[
{
"title": "ACA Federal Upper Limits",
"identifier": "ce4cf49b-a21b-5a53-bbc3-509414940847",
"description": "Affordable Care Act Federal Upper Limits (FUL) based on the weighted average of the most recently reported monthly average manufacturer price (AMP) for pharmaceutically and therapeutically equivalent multiple source drug products that are available for purchase by retail community pharmacies on a nationwide basis.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-04T14:18:00+00:00",
"download_url": "https://download.medicaid.gov/data/aca-federal-upper-limits-07292026.csv",
"format": "csv",
"keywords": [
"Average Manufacturer Price (AMP)",
"Federal Upper Limits (FUL)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Quarterly FUL prices for multiple-source drugs. Ceiling on what Medicaid reimburses. Compare with NADAC and AMP.",
"relationships": []
},
{
"title": "Clotting Factor Drug Report",
"identifier": "f45f35c5-7aa4-4500-b196-ae7833717add",
"description": "Clotting Factor (CF) designation allows for a minimum rebate percentage of 17.1 percent of Average Manufacturer Price (AMP) for single source and innovator multiple source drugs. ",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-10T23:04:00+00:00",
"download_url": "https://download.medicaid.gov/data/cf-drug-report-08092026.2.csv",
"format": "csv",
"keywords": [
"Drug Rebate Program"
],
"theme": [],
"notes": "Pricing for clotting factor products, which are carved out of standard rebate calculations.",
"relationships": []
},
{
"title": "Division of Pharmacy Releases Index dataset",
"identifier": "0d425780-16be-4ded-8420-69def8f4ee29",
"description": "Division of Pharmacy Releases Index dataset. The list of keywords for this dataset can be found in Additional information table below.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2025-07-24T14:50:00+00:00",
"download_url": "https://download.medicaid.gov/data/division-of-pharmacy-releases-07242025.csv",
"format": "csv",
"keywords": [
"Pharmacy"
],
"theme": [],
"notes": "Index of CMS pharmacy-related data releases. Meta-dataset pointing to individual release files.",
"relationships": []
},
{
"title": "Drug AMP Reporting - Monthly",
"identifier": "91d4309d-3ca8-5a1e-8f78-79984027392d",
"description": "Drugs that have been reported under the Medicaid Drug Rebate Program along with an indication of whether or not the required Average Manufacturer Price (AMP) was reported for each drug. All drugs are identified in the file by the 11-digit National Drug Code, product name, labeler name, and reported (R) or not reported (NR).",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-13T19:19:00+00:00",
"download_url": "https://download.medicaid.gov/data/DrugAMPReportingMonthly062026.csv",
"format": "csv",
"keywords": [
"Average Manufacturer Price (AMP)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Average Manufacturer Price reporting data. AMP is the basis for rebate calculations and FUL setting.",
"relationships": []
},
{
"title": "Drug AMP Reporting - Quarterly",
"identifier": "80956a7d-e343-54f3-94a7-45d41b34fc0b",
"description": "Drugs that have been reported under the Medicaid Drug Rebate Program along with an indication of whether or not the required Average Manufacturer Price (AMP) was reported for each drug. All drugs are identified in the file by the 11-digit National Drug Code, product name, labeler name, and reported (R) or not reported (NR).",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-14T17:04:00+00:00",
"download_url": "https://download.medicaid.gov/data/DrugAMPReportingQuarterly-2q2026.csv",
"format": "csv",
"keywords": [
"Average Manufacturer Price (AMP)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Average Manufacturer Price reporting data. AMP is the basis for rebate calculations and FUL setting.",
"relationships": []
},
{
"title": "Drug Manufacturer Contacts",
"identifier": "9fcb14ec-d5f0-536e-9938-3f0024531e5b",
"description": "Drug Manufacturer Contact Information contains Optional Effective Date, Termination Date (if applicable), and Legal, Invoice and Technical Contact information for each drug company participating in the Medicaid Drug Rebate Program. For more information see: https://www.medicaid.gov/medicaid/prescription-drugs/medicaid-drug-rebate-program/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-13T17:21:00+00:00",
"download_url": "https://download.medicaid.gov/data/2q2026-labeler-contacts.csv",
"format": "csv",
"keywords": [
"Drug Manufacturer Contacts"
],
"theme": [
"Uncategorized"
],
"notes": "Contact directory for drug manufacturers participating in the Medicaid Drug Rebate Program.",
"relationships": []
},
{
"title": "Drug Products in the Medicaid Drug Rebate Program",
"identifier": "0ad65fe5-3ad3-5d79-a3f9-7893ded7963a",
"description": "Active drugs that have been reported by participating drug manufacturers under the Medicaid Drug Rebate Program. All drugs are identified by National Drug Code (NDC), unit type, units per package size, product name, Food and Drug Administration (FDA) approval date, the date the drug entered the market, plus indicators to show whether the drug is an innovator or non-innovator drug; whether it is available by prescription or over-the-counter (OTC); the FDA therapeutic equivalency code; and the Drug Efficacy Study Implementation (DESI) rating and termination date. Each quarter posted represents a snapshot of data in the system at that time and is not updated by subsequent changes.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-13T19:54:00+00:00",
"download_url": "https://download.medicaid.gov/data/drugproducts-q2-2026.csv",
"format": "csv",
"keywords": [
"Drug Rebate Program"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Master list of all NDCs enrolled in the rebate program with labeler, product name, and drug category (S/I/N). Reference file for joining against SDUD and NADAC.",
"relationships": [
{
"target_uuid": "f7162680-b174-48b4-b3e3-3f0f735264ab",
"target_title": "SDUD",
"join_key": "NDC",
"analysis": "Enrich utilization data with drug name, category, and labeler"
}
]
},
{
"title": "Exclusive Pediatric Drugs",
"identifier": "a54d7605-b780-4cf0-b53d-50313798f528",
"description": "Exclusively Pediatric (EP) designation allows for a minimum rebate percentage of 17.1 percent of Average Manufacturer Price (AMP) for single source and innovator multiple source drugs. ",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-10T23:03:00+00:00",
"download_url": "https://download.medicaid.gov/data/ep-drugs-08092026.2.csv",
"format": "csv",
"keywords": [
"Drug Rebate Program"
],
"theme": [],
"notes": "NDCs with exclusive pediatric indications \u2014 relevant because they get different rebate treatment under the MDRP.",
"relationships": []
},
{
"title": "First Time NADAC Rates",
"identifier": "e3af839d-8175-5be0-b94e-4a302ed7a035",
"description": "The tables below display new National Average Drug Acquisition Cost (NADAC) rates, sorted by Drug Product and Date. The drug products listed have not had a NADAC rate in the past.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-24T14:16:01+00:00",
"download_url": "https://download.medicaid.gov/data/first-time-nadac-08242026.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Drugs receiving their initial NADAC rate. Useful for tracking new market entries and generic launches.",
"relationships": []
},
{
"title": "Medicaid Drug Rebate Program State Contact Information",
"identifier": "46a5d780-feef-521a-af7b-25119ec3dc09",
"description": "Contains each state's policy, rebate and technical contact information for the Medicaid Drug Rebate Program. Updated quarterly.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-13T16:48:00+00:00",
"download_url": "https://download.medicaid.gov/data/2Q2026StateContacts.csv",
"format": "csv",
"keywords": [
"Quarterly State Contact File"
],
"theme": [
"Uncategorized"
],
"notes": "State-level contacts for the MDRP. Administrative reference.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2013",
"identifier": "1fe73992-cbfd-5109-97bc-dee8b33fdcff",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T18:00:05+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.1fe73992-cbfd-5109-97bc-dee8b33fdcff.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2014",
"identifier": "ba0c3734-8012-549a-8f50-2ff389d0e0ef",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:58:02+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.ba0c3734-8012-549a-8f50-2ff389d0e0ef.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2015",
"identifier": "4d7af295-2132-55a8-b40c-d6630061f3e8",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:58:12+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.4d7af295-2132-55a8-b40c-d6630061f3e8.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2016",
"identifier": "7656fc17-f1b4-566b-9a2d-c4a4f2ac7ae1",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:58:05+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.7656fc17-f1b4-566b-9a2d-c4a4f2ac7ae1.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2017",
"identifier": "1c5d0fc9-693a-534a-8240-4627d9362b0d",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:58:06+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.1c5d0fc9-693a-534a-8240-4627d9362b0d.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2018",
"identifier": "8de1b213-73c5-552b-b84e-ac795f34d056",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:58:04+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.8de1b213-73c5-552b-b84e-ac795f34d056.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2019",
"identifier": "76a1984a-6d69-5e4d-86c8-65eb31f0506d",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T18:00:11+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.76a1984a-6d69-5e4d-86c8-65eb31f0506d.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2020",
"identifier": "c933dc16-7de9-52b6-8971-4b75992673e0",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-08-23T17:59:01+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost.a4y5-998d.c933dc16-7de9-52b6-8971-4b75992673e0.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2021",
"identifier": "d5eaf378-dcef-5779-83de-acdd8347d68e",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-12-28T09:56:01+00:00",
"download_url": "https://download.medicaid.gov/data/national-average-drug-acquisition-cost-12-29-2021.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2022",
"identifier": "dfa2ab14-06c2-457a-9e36-5cb6d80f8d93",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2023-01-18T16:47:01+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-2022.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2023",
"identifier": "4a00010a-132b-4e4d-a611-543c9521280f",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2023-12-26T16:17:01+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-12-27-2023.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2024",
"identifier": "99315a95-37ac-4eee-946a-3c523b4c481e",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2024-12-23T21:05:00+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-12-25-2024.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2025",
