Monthly claims total spending is calculated independent of Medicaid eligibility status; the CCW sums the MDCD_PD_AMT for all claim header records. This means there may be payment amounts for months when the beneficiary did not meet the MMLEADS population criteria. Therefore, for a small number of beneficiaries, you may observe payments for months that do not correspond with monthly Medicaid or Medicare enrollment in the MMLEADS Beneficiary file.
Note that the Center for Medicaid and CHIP Services (CMCS) at CMS has required redaction of the MDCD_PD_AMT field for managed care claims due to the proprietary and confidential nature of this information. Therefore, these monthly totals do not reflect the redacted managed care expenditures. MMLEADS counts all claims in the monthly MDCD_TOTAL_USE_01–12 variables. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Values: $
Source: T-MSIS Claims files (derived)