Medicaid

A joint federal and state program that helps provide health care coverage for people with low incomes and limited resources.

TAF Long Term Care File

The Medicaid and CHIP TAF (T-MSIS Analytic File) Long Term Care (LT) file contains records for institutional long term care provided by specific facilities identified by the Type of Service variable:

  • Nursing Facility Services
  • Mental Facility Services
  • Independent (free-standing) Psychiatric Wings of Acute Care Hospitals
  • Intermediate Care Facility (ICF) Services for Individuals With Intellectual Disabilities

The records in the LT TAF include fee-for-service (FFS) claims, managed care encounters and supplemental payments for Medicaid, Medicaid-expansion CHIP, and separate CHIP.

What does this file include? (variable highlights)

  • Diagnosis codes
  • Present on Admission indicator
  • Admission date
  • Charges and payments
  • Provider identifier
  • Patient discharge status or destination
  • Counts of covered days

Special considerations

  • Encounter data reporting may vary by state, year and eligibility group.
  • Stays may be made up of multiple records.
  • Long term care services provided to community-dwelling beneficiaries are found in the TAF OT file.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. CMS has fee information for TAF data pricing.
  • ResDAC provides resources on Medicaid TAF data quality.
  • A bridge file will be provided to assist researchers that are conducting longitudinal analysis involving 2020 TAF research files along with earlier service years. For additional information, please see the CCW T-MSIS Analytic Files (TAF) User Guide posted on CCW’s User Documentation page.

TAF Inpatient File

The Medicaid and CHIP TAF (T-MSIS Analytic File) Inpatient (IP) file contains records for enrollees who had an inpatient hospital stay. Records include fee-for-service (FFS) claims, managed care encounters and supplemental payments for Medicaid, Medicaid-expansion CHIP and separate CHIP.

What does this file include? (variable highlights)

  • Records included based on discharge date within the file calendar year
  • Active, non-voided, non-denied final action claims
  • Diagnosis codes
  • Present on Admission Indicator
  • Procedure codes
  • Procedure date
  • Discharge status
  • Charges and payments
  • Provider identifier

Special considerations

  • Available encounter data may vary by state, year and eligibility group.
  • CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. CMS has fee information for TAF data pricing.
  • ResDAC provides resources on Medicaid TAF data quality.
  • A bridge file will be provided to assist researchers that are conducting longitudinal analysis involving 2020 TAF research files along with earlier service years. For additional information, please see the CCW T-MSIS Analytic Files (TAF) User Guide posted on CCW’s User Documentation page.

Long Term Care Minimum Data Set (MDS) - Swing-Bed 2.0

The Long Term Care Minimum Data Set (MDS)-Swing Bed is a health status screening and assessment tool. It is required for Medicare payment of hospital-based skilled nursing care. Swing-bed providers are hospitals that can use beds, as needed, to provide either acute or post-acute skilled nursing care.  The swing-bed assessment includes a subset of the skilled nursing facility (SNF) MDS items. MDS Swing Bed 2.0 was replaced by version 3.0 in October, 2010.

What does this file include? (variable highlights)

  • Resource Utilization Group (RUG) code
  • Clinical status measures
  • Physical functioning assessment
  • Psychological status measures
  • Psycho-social functioning measure

Medicaid Enrollee Supplemental File (MESF): National Death Index (NDI) Segment

The National Death Index segment of the MESF includes cause of death information from death certificates provided through linkage with the National Death Index (NDI) cause of death information.

What does this file include? (variable highlights)

  • NDI date of death
  • ICD-10 description and code for cause of death
  • Underlying conditions for cause of death
  • CDC category code for cause of death

Special considerations

  • Some states are not included in the later years. See specific availability below.
  • This is a segment of the MESF file. Another segment, the Conditions Segment can also be requested.
  • Only beneficiaries with a date of death in the annual Medicaid enrollment file are included in the file. The date can be the Medicaid date of death reported in MAX/TAF or the Medicare date of death for the dually eligible.
  • A bridge file will be provided to assist researchers who are conducting longitudinal analysis involving the 2020 MESF NDI file and the 2020 or 2021 TAF research files. For additional information, see the CCW T-MSIS Analytic Files (TAF) User Guide, section 5A, footnote 29, posted on CCW’s User Documentation page.

Medicaid Enrollee Supplemental File (MESF): Conditions Segment

The Conditions segment of the MESF flags each Medicaid beneficiary for the presence of one of 27 specific chronic conditions or one of 35 other chronic or potentially disabling conditions.

What does this file include? (variable highlights)

  • Three flags for each chronic condition (based on end of calendar year):
    • Medicaid only (found in Medicaid claims)
    • Medicare only (found in Medicare claims)
    • Combined data (found in Medicare and Medicaid claims)

Special considerations

  • The algorithms used to assign the flags are available from the CCW website.
  • Algorithms that include multi-year look-back periods are applied without the purchase of additional years of data.
  • This is a segment of the MESF file. Another segment, the National Death Index (NDI) segment can also be requested.

MAX Long Term Care File

Medicaid MAX (Medicaid Analytic Extract) Long Term (LT) Care file contains claim records for institutional long term care provided at four specific facility identified by the MAX Type of Service:

  • Nursing Facility Services
  • Mental Hospital Services for the Aged
  • Inpatient Psychiatric Facility Services for Individuals Under the Age Of 21
  • Intermediate Care Facility (ICF) Services for Individuals With Intellectual Disabilities

What does this file include? (variable highlights)

  • 5 diagnosis codes
  • Admission date
  • Charges and payments (FFS only)
  • Provider identifier
  • Patient discharge status or destination
  • Counts of covered days

Special considerations

  • Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group.
  • Stays may be made up of multiple records.
  • Long term care services provided to community-dwelling beneficiaries are found the MAX OT file.

MAX Inpatient File

The Medicaid MAX (Medicaid Analytic Extract) Inpatient (IP) file contains complete stay records for enrollees who had an inpatient hospital stay. Records include fee-for-service (FFS) claims and encounter records submitted for stays covered by Medicaid managed care.

What does this file include? (variable highlights)

  • 10 diagnosis code fields
  • 7 procedure code fields
  • Discharge status
  • Charges and payments (FFS only)
  • Provider identifier             

Special considerations

  • Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group.

MAX Other Services File

Medicaid MAX (Medicaid Analytic Extract) Other Services (OT) file contains claim records for a variety of Medicaid services, including physician services, outpatient hospital institutional utilization, lab/X-ray, clinic services, home health, hospice and premium payments.

What does this file include? (variable highlights)

  • As appropriate for the type of service on the record:
    • 2 diagnosis codes
    • 1 procedure code
  • Broadly defined Type of Service codes
  • Charges and payments (FFS only)
  • Provider identifier

Special considerations

  • Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group

MAX Prescription Drug File

Medicaid MAX (Medicaid Analytic Extract) Prescription Drug (RX) file includes records of filled prescriptions from fee-for-service (FFS) claims paid by Medicaid and encounter records for prescription drugs paid by a Medicaid managed care organization.

The Medicaid RX Prescription Drug file includes fee-for-service (FFS) claim and managed care encounter records that contain a National Drug Code (NDC) for a filled prescription.

What does this file include? (variable highlights)

Special considerations

  • Encounter record reporting may not be complete. Data reporting may vary by state, year, eligibility group
  • Information on the drug name, dosage and format is not recorded in the MAX RX file. An external source of NDC data will be required if that information is needed.