"identifier": "f38d0706-1239-442c-a3cc-40ef1b686ac0",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2025-12-30T15:25:00+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-12-31-2025.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC (National Average Drug Acquisition Cost) 2026",
"identifier": "fbb83258-11c7-47f5-8b18-5f8e79f7e704",
"description": "National Average Drug Acquisition Cost (NADAC) weekly reference data for the calendar year.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-25T11:42:01+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-national-average-drug-acquisition-cost-08-26-2026.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Annual NADAC file for this calendar year. Weekly pharmacy acquisition cost surveys aggregated annually.",
"relationships": []
},
{
"title": "NADAC Comparison",
"identifier": "a217613c-12bc-5137-8b3a-ada0e4dad1ff",
"description": "The NADAC Weekly Comparison identifies the drug products with current NADAC rates that are replaced with new NADAC rates. Other changes (e.g. NDC additions and terminations) to the NADAC file are not reflected in this comparison.\n\nNote: Effective Date was not recorded in the dataset until 6/7/2017",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-08-25T11:56:01+00:00",
"download_url": "https://download.medicaid.gov/data/nadac-comparison-08-26-2026.csv",
"format": "csv",
"keywords": [
"National Average Drug Acquisition Cost (NADAC)",
"Comparison"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Side-by-side NADAC rates across survey periods for the same drugs. Useful for tracking acquisition cost trends over time.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 06/1/2024)",
"identifier": "d32dc095-de60-45f0-9e58-852257970244",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2024-06-28T16:08:55+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/Clotting-Factor-June2024.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 06/1/2025)",
"identifier": "666bbb60-13ea-4545-b696-d65776db2bab",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2025-06-30T19:06:00+00:00",
"download_url": "https://download.medicaid.gov/data/Clotting-Factor-June-2025.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 06/1/2026)",
"identifier": "190326eb-878c-4aaf-ae2b-1082bf34ff70",
"description": "The Reference Document link for the downloadable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-01T17:53:00+00:00",
"download_url": "https://download.medicaid.gov/data/Clotting-Factor-June2026.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 12/1/2021)",
"identifier": "52d7cf12-5c8d-450c-884d-7dca2632142a",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2022-12-20T12:30:55+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/Clotting-Factor-Dec2021.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 12/1/2022)",
"identifier": "d8df4c15-38e0-43c8-ba3b-c56ffa61de5f",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2022-12-20T10:55:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/Clotting-Factor-Dec2022_0.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 12/1/2023)",
"identifier": "8865d8e5-85fe-44f2-832d-2d6b984c312b",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2023-12-29T14:36:41+00:00",
"download_url": "https://download.medicaid.gov/data/Clotting-Factor-Dec2023.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 12/1/2024)",
"identifier": "9e2d6cdf-a835-4b90-a5de-8a6c47eb471d",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2025-01-08T21:41:00+00:00",
"download_url": "https://download.medicaid.gov/data/Clotting-Factor-December2024.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 12/1/2025)",
"identifier": "c5ac742e-cffa-4e04-a043-fb8324e5512c",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-01-07T19:50:00+00:00",
"download_url": "https://download.medicaid.gov/data/Clotting-Factor-December-2025.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 6/1/2022)",
"identifier": "1d3ffff8-2cf5-4cc9-a820-5879e957caa2",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2022-12-20T16:22:13+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/Clotting-Factor-Jun2022.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Pricing Comparison for Blood Disorder Treatments (Pricing as of 6/1/2023)",
"identifier": "8185fa9f-cf59-49a4-9d67-10cef09f9aa4",
"description": "The Reference Document link for the downable Blood Disorder Treatment Spreadsheet can be accessed below under the Additional Information table under Related Documents.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2023-07-05T16:30:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/Clotting-Factor-Jun-2023.csv",
"format": "csv",
"keywords": [
"Drug Products"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Semi-annual pricing comparison for clotting factors and related hemophilia treatments across pricing benchmarks.",
"relationships": []
},
{
"title": "Product Data for Newly Reported Drugs in the Medicaid Drug Rebate Program",
"identifier": "6b53cee3-300d-4779-b882-556d43ffe45b",
"description": "The Table below, updated weekly, contains newly reported, active covered outpatient drugs which were reported by participating drug manufacturers since the last quarterly update of the Drug Products in the Medicaid Drug Rebate Program (MDRP) database. Each file on this table represents a snapshot of data in the system and is not updated by subsequent changes. Once the covered outpatient drugs in each of these files appear in the quarterly MDRP database, the file will be removed from this table. States can utilize these files to identify newly reported covered outpatient drugs.",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2021-10-13T11:43:22+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/newly-reported-drugs-october-files.csv",
"format": "csv",
"keywords": [
"Drug Rebate Program"
],
"theme": [
"Drug Pricing and Payment"
],
"notes": "Master list of drugs newly reported to the MDRP. Cumulative version (not weekly micro-releases).",
"relationships": []
},
{
"title": "SDUD",
"identifier": "f7162680-b174-48b4-b3e3-3f0f735264ab",
"description": "SDUD",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2022-03-31T09:38:01+00:00",
"download_url": "https://download.medicaid.gov/data/DrugUtilization_merged.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Current cumulative State Drug Utilization Data file. State-level Rx claims by NDC: units reimbursed and Medicaid amount paid. Cross-reference with NADAC for acquisition cost spread analysis.",
"relationships": [
{
"target_uuid": "c5bd69ae-7c98-4787-beb6-cb347ebf329f",
"target_title": "NADAC",
"join_key": "NDC",
"analysis": "Drug acquisition cost vs. Medicaid reimbursement spread"
},
{
"target_uuid": "0ad65fe5-3ad3-5d79-a3f9-7893ded7963a",
"target_title": "Drug Products in the Medicaid Drug Rebate Program",
"join_key": "NDC",
"analysis": "Enrich utilization data with drug name, category, and labeler"
}
]
},
{
"title": "State Drug Utilization Data 1991",
"identifier": "ae4d5347-5137-5f6c-b66c-3420fa0316d8",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T13:53:37+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1991.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1992",
"identifier": "acbd1537-69b8-548d-a90f-eedb416acd71",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:04:11+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1992.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1993",
"identifier": "ec0d4b04-55bc-56d1-bff5-280f68915442",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:06:26+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1993.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1994",
"identifier": "602e7c79-774d-529a-a377-75faa749e878",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:13:53+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1994.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1995",
"identifier": "17c4bf03-ba38-5c0a-9f08-96e9ed812bdf",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:19:32+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1995.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1996",
"identifier": "56adbcf4-f86b-5ab3-98fe-e713bbf99f12",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:31:39+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1996.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1997",
"identifier": "b28a22a2-2c7b-5745-a3f9-d64621f51388",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:35:24+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1997.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1998",
"identifier": "d371b0f4-db36-56f0-8aab-8f8ecb2b66e7",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:40:42+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1998.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 1999",
"identifier": "c39d3302-2d39-5209-9310-388ab1c8cbb8",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:51:30+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-1999.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2000",
"identifier": "57c03da7-5c35-54d5-a1d5-09600eea07c2",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:51:38+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2000.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2001",
"identifier": "915e5174-0869-5c6d-a5bb-454cb31ef605",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T14:56:31+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2001.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2002",
"identifier": "f3144e50-5f27-5e2c-acbb-1962a2aeae55",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:01:59+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2002.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2003",
"identifier": "17169c68-671e-5fc3-ae52-73c1dc97aafb",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:08:04+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2003.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2004",
"identifier": "4d88c014-8989-5a88-bd21-17c1beed0dd3",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T04:11:55+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2004.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2005",
"identifier": "5b10a5b4-dabe-5419-99d8-043df47b8e4b",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:20:45+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2005.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2006",
"identifier": "0a2ec693-b322-54fb-a950-dfcdc873e3cf",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:28:01+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2006.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2007",
"identifier": "bb63ad8e-cab1-56e3-b492-da95d7e8cc5f",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:31:48+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2007.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2008",
"identifier": "89de7fb8-b9ef-52fb-badc-ffc1128a9ada",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:37:01+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2008.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2009",
"identifier": "737f7186-b4d5-5272-a997-0ee94f4d4c3b",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:42:43+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2009.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2010",
"identifier": "1db0f12c-e4d6-5a70-8c1b-5af9635999be",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T15:49:50+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2010.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2011",
"identifier": "138872f1-b1ba-5e05-be13-8be200306a58",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T05:58:16+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2011.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2012",
"identifier": "992936b2-2a72-5df6-a734-a56a8631b87a",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T16:08:16+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2012.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2013",
"identifier": "6a91f80f-e2fd-5f43-8e38-afcebebb8387",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T16:17:41+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2013.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2014",
"identifier": "a9cfe5e9-d7d8-5b87-a7db-b45a7daf84fc",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T04:31:11+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2014.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2015",
"identifier": "2fed5758-5fd6-5dbb-8f92-34b3a0c3c8dd",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T16:44:56+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2015.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2016",
"identifier": "53cf9f05-97e3-5bd6-a237-bc971e3642d9",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T17:28:43+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2016.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2017",
"identifier": "776a3880-a62d-5990-8b40-4406e6861dbb",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T11:59:02+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2017.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2018",
"identifier": "a1f3598e-fc71-51aa-8560-78e7e1a61b09",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T13:49:18+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2018.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2019",
"identifier": "daba7980-e219-5996-9bec-90358fd156f1",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-04-03T13:29:08+00:00",
"download_url": "https://download.medicaid.gov/data/StateDrugUtilizationData-2019.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2020",
"identifier": "cc318bfb-a9b2-55f3-a924-d47376b32ea3",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T16:16:50+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2020_updatedJuly2026.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2021",
"identifier": "eec7fbe6-c4c4-5915-b3d0-be5828ef4e9d",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T16:12:19+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2021_updatedJuly2026.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2022",
"identifier": "200c2cba-e58d-4a95-aa60-14b99736808d",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T15:54:01+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2022_updatedJuly2026.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2023",
"identifier": "d890d3a9-6b00-43fd-8b31-fcba4c8e2909",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T15:43:41+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2023_updatedJuly2026.csv",
"format": "csv",
"keywords": [
"Medicaid Reimbursements",
"Drug Utilization",
"Pharmacy"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2024",
"identifier": "61729e5a-7aa8-448c-8903-ba3e0cd0ea3c",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T15:37:28+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2024_updatedJuly2026.csv",
"format": "csv",
"keywords": [
"Pharmacy",
"Medicaid Reimbursements",
"Drug Utilization"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2025",
"identifier": "158a1baa-5506-400a-8ec3-97756f0b0536",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2026-07-13T15:28:32+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2025_updatedjuly2026.csv",
"format": "csv",
"keywords": [
"Pharmacy",
"Medicaid Reimbursements",
"Drug Utilization"
],
"theme": [
"State Drug Utilization"
],
"notes": "Annual SDUD file. State-level Rx utilization by NDC for this calendar year. Part of the longitudinal SDUD series.",
"relationships": []
},
{
"title": "State Drug Utilization Data 2026",
"identifier": "2957a7f9-9a15-453e-9afd-3bbdcbac8fd3",
"description": "Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html",
"category": "Drug Pricing & Utilization",
"cadence": "Decennial",
"modified": "2026-07-10T21:08:05+00:00",
"download_url": "https://download.medicaid.gov/data/sdud2026_updated072026.csv",
"format": "csv",
"keywords": [
"Pharmacy",
"Medicaid Reimbursements",
"Drug Utilization"
],
"theme": [
"State Drug Utilization"
],
"notes": "",
"relationships": []
},
{
"title": "Benefit Package for Medicaid and CHIP Beneficiaries by Month",
"identifier": "e7d5089e-647c-4aa7-8c7b-f98dd8ea3852",
"description": "This data set includes monthly enrollment counts of Medicaid and CHIP beneficiaries by benefit package (full-scope, comprehensive, limited, or unknown). \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topic Restricted Benefits Code. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2024-01-05T16:36:00+00:00",
"download_url": "https://download.medicaid.gov/data/BenefitPackage-montly.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Monthly breakout of enrollees by benefit package type (comprehensive, limited, benchmark). From T-MSIS.",
"relationships": [],
"_category_conflict": {
"existing": "Eligibility & Enrollment Policy",
"classifier": "Enrollment"
}
},
{
"title": "Benefit Package for Medicaid and CHIP Beneficiaries by Year",
"identifier": "50f83c5a-6fa9-4e91-b36c-3d3e225c905f",
"description": "This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by benefit package (full-scope, comprehensive, limited, or unknown). There are three metrics presented: (1) the number of beneficiaries ever enrolled with each benefit package over the year (duplicated count); (2) the number of beneficiaries enrolled with each benefit package as of an individual\u2019s last month of enrollment (unduplicated count); and (3) average monthly enrollment with each benefit package. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topic Restricted Benefits Code. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Some cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.\n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2024-01-05T16:50:00+00:00",
"download_url": "https://download.medicaid.gov/data/BenefitPackage-anul.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Annual version of benefit package enrollment data.",
"relationships": [],
"_category_conflict": {
"existing": "Eligibility & Enrollment Policy",
"classifier": "Enrollment"
}
},
{
"title": "Continuous Eligibility for Medicaid and CHIP Coverage",
"identifier": "cdb769be-0d7b-524b-9d25-2062d36b60ab",
"description": "States have the option to provide children with 12 months of continuous coverage through Medicaid and CHIP, even if the family experiences a change in income during the year. Continuous eligibility is a valuable tool that helps States ensure that children stay enrolled in the health coverage for which they are eligible and have consistent access to needed health care services.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2018-12-20T21:41:33+00:00",
"download_url": "https://download.medicaid.gov/data/continuous-eligibility-for-medicaid-and-chip-coverage.gz34-pjff.csv",
"format": "csv",
"keywords": [
"Continuous Eligibility",
"Enrollment Strategies"
],
"theme": [
"Eligibility"
],
"notes": "State policies on continuous eligibility periods. Key context for understanding churn and unwinding impacts.",
"relationships": []
},
{
"title": "Express Lane Eligibility for Medicaid and CHIP Coverage",
"identifier": "601a8897-1453-5282-81cd-be49d7ec7503",
"description": "States may rely on eligibility information from \"Express Lane\" agency programs to streamline and simplify enrollment and renewal in Medicaid and CHIP. Express Lane agencies may include Supplemental Nutrition Assistance Program (SNAP), School Lunch programs, Temporary Assistance for Needy Families, Head Start, and the Women, infant, and children's program (WIC) , among others. States can also use state income tax data to determine Medicaid and CHIP eligibility for children.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2019-01-18T19:51:17+00:00",
"download_url": "https://download.medicaid.gov/data/express-lane-eligibility-for-medicaid-and-chip-coverage.8vcd-dnq9.csv",
"format": "csv",
"keywords": [
"Enrollment Strategies"
],
"theme": [
"Eligibility"
],
"notes": "States using data from other programs (SNAP, school lunch) to streamline Medicaid/CHIP eligibility. Limited adoption.",
"relationships": []
},
{
"title": "Major Eligibility Group Information for Medicaid and CHIP Beneficiaries by Month",
"identifier": "ea9b7db3-db71-4663-b4e1-67e11d1d4fcc",
"description": "This data set includes monthly enrollment counts of Medicaid and CHIP beneficiaries by major eligibility group (children, adult expansion group, adult, aged, persons with disabilities, or COVID newly-eligible).\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topic Eligibility Group Code. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2025-10-20T12:40:00+00:00",
"download_url": "https://download.medicaid.gov/data/MajorEligibilityGroup-montly-102025.csv",
"format": "csv",
"keywords": [
"Major Eligibility Group",
"Medicaid",
"Children's Health Insurance Program (CHIP)",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Monthly enrollment counts by major eligibility category (aged, blind/disabled, children, adults, expansion). From T-MSIS.",
"relationships": [],
"_category_conflict": {
"existing": "Eligibility & Enrollment Policy",
"classifier": "Enrollment"
}
},
{
"title": "Major Eligibility Group Information for Medicaid and CHIP Beneficiaries by Year",
"identifier": "bffd757a-3ae9-42fc-809a-820c2919496b",
"description": "This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by major eligibility group (children, adult expansion group, adult, aged, persons with disabilities, or COVID newly-eligible). There are three metrics presented: (1) the number of beneficiaries ever enrolled in each major eligibility group over the year (duplicated count); (2) the number of beneficiaries enrolled in each major eligibility group as of an individual\u2019s last month of enrollment (unduplicated count); and (3) average monthly enrollment in each major eligibility group. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for calculating these measures. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state and year are considered unusable or of high concern based on DQ Atlas thresholds for the topic Eligibility Group Code. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n \nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2025-10-20T12:34:00+00:00",
"download_url": "https://download.medicaid.gov/data/MajorEligibilityGroup-anul-102025.csv",
"format": "csv",
"keywords": [
"Major Eligibility Group",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Annual version of eligibility group enrollment breakout.",
"relationships": [],
"_category_conflict": {
"existing": "Eligibility & Enrollment Policy",
"classifier": "Enrollment"
}
},
{
"title": "Medicaid and CHIP Eligibility Levels",
"identifier": "d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4",
"description": "The following table provides eligibility levels in each state for key coverage groups that use Modified Adjusted Gross Income (MAGI), as of April 1, 2018. The data represent the principal, but not all, MAGI coverage groups in Medicaid, the Children\u2019s Health Insurance Program (CHIP), and the Basic Health Program (BHP). All income standards are expressed as a percentage of the federal poverty level (FPL). The MAGI-based rules generally include adjusting an individual\u2019s income by an amount equivalent to a 5% FPL disregard. Other eligibility criteria also apply, such as citizenship, immigration status, and state residency.\n\nFor more information, see: \nhttps://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-eligibility-levels/index.html",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2018-11-17T19:41:13+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-and-chip-eligibility-levels.xy8t-auhk.csv",
"format": "csv",
"keywords": [
"Children's Health Insurance Program (CHIP)",
"Eligibility Levels",
"Medicaid",
"Federal Poverty Level (FPL)",
"Modified Adjusted Gross Income (MAGI)"
],
"theme": [
"Eligibility"
],
"notes": "Income thresholds by state for each eligibility group (children, pregnant women, parents, expansion adults). The reference for who qualifies where.",
"relationships": [
{
"target_uuid": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"target_title": "PI dataset",
"join_key": "state",
"analysis": "Eligibility thresholds vs. actual enrollment levels by state"
}
]
},
{
"title": "Presumptive Eligibility for Medicaid and CHIP Coverage",
"identifier": "47329369-e935-5de3-880f-d6a85a5fe9d1",
"description": "Health care providers and Head Start programs can play a major role in finding and enrolling uninsured children through presumptive eligibility. States can authorize \u201cqualified entities\u201d -- health care providers, community-based organizations, and schools, among others -- to screen for Medicaid and CHIP eligibility and immediately enroll children who appear to be eligible.\n\nPresumptive eligibility allows children to get access to Medicaid or CHIP services without having to wait for their application to be fully processed. Qualified entities can also help families gather the documents needed to complete the full application process, thereby reducing the administrative burden on States to obtain missing information.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2019-01-24T00:18:34+00:00",
"download_url": "https://download.medicaid.gov/data/presumptive-eligibility-for-medicaid-and-chip-coverage.xjuw-wgmy.csv",
"format": "csv",
"keywords": [
"Enrollment Strategies",
"Presumptive Eligibility"
],
"theme": [
"Eligibility"
],
"notes": "State-by-state policies on presumptive eligibility \u2014 temporary coverage before formal determination.",
"relationships": []
},
{
"title": "Section 1915(c) waiver program participants",
"identifier": "4d4eaf55-33d3-4468-80b4-63553f4530ae",
"description": "This data set includes annual counts and percentages of Medicaid and Children\u2019s Health Insurance Program (CHIP) enrollees who received a well-child visit paid for by Medicaid or CHIP, overall and by five subpopulation topics: age group, race and ethnicity, urban or rural residence, program type, and primary language.\nThese results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, except where otherwise noted. Enrollees in Guam, American Samoa, and the Northern Mariana Islands are not included. Results include enrollees with comprehensive Medicaid or CHIP benefits for all 12 months of the year and who were younger than age 19 at the end of the calendar year. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. Some rows in the data set have a value of \"DS,\" which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services\u2019 Cell Suppression Policy for values between 1 and 10.\nThis data set is based on the brief: \"Medicaid and CHIP enrollees who received a well-child visit in 2020.\" Enrollees are identified as receiving a well-child visit in the year according to the Line 6 criteria in the Form CMS-416 reporting instructions. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to a race and ethnicity subpopulation using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG) (Race and ethnicity of the national Medicaid and CHIP population in 2020). Enrollees are assigned to an urban or rural subpopulation based on the 2010 Rural-Urban Commuting Area (RUCA) code associated with their home or mailing address ZIP code in TAF (Rural Medicaid and CHIP enrollees in 2020). Enrollees are assigned to a program type subpopulation based on the CHIP code and eligibility group code that applies to the majority of their enrolled-months during the year (Medicaid-Only Enrollment; M-CHIP and S-CHIP Enrollment). Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Unknown",
"modified": "2025-01-17T04:40:10+00:00",
"download_url": "https://download.medicaid.gov/data/1915c-waiver-2020-2022-01162025.csv",
"format": "csv",
"keywords": [
"Medicaid",
"Section 1915(C) Waivers",
"T-MSIS Analytic Files (TAF)",
"Home And Community-Based Services (HCBS)"
],
"theme": [
"Eligibility"
],
"notes": "Enrollment counts in HCBS waiver programs by state. Covers I/DD, aging, physical disability, and other LTSS populations.",
"relationships": []
},
{
"title": "State Medicaid and CHIP Eligibility Processing Data",
"identifier": "5abea2e0-3f8e-4b49-a50d-d63d5fd9103c",
"description": "All states (including the District of Columbia) provide data to the Centers for Medicare & Medicaid Services (CMS) on a range of Medicaid and Children\u2019s Health Insurance Program (CHIP) eligibility and enrollment metrics. These data reflect state-reported information on Medicaid and CHIP eligibility renewals initiated and scheduled for completion during the reporting period. In addition to reporting the outcomes of renewals at the end of each reporting period, states also provide an update on renewals that were reported pending as of the end of a reporting period. For more information on these data, see Sections II and III of the Eligibility Processing Data Report specifications.
\nNotes:
Georgia reported data for individuals who continue to be eligible following a change in circumstances and were granted a new 12-month eligibility period during the reporting period, along with data on individuals due for renewal in the month.
\nNorth Carolina reports renewal outcomes for only initiated renewals scheduled for completion in the report month, and as such, the data do not reflect renewals that should have been completed in the reporting period that the state was unable to initiate by the end of the report month.",
"category": "Eligibility & Enrollment Policy",
"cadence": "Monthly",
"modified": "2026-07-31T18:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/renewal-dataset-july-2026-release.csv",
"format": "csv",
"keywords": [
"Medicaid",
"Child Enrollment",
"Eligibility Determinations",
"Children's Health Insurance Program (CHIP)",
"Program Enrollment",
"Renewals"
],
"theme": [
"Enrollment"
],
"notes": "Processing timelines and volumes for eligibility determinations by state. Measures how fast states process applications.",
"relationships": [],
"_category_conflict": {
"existing": "Eligibility & Enrollment Policy",
"classifier": "Enrollment"
}
},
{
"title": "CHIP Applications, Eligibility Determinations, and Enrollment Data",
"identifier": "eba2c172-07ba-4a6a-877e-5373ca442243",
"description": "All states (including the District of Columbia) are required to provide data to The Centers for Medicare & Medicaid Services (CMS) on a range of indicators related to key application, eligibility, and enrollment processes within the state Medicaid and Children\u2019s Health Insurance Programs (CHIP). These data reflect enrollment activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, as well as state program performance.",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2022-04-27T11:46:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/StateMedicaidandCHIPApplicationsEligibilityDeterminationsandEnrollmentData04282022.csv",
"format": "csv",
"keywords": [
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "CHIP-specific application and enrollment pipeline data. Separate from the combined Medicaid/CHIP reporting.",
"relationships": []
},
{
"title": "Dual Status Information for Medicaid and CHIP Beneficiaries by Month",
"identifier": "36ed6909-ab49-4ca5-a38e-6790138cd613",
"description": "This data set includes monthly enrollment counts of Medicaid and CHIP beneficiaries by dual eligibility status for Medicaid and Medicare (full dual eligibility, partial dual eligibility, or not dually eligible).\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topic Dually Enrolled in Medicare. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods.\n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries. ",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2024-01-05T16:52:00+00:00",
"download_url": "https://download.medicaid.gov/data/DualStatus-montly.csv",
"format": "csv",
"keywords": [
"Dual Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Monthly counts of dual-eligible (Medicare + Medicaid) beneficiaries by state. From T-MSIS.",
"relationships": []
},
{
"title": "Dual Status Information for Medicaid and CHIP Beneficiaries by Year",
"identifier": "93b36a8e-4dd5-4ff4-9a8b-8c6537684705",
"description": "This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by dual eligibility status for Medicaid and Medicare (full dual eligibility, partial dual eligibility, or not dually eligible). There are three metrics presented: (1) the number of beneficiaries ever dually eligible for Medicaid and Medicare over the year (duplicated count); (2) the number of beneficiaries dually eligible for Medicaid and Medicare as of an individual\u2019s last month of enrollment (unduplicated count); and (3) average monthly eligibility for Medicaid and Medicare. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topic Dually Enrolled in Medicare. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2024-01-05T16:54:00+00:00",
"download_url": "https://download.medicaid.gov/data/DualStatus-anul.csv",
"format": "csv",
"keywords": [
"Dual Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Annual dual-eligible enrollment counts.",
"relationships": []
},
{
"title": "Medicaid Enrollment - New Adult Group",
"identifier": "6c114b2c-cb83-559b-832f-4d8b06d6c1b9",
"description": "Total Medicaid Enrollees - VIII Group Break Out Report Reported on the CMS-64\n\nThe enrollment information is a state-reported count of unduplicated individuals enrolled in the state\u2019s Medicaid program at any time during each month in the quarterly reporting period. The enrollment data identifies the total number of Medicaid enrollees and, for states that have expanded Medicaid, provides specific counts for the number of individuals enrolled in the new adult eligibility group, also referred to as the \u201cVIII Group\u201d. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. This data includes state-by-state data for this population as well as a count of individuals whom the state has determined are newly eligible for Medicaid. All 50 states, the District of Columbia and the US territories are represented in these data.\n\nNotes:\n1. \u201cVIII GROUP\u201d is also known as the \u201cNew Adult Group.\u201d\n2. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. VIII Group enrollment information for the states that have not expanded their Medicaid program is noted as \u201cN/A.\u201d",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2026-02-05T15:17:00+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-enrollment-new-adult-group-02052026.csv",
"format": "csv",
"keywords": [
"VIII Group",
"Expansion Population",
"New Adult Group",
"CMS-64",
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Monthly enrollment specifically for the ACA expansion (new adult group) population by state. Pair with CMS-64 expansion expenditures for per-enrollee expansion cost.",
"relationships": [
{
"target_uuid": "00505e90-f8ac-5921-b12f-5e23ba7ffcf3",
"target_title": "Medicaid CMS-64 New Adult Group Expenditures",
"join_key": "state + quarter",
"analysis": "Per-capita expansion cost by state"
}
]
},
{
"title": "PI dataset",
"identifier": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"description": "All states (including the District of Columbia) are required to provide data to The Centers for Medicare & Medicaid Services (CMS) on a range of indicators related to key application, eligibility, and enrollment processes within the state Medicaid and Children\u2019s Health Insurance Programs (CHIP). These data reflect enrollment activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, as well as state program performance.",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2024-10-22T15:41:14+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/pi-dataset-test1.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Primary enrollment dataset. Monthly point-in-time Medicaid/CHIP enrollment by state, eligibility group, managed care status. The workhorse denominator for per-enrollee calculations.",
"relationships": [
{
"target_uuid": "5b19d1d4-ae43-5fcd-ba14-3cecd99f473f",
"target_title": "Medicaid Financial Management Data",
"join_key": "state + period (quarterly alignment required)",
"analysis": "Per-enrollee Medicaid expenditure by state"
},
{
"target_uuid": "00505e90-f8ac-5921-b12f-5e23ba7ffcf3",
"target_title": "Medicaid CMS-64 New Adult Group Expenditures",
"join_key": "state + quarter",
"analysis": "Per-enrollee spending for ACA expansion population"
},
{
"target_uuid": "e6205a51-e6d7-4849-9882-4483b8a28c41",
"target_title": "Medicaid and CHIP Updated Renewal Outcomes",
"join_key": "state + month",
"analysis": "Unwinding disenrollment impact on total enrollment trends"
},
{
"target_uuid": "d7e4cccb-1c56-5b5d-acce-5e7744c6d3b4",
"target_title": "Medicaid and CHIP Eligibility Levels",
"join_key": "state",
"analysis": "Eligibility thresholds vs. actual enrollment levels by state"
},
{
"target_uuid": "f403f019-48f5-48f0-b0ce-c051cfe04a5e",
"target_title": "Behavioral Health Services\u00a0Provided to the Medicaid and CHIP Population",
"join_key": "state + month",
"analysis": "BH service intensity per enrollee by state"
}
]
},
{
"title": "Program Information for Medicaid and CHIP Beneficiaries by Month",
"identifier": "3da9f4e6-7976-43a8-8d1b-72f2c557a5ca",
"description": "This data set includes monthly enrollment counts of Medicaid and CHIP beneficiaries by program type (Medicaid or CHIP). \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topics Medicaid-only Enrollment and M-CHIP and S-CHIP Enrollment. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2024-01-05T16:45:00+00:00",
"download_url": "https://download.medicaid.gov/data/ProgramType-montly.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Monthly enrollment by program type (Medicaid, S-CHIP, M-CHIP) from T-MSIS.",
"relationships": []
},
{
"title": "Program Information for Medicaid and CHIP Beneficiaries by Year",
"identifier": "5c267647-50e9-4a81-b2f2-8f23cec6631a",
"description": "This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by program type (Medicaid or CHIP). There are three metrics presented: (1) the number of beneficiaries ever enrolled in each program type over the year (duplicated count); (2) the number of beneficiaries enrolled in each program type as of an individual\u2019s last month of enrollment (unduplicated count); and (3) average monthly enrollment in each program type. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for calculating these measures. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state and year are considered unusable or of high concern based on DQ Atlas thresholds for the topics Medicaid-only enrollment and M-CHIP and S-CHIP Enrollment. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods.\n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Enrollment",
"cadence": "Unknown",
"modified": "2024-01-05T16:47:00+00:00",
"download_url": "https://download.medicaid.gov/data/ProgramType-anul.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Annual enrollment by program type.",
"relationships": []
},
{
"title": "Separate CHIP Enrollment by Month and State",
"identifier": "4723da0d-4d04-46ce-8163-e4b58c8fe728",
"description": "This dataset includes total enrollment in separate CHIP (S-CHIP) programs by month and state from April 2023 forward.\nSources: T-MSIS Analytic Files (TAF) and state-submitted enrollment totals. The data notes indicate when a state\u2019s monthly total was a state-submitted value, rather than from T-MSIS.
\nMethods: Enrollment includes individuals enrolled in S-CHIP at any point during the coverage month, excluding those enrolled in dental-only coverage. The S-CHIP enrollment in this report also excludes enrollees covered by Medicaid expansion CHIP, a program in which a state receives federal funding to expand Medicaid eligibility to optional targeted low-income children that meets the requirements of section 2103 of the Social Security Act. If an individual is enrolled in both Medicaid or Medicaid-expansion CHIP and S-CHIP in a given month, TAF picks the program in which they were last enrolled.
\nUnless S-CHIP enrollment counts are replaced with a state-submitted value, each state's monthly S-CHIP enrollment is equal to the number of unique people in TAF with a CHIP_CODE = 3 (S-CHIP) and ELGBLTY_GRP_CD not equal to \u201866\u2019 (Children Eligible for Dental Only Supplemental Coverage). More information about TAF is available at https://www.medicaid.gov/medicaid/data-systems/macbis/medicaid-chip-research-files/transformed-medicaid-statistical-information-system-t-msis-analytic-files-taf/index.html.
\t\nNote: A historic dataset with S-CHIP enrollment by month and state from April 2023 to June 2024 is also available at: https://data.medicaid.gov/dataset/d30cfc7c-4b32-4df1-b2bf-e0a850befd77. This historic dataset was created to fulfill reporting requirements under section 1902(tt)(1) of the Social Security Act, which was added by section 5131(b) of subtitle D of title V of division FF of the Consolidated Appropriations Act, 2023 (P.L. 117-328) (CAA, 2023). Please note that the methods used to count S-CHIP enrollees differ slightly between the two datasets; as a result, data users should exercise caution if comparing S-CHIP enrollment across the two datasets.
\nState notes:\n Alaska, District of Columbia, Hawaii, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, South Carolina, Vermont, and Wyoming do not have S-CHIP programs.
\n Maryland has an S-CHIP program for the from conception to end of pregnancy group that began in July 2023; April 2023 - June 2023 data for Maryland represents retroactive coverage.
\n Oregon moved all its S-CHIP enrollees, other than those in the from conception to the end of pregnancy group, to a Medicaid-expansion CHIP program effective January 1, 2024.
\nCHIP: Children's Health Insurance Program",
"category": "Enrollment",
"cadence": "Quarterly",
"modified": "2026-06-26T18:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/current-chip-caa-reporting-metrics-june-2026-release.csv",
"format": "csv",
"keywords": [
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Program Enrollment"
],
"theme": [
"Enrollment"
],
"notes": "Monthly CHIP enrollment for states with separate CHIP programs (not Medicaid expansion CHIP).",
"relationships": []
},
{
"title": "Separate CHIP Enrollment by Month and State \u2013 Historic CAA/Unwinding Period",
"identifier": "d30cfc7c-4b32-4df1-b2bf-e0a850befd77",
"description": "This historic dataset with total enrollment in separate CHIP programs by month and state was created to fulfill reporting requirements under section 1902(tt)(1) of the Social Security Act, which was added by section 5131(b) of subtitle D of title V of division FF of the Consolidated Appropriations Act, 2023 (P.L. 117-328) (CAA, 2023). For each month from April 1, 2023, through June 30, 2024, states were required to submit to CMS (on a timely basis), and CMS was required to make public, certain monthly data, including the total number of beneficiaries who were enrolled in a separate CHIP program. Accordingly, this historic dataset contains separate CHIP enrollment by month and state between April 2023 and June 2024.
\nCMS will continue to publicly report separate CHIP enrollment by month and state (beyond the historic CAA/Unwinding period) in a new dataset, which is available at [link]. Please note that the methods used to count separate CHIP enrollees differ slightly between the two datasets; as a result, data users should exercise caution if comparing separate CHIP enrollment across the two datasets.
\nSources: T-MSIS Analytic Files (TAF) and state-submitted enrollment totals. The data notes indicate when a state\u2019s monthly total was a state-submitted value, rather than from T-MSIS.
TAF data were pulled as follows:
April 2023 enrollment - TAF as of August 2023
May 2023 enrollment - TAF as of August 2023
June 2023 enrollment - TAF as of September 2023
July 2023 enrollment - TAF as of October 2023
August 2023 enrollment - TAF as of November 2023
September 2023 enrollment - TAF as of December 2023
October 2023 enrollment - TAF as of January 2024
November 2023 enrollment - TAF as of February 2024
December 2023 enrollment - TAF as of March 2024
January 2024 enrollment - TAF as of April 2024
February 2024 enrollment - TAF as of May 2024
March 2024 enrollment - TAF as of June 2024
April 2024 enrollment \u2013 TAF as of July 2024
May 2024 enrollment \u2013 TAF as of August 2024
June 2024 enrollment \u2013 TAF as of September 2024
\t\nTAF are produced one month after the T-MSIS submission month. For example, TAF as of August 2023 is based on July T-MSIS submissions.
\nNotes: The separate CHIP enrollment in this report is not inclusive of enrollees covered by Medicaid expansion CHIP. Enrollment includes individuals enrolled in separate CHIP at any point during the month but excludes those enrolled in both Medicaid and separate CHIP during the month. See the Data Sources and Metrics Definitions Overview document for a full description of the data sources, metric definitions, and general data limitations.
Alaska, District of Columbia, Hawaii, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, South Carolina, Vermont, and Wyoming do not have separate CHIP Programs. Maryland has a separate CHIP program that began in July 2023; April 2023 - June 2023 data for Maryland represents retroactive coverage.
This document includes separate CHIP data submitted to CMS by states via T-MSIS or a separate collection form. These data include reporting metrics consistent with section 1902(tt)(1) of the Social Security Act.
CHIP: Children's Health Insurance Program
\t\nData notes: \n(a) State-submitted value; data not from T-MSIS
(b1) May 2023 enrollment pulled from TAF as of September 2023
(b2) Data was restated using TAF as of October 2023
(b3) Data was restated using TAF as of April 2024
(b4) Data was restated using TAF as of July 2024
(b5) Data was restated using TAF as of August 2024
(c) Enrollment counts include postpartum women with coverage funded via a Health Services Initiative
",
"category": "Enrollment",
"cadence": "Monthly",
"modified": "2024-12-27T18:57:00+00:00",
"download_url": "https://download.medicaid.gov/data/chip-caa-reporting-metrics-long-table-november-2024-release.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Unwinding",
"Enrollment"
],
"notes": "CHIP enrollment during the CAA continuous enrollment period and subsequent unwinding.",
"relationships": []
},
{
"title": "State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data",
"identifier": "6165f45b-ca93-5bb5-9d06-db29c692a360",
"description": "All states (including the District of Columbia) are required to provide data to The Centers for Medicare & Medicaid Services (CMS) on a range of Medicaid and Children\u2019s Health Insurance Program (CHIP) indicators related to key application, eligibility, enrollment and call center processes. These data reflect enrollment activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, as well as state program performance.
\nStates submit this data via the Performance Indicator dataset. Further information about this dataset is available at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-data/performance-indicator-technical-assistance/index.html.",
"category": "Enrollment",
"cadence": "Monthly",
"modified": "2026-07-31T18:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/pi-dataset-july-2026-release.csv",
"format": "csv",
"keywords": [
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"Call Center",
"Modified Adjusted Gross Income (MAGI) Application Processing"
],
"theme": [
"Enrollment"
],
"notes": "Combined Medicaid and CHIP application volume, determination outcomes, and resulting enrollment by state.",
"relationships": []
},
{
"title": "Disproportionate Share Hospital (DSH) Payments - Annual Reporting Requirements",
"identifier": "c491f14b-6dd5-5e00-9e8d-0c49420e7caa",
"description": "Federal law requires that state Medicaid programs make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. State-specific annual DSH reports are posted as submitted by states based on their availability.\n\nFor more information, visit https://www.medicaid.gov/medicaid/finance/dsh/index.html.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2019-01-24T18:19:56+00:00",
"download_url": "https://download.medicaid.gov/data/disproportionate-share-hospital-dsh-payments-annual-reporting-requirements.88ti-fz9c.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Annual DSH allotments and payments by state. Tracks safety-net hospital subsidies.",
"relationships": []
},
{
"title": "MLR Summary Reports",
"identifier": "743f9f04-4473-41e2-9da2-9a89db65ee55",
"description": "The MLR Summary Reports provide plan-specific MLRs for Medicaid managed care programs. The MLR summary report data include MLRs for MCOs, PIHPs, and PAHPs submitted by states under 42 CFR \u00a7 438.74.\n\nPlan-specific data include: \n\u2022\tPlan name\n\u2022\tReporting period start and end dates\n\u2022\tReport Year\n\u2022\tMLR numerator\n\u2022\tMLR denominator\n\u2022\tMember months\n\u2022\tAdjusted MLR\n\u2022\tRemittance amount owed by plan\n\nThe report also provides: \n\u2022\tState \n\u2022\tProgram name \n\u2022\tProgram type \n\u2022\tEligibility group (if applicable)",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2026-06-26T18:40:00+00:00",
"download_url": "https://download.medicaid.gov/data/mlr-public-use-file-updated06262026.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Medical Loss Ratio reports for Medicaid managed care organizations. Shows how much premium revenue goes to medical care vs. admin.",
"relationships": []
},
{
"title": "Medicaid CMS-64 CAA 2023 Increased FMAP Expenditure Data Collected through MBES/CBES",
"identifier": "1b03ec9b-07dd-4547-99a5-aacf206162d5",
"description": "Notes:\n1. CAA 2023 provides a temporary 5.0 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning April 1, 2023 through June 30, 2023.\t\t\t\t\t\t\t\n2. CAA 2023 provides a temporary 2.5 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning July 1, 2023 through September 30, 2023.\t\t\t\t\t\t\t\n3. CAA 2023 provides a temporary 1.5 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning October 1, 2023 through December 31, 2023.\t\t\t\t\t\t\t\n4. States that have reported \u201c0\u201d either have no expenditures for that reporting category or have not yet reported expenditures for that category. \t\t\t\t\t\t\t\n5. This report is a cumulative summary report that includes current and prior period adjustment expenditures that apply to this quarter and does not include Collections or Overpayment Recoveries.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2026-02-18T15:35:00+00:00",
"download_url": "https://download.medicaid.gov/data/Medicaid-CMS-64-CAA-2023-Increased-FMAP-Expenditure-Data-Collected-through-MBES-CBES-2-18-2026.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Expenditure data tied to the Consolidated Appropriations Act 2023 increased FMAP provisions.",
"relationships": []
},
{
"title": "Medicaid CMS-64 FFCRA Increased FMAP Expenditure",
"identifier": "e02d3bb0-600d-5451-945f-978a8a511770",
"description": "During a public health emergency in the Families First Coronavirus Response Act (FFCRA), a new optional Medicaid eligibility group was added called COVID-19 testing eligibility group. States reported these expenditures under sections 6004 and 6008 through the Medicaid Budget and Expenditure System (MBES) on the Form CMS-64. The data in these reports constitute summary level preliminary expenditure information related to these FFCRA provisions for each state\n\nNotes:\n1. The Families First Coronavirus Response Act (FFCRA), enacted on March 18, 2020, provided a temporary FMAP increase to states and territories meeting certain qualifications and added a new optional \t\t\t\t\t\n Medicaid eligibility group for uninsured individuals during a public health emergency in section 1902(a)(10)(A)(ii)(XXIII) of the Act, referred to as the \u201cCOVID - 19 Testing Group.\u201d\t\t\t\t\t\n2. FFCRA Section 6008 provides a temporary 6.2 percentage point FMAP increase to each qualifying state and territory's FMAP under section 1905(b) of the Act, beginning January 1, 2020 and lasting through \t\t\t\t\t\n the end of the quarter in which the public health emergency (PHE) declared by the Secretary for COVID-19 ends, including any extensions.\t\t\t\t\t\n3. FFCRA Section 6004 provides a 100 percent match rate for individuals eligible under the new optional Medicaid eligibility group in section 1902(a)(10)(A)(ii)(XXIII) of the Act, beginning no earlier than \t\t\t\t\t\n March 18, 2020 and lasting through the end of the PHE for COVID-19.\t\t\t\t\t\n4. States that have reported \u201c0\u201d either have no expenditures for that reporting category or have not yet reported expenditures for that category.\t\t\t\t\t\n5. This report is a cumulative summary report that includes current and prior period adjustment expenditures that apply to this quarter\t\n6. For the Quarter ending 03/31/2020: Delaware has Negative Total Computable Expenditures and Total Federal Share Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\n7. For the Quarter ending 09/30/2020: Colorado has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n8. For the Quarter ending 03/31/2021: California has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period. This corrected FY 2020 Q4 expenditures for Treatment services that are not allowed for Section 6004 100% FMAP match.\n9. For the Quarter ending 03/31/2021: Utah has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\n10. For the Quarter ending 12/31/2022: California has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\n11. For the Quarter ending 12/31/2022: Connecticut has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\n12. For the Quarter ending 09/30/2023: Connecticut has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n13. For the Quarter ending 09/30/2023: Illinois has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n14. For the Quarter ending 09/30/2023: Minnesota has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n15. For the Quarter ending 09/30/2023: Utah has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n16. For the Quarter ending 09/30/2023: Washington has Negative Total Computable Section 6008 Covid 19 Expenditures and Total Federal Share Section 6008 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\t\t\t\t\n17. For the Quarter ending 12/31/2023: Colorado has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n18. For the Quarter ending 12/31/2023: Connecticut has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n19. For the Quarter ending 12/31/2023: Minnesota has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n20. For the Quarter ending 12/31/2023: New Mexico has Negative Total Computable Section 6004 Covid 19 Expenditures and Total Federal Share Section 6004 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.\t\t\t\t\t\t\n21. For the Quarter ending 12/31/2023: Hawaii has Negative Total Computable Section 6008 Covid 19 Expenditures and Total Federal Share Section 6008 Covid 19 Expenditures due to the reporting of prior period adjustments during this period.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2026-03-19T13:23:00+00:00",
"download_url": "https://download.medicaid.gov/data/Medicaid-CMS-64-FFCRA-Increased-FMAP-Expenditure-03182026.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Tracks additional federal spending under the Families First Coronavirus Response Act's temporary FMAP increase. Covers the continuous enrollment condition period.",
"relationships": []
},
{
"title": "Medicaid CMS-64 New Adult Group Expenditures",
"identifier": "00505e90-f8ac-5921-b12f-5e23ba7ffcf3",
"description": "This dataset reports summary level expenditure data associated with the new adult group established under the Affordable Care Act. These state expenditures are reported through the federal Medicaid Budget and Expenditure System (MBES).\n\nNotes:\n1. \u201cVIII GROUP\u201d is also known as the \u201cNew Adult Group.\u201d\n2. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. VIII Group expenditure information\nfor the states that have not expanded their Medicaid program is noted as \u201cN/A.\u201d\n3. States that have reported \u201c0\u201d either have no expenditures for that reporting category or have not yet reported expenditures for that category.\n4. MCHIP expenditures are not included in the All Medical Assistance Expenditures.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2026-02-17T19:09:00+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-cms-64-new-adult-group-expenditures-dataset-02172026.csv",
"format": "csv",
"keywords": [
"Expenditures",
"VIII Group",
"Expansion Population",
"New Adult Group",
"CMS-64",
"Medicaid",
"Medicaid Budget and Expenditure System (MBES)"
],
"theme": [
"Uncategorized"
],
"notes": "Quarterly expenditures for the ACA expansion population, broken out by service category. Only expansion states report. Key for tracking Medicaid expansion fiscal impact.",
"relationships": [
{
"target_uuid": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"target_title": "PI dataset",
"join_key": "state + quarter",
"analysis": "Per-enrollee spending for ACA expansion population"
},
{
"target_uuid": "6c114b2c-cb83-559b-832f-4d8b06d6c1b9",
"target_title": "Medicaid Enrollment - New Adult Group",
"join_key": "state + quarter",
"analysis": "Per-capita expansion cost by state"
}
]
},
{
"title": "Medicaid Financial Management Data",
"identifier": "5b19d1d4-ae43-5fcd-ba14-3cecd99f473f",
"description": "This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state expenditures are tracked through the automated Medicaid Budget and Expenditure System/State Children's Health Insurance Program Budget and Expenditure System (MBES/CBES).\n\nFor more information, visit https://medicaid.gov/medicaid/finance/state-expenditure-reporting/expenditure-reports/index.html.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2024-12-11T19:51:00+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-financial-management-data.7kua-37xz.csv",
"format": "csv",
"keywords": [
"CMS-64 Expenditures",
"Financial Management"
],
"theme": [
"Uncategorized"
],
"notes": "State-by-state quarterly expenditure data from CMS-64 reports. Covers all major service categories. The primary source for total Medicaid spending by state.",
"relationships": [
{
"target_uuid": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"target_title": "PI dataset",
"join_key": "state + period (quarterly alignment required)",
"analysis": "Per-enrollee Medicaid expenditure by state"
}
]
},
{
"title": "Medicaid Financial Management Data \u2013 National Totals",
"identifier": "4011579c-33ea-5741-a763-a2558d635561",
"description": "This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state expenditures are tracked through the automated Medicaid Budget and Expenditure System/State Children's Health Insurance Program Budget and Expenditure System (MBES/CBES).\n\nFor more information, visit https://medicaid.gov/medicaid/finance/state-expenditure-reporting/expenditure-reports/index.html.",
"category": "Expenditures",
"cadence": "Unknown",
"modified": "2024-12-11T21:31:00+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-financial-management-data-national-totals.h7at-haku.csv",
"format": "csv",
"keywords": [
"CMS-64 Expenditures",
"Financial Management",
"National Totals"
],
"theme": [
"Uncategorized"
],
"notes": "National aggregate of CMS-64 data. Quick reference for total program spending without state-level detail.",
"relationships": []
},
{
"title": "2017 Managed Care Programs by State",
"identifier": "8f39b637-9bb1-5894-9062-2c4f2ad70fba",
"description": "Provides program names, program features, population enrolled, benefits covered, quality assurance and improvement, performance incentives, provider value-based purchasing, participating plans, regions served and program notes.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-17T20:44:00+00:00",
"download_url": "https://download.medicaid.gov/data/2017-managed-care-programs-by-state.hc9x-7kex101725.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Annual/current managed care program structures by state.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "2018 Managed Care Programs By State",
"identifier": "b7cf4576-a930-59b4-86c8-c8685aaa5c2c",
"description": "Dataset.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-17T14:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/2018-manged-care-programs-by-state_310172025.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2019 Managed Care Programs By State",
"identifier": "72135da5-f8b4-475b-b602-91621f4205d9",
"description": "Dataset.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2022-06-13T15:45:14+00:00",
"download_url": "https://download.medicaid.gov/data/2019_Table9_10_updated.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2020 Managed Care Programs By State",
"identifier": "8483cef4-972a-4c39-8290-c9d19bead88d",
"description": "Dataset.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-17T12:22:00+00:00",
"download_url": "https://download.medicaid.gov/data/2020-Table9_06132022_2_100825-10172025.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2021 Managed Care Programs By State",
"identifier": "7459d190-e592-42e0-9b66-6f4e7e05eb9b",
"description": "Dataset.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2023-07-21T16:59:15+00:00",
"download_url": "https://download.medicaid.gov/data/2021-Table9_07212023_2.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2022 Managed Care Programs By State",
"identifier": "ac74549c-a621-4f6b-a42d-1a05bc0eb5a3",
"description": "Dataset.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2024-10-16T20:22:18+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2022-Managed-care-prgrm-features-by-state.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2023 Managed Care Programs By State",
"identifier": "a760aac0-5148-43e9-900a-bb128e667218",
"description": "The Managed Care Program Features lists characteristics of each state\u2019s Medicaid managed care programs, including federal operating authority, population enrolled, and benefits covered.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-12T19:57:15+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-program-by-state-2023.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state.",
"relationships": []
},
{
"title": "2024 Managed Care Programs By State",
"identifier": "ef16c490-861a-4b1f-9e6d-f321abdcaab1",
"description": "The Managed Care Program Features lists characteristics of each state\u2019s Medicaid managed care programs, including federal operating authority, population enrolled, and benefits covered.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-11T19:48:14+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-program-by-state-2024.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "Annual snapshot of managed care program structures by state: plan types, populations served, and key program features.",
"relationships": []
},
{
"title": "Managed Care Enrollment Summary",
"identifier": "52ed908b-0cb8-5dd2-846d-99d4af12b369",
"description": "2024 Medicaid Managed Care Enrollment Summary\n\nThe Medicaid Managed Care Enrollment Summary table (Table 1 in the Enrollment Report) displays each state and territory\u2019s total number of Medicaid enrollees, total managed care enrollment, number of enrollees in comprehensive managed care, and the number of enrollees in comprehensive managed care under the Affordable Care Act\u2019s Section VIII Expansion. \n\n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tThe \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit plans such as prepaid inpatient and ambulatory health plans, PCCMs, and PCCM Entities.\n3.\tThe \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), or PACE program. It excludes enrollees in a Financial Alignment Demonstration Medicare-Medicaid Plan as their only form of managed care.\n4.\tThe \u201cMedicaid Enrollment in Comprehensive MCOs Under ACA Section VIII Expansion\u201d column is a subset of the total reported in the \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d column and includes individuals enrolled in comprehensive MCOs and who are low-income adults, with or without dependent children, eligible for Medicaid under ACA Section VIII.\n5.\tWhile Colorado did not report a Comprehensive Managed Care program in their 2024 data submission, the state operates Accountable Care Organization-PCCM-E collaboratives that the state considers to be comprehensive managed care.\n6.\tTennessee\u2019s 2024 data submission indicated that they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d was used to populate \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d in Table 1.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type or does not have a managed care program.\nTen states (California, Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d but did not provide an explanation for why the number was greater. \n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of June 1, 2024, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.\t\n\n2023 Medicaid Managed Care Enrollment Summary\n\nThe Medicaid Managed Care Enrollment Summary table (Table 1 in the Enrollment Report) displays each state and territory\u2019s total number of Medicaid enrollees, total managed care enrollment, number of enrollees in comprehensive managed care, and the number of enrollees in comprehensive managed care under the Affordable Care Act\u2019s Section VIII Expansion. \n\n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tThe \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit plans such as prepaid inpatient and ambulatory health plans, PCCMs, and PCCM Entities.\n3.\tThe \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), or PACE program. It excludes enrollees in a Financial Alignment Demonstration Medicare-Medicaid Plan as their only form of managed care.\n4.\tThe \u201cMedicaid Enrollment in Comprehensive MCOs Under ACA Section VIII Expansion\u201d column is a subset of the total reported in the \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d column and includes individuals enrolled in comprehensive MCOs and who are low-income adults, with or without dependent children, eligible for Medicaid under ACA Section VIII.\n5.\tWhile Colorado did not report a Comprehensive Managed Care program in their 2023 data submission, the state operates Accountable Care Organization-PCCM-E collaboratives that the state considers to be comprehensive managed care.\n6.\tTennessee\u2019s 2023 data submission indicated that they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d was used to populate \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d in Table 1.\n\nNotes: \u201c--\u201d indicates the state or territory does not operate a specific program type or does not have a managed care program. \nNine states (Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d but did not provide an explanation for why the number was greater. One of these states (Michigan) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollees\u201d but did not provide an explanation for why the number was greater.\n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of July 1, 2023, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-11T23:28:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-enrollment-summary-2024-table1.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Total managed care enrollment by state. High-level view of MC penetration.",
"relationships": [
{
"target_uuid": "79692ea5-21e1-56bf-8149-97d437120c4b",
"target_title": "Share of Medicaid Enrollees in Managed Care",
"join_key": "state + year",
"analysis": "MC penetration trends with absolute and relative enrollment"
}
],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Enrollment by Program and Plan",
"identifier": "0bef7b8a-c663-5b14-9a46-0b5c2b86b0fe",
"description": "2024 Enrollment Data by Program and Plan\n\nThe Enrollment Data by Program and Plan table (Table 5 in the Enrollment Report) lists each managed care program\u2019s name and type by state. The data provides details such as the plan name, parent organization, geographic region, Medicaid-only enrollment, dual enrollment, and total enrollment by program.\n\nNote: \u201c0\u201d may not truly represent 0 if a state opted to suppress data for enrollee confidentiality reasons. For example, if a plan had dual enrollment of less than 10, the state may have opted to report 0 instead. \"--\" indicates the state or territory did not provide information for a given program and plan.\n\n2023 Enrollment Data by Program and Plan\n\nThe Enrollment Data by Program and Plan table (Table 5 in the Enrollment Report) lists each managed care program\u2019s name and type by state. The data provides details such as plan name, parent organization, geographic region, Medicaid-only enrollment, dual enrollment, and total enrollment by program.\n\nNote: \u201c0\u201d may not truly represent 0 if a state opted to suppress data for enrollee confidentiality reasons. For example, if a plan had dual enrollment of less than 10, the state may have opted to report 0 instead. \"--\" indicates the state or territory did not provide information for a given program and plan. ",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-11T13:23:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-enrollment-by-program-and-plan2024-table4.csv",
"format": "csv",
"keywords": [
"Comprehensive Managed Care Organizations (MCO)",
"Managed Care Enrollment",
"Medicare",
"Behavioral Health Organization (BHO)",
"Medicaid",
"Prepaid Inpatient Health Plan (PIHP)",
"Primary Care Case Manager (PCCM)",
"Prepaid Ambulatory Health Plan (PAHP)",
"Program of All-Inclusive Care for the Elderly (PACE)",
"Managed Long-Term Services and Supports (MLTSS)",
"Managed Care Organizations (MCO)"
],
"theme": [
"Enrollment"
],
"notes": "Enrollment broken out by individual managed care plan within each state and program.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Enrollment by Program and Population (All)",
"identifier": "e2ce0d2f-07c5-5213-947a-31e19bc649f6",
"description": "2024 Enrollment Data by Program and Population\n\nThe Enrollment Data by Program and Population (Table 2 in the Enrollment Report) displays each state and territory\u2019s number of Medicaid enrollees, and the enrollment by the managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.\n\n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tMontana could not provide unduplicated data for their PCCM program. As a result, Montana\u2019s Medicaid enrollment by managed care program type is not reported in Table 2.\n3.\tTennessee\u2019s 2024 data submission indicated they were unable to provide an unduplicated count of enrollees in their \"Comprehensive MCO (with or without MLTSS)\" program. As a result, Tennessee's Medicaid enrollment by managed care program type is not reported in Table 2. The column \"Comprehensive MCO (with or without MLTSS)\" in Table 2 does not include PACE; therefore, we are unable to use the state-reported \"Total Medicaid Enrollment in Any Type of Managed Care\" as reported in Tables 1 and 4.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type or does not have a managed care program. \u201c***\u201d indicates the state operated a program of this type in 2024 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.\n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of June 1, 2024, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.\n\nBecause Medicaid enrollees may be concurrently enrolled in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees.\n\n2023 Enrollment Data by Program and Population\n\nThe Enrollment Data by Program and Population table (Table 2 in the Enrollment Report) displays each state and territory\u2019s number of Medicaid enrollees, and the enrollment by the managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.\n \n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tMontana could not provide unduplicated data for their PCCM program which is the only managed care program in the state. As a result, the data for the PCCM program in Table 2 is equivalent to their total unduplicated number of managed care enrollees. \n3.\tNevada reported a number for total enrollment in \u201cNEMT\u201d that was greater than \u201cTotal Medicaid Enrollees\u201d but did not provide an explanation for why this number was greater.\n4.\tTennessee\u2019s 2023 data submission indicated they were unable to provide an unduplicated count of enrollees in their \"Comprehensive MCO (with or without MLTSS)\" program. As a result, Tennessee's Medicaid enrollment by managed care program type is not reported in Table 2. The column \"Comprehensive MCO (with or without MLTSS)\" in Table 2 does not include PACE; therefore, we are unable to use the state-reported \"Total Medicaid Enrollment in Any Type of Managed Care\" as reported in Tables 1 and 4.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type or does not have a managed care program. \u201c***\u201d indicates the state operated a program of this type in 2023 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.\n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of July 1, 2023, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/. \n\nBecause Medicaid enrollees may be concurrently enrolled in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-12T03:11:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-enrollment-by-program-and-population-all-2024-table2.csv",
"format": "csv",
"keywords": [
"Managed Care Enrollment",
"Medicare",
"Behavioral Health Organization (BHO)",
"Medicaid",
"Prepaid Inpatient Health Plan (PIHP)",
"Primary Care Case Manager (PCCM)",
"Prepaid Ambulatory Health Plan (PAHP)",
"Program of All-Inclusive Care for the Elderly (PACE)",
"Managed Long-Term Services and Supports (MLTSS)",
"Managed Care Organizations (MCO)"
],
"theme": [
"Enrollment"
],
"notes": "MC enrollment by population group (children, adults, aged/disabled) across all plan types.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Enrollment by Program and Population (Duals)",
"identifier": "8e7be65b-97ba-5ecf-8394-ca8e6f63685a",
"description": "2024 Enrollment Data by Program and Population (Dually Eligible Individuals)\n\nThe Enrollment Data by Program and Population (Dually Eligible Individuals) table (Table 3 in the Enrollment Report) shows each state and territory\u2019s number of dually eligible individuals in the total population, and the number of dually eligible individuals enrolled each managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.\n \n1.\tThe \u201cTotal Dually Eligible Individuals\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including enrollees receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tStates are asked to abstain from reporting Financial Alignment Initiatives (FAI) in their enrollment data submissions. However, in 2024, New York reported a FAI program called Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). \n3.\tTennessee\u2019s 2024 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Therefore, Table 3 does not include Tennessee\u2019s dually eligible enrollees enrolled in managed care by program type.\n4.\tWashington reported a number for total dually eligible individuals in \u201cBHO (PIHP and/or PAHP)\u201d that was greater than \u201cTotal Dually Eligible Individuals\u201d but did not provide an explanation for why this number was greater.\n\nNotes: \u201c--\u201d indicates the state or territory does not operate a specific program type or does not have a managed care program; this value could not be collected for FFS states and territories. \u201c0\u201d indicates that a state operated a program of this type in 2024 but reported 0 dually eligible individuals enrolled as of July 1, 2024. \u201c***\u201d indicates the state operated a program of this type in 2024 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.\n\nBecause dually eligible individuals may be concurrently enrolled in more than one type of managed care program (e.g., a comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees.\n\n2023 Enrollment Data by Program and Population (Dually Eligible Individuals)\n\nThe Enrollment Data by Program and Population (Dually Eligible Individuals) table (Table 3 in the Enrollment Report) displays each state and territory\u2019s number of dually eligible individuals in the total population, and the number of dually eligible individuals enrolled each managed care program type - Comprehensive Managed Care Organization (MCO), Primary Care Case Manager (PCCM), Primary Care Case Management Entity (PCCM Entity), Managed Long-Term Services and Supports (MLTSS), Behavioral Health Organization (BHO), Dental, Non-Emergency Medical Transportation (NEMT), Program of All-Inclusive Care for the Elderly (PACE), and Other.\n\n1.\tThe \u201cTotal Dually Eligible Individuals\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including enrollees receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tMinnesota reported a number for dually eligible individuals in \u201cComprehensive MCO (with or without MLTSS)\u201d that was greater than \u201cTotal Dually Eligible Individuals\u201d but did not provide an explanation for why this number was greater.\n3.\tIn 2023, New York reported a program called Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). This additional program combined with an increase in enrollment due to the Public Health Emergency, resulted in an increase from 2022 for total dually eligible individuals in \u201cComprehensive Managed Care (with or without MLTSS)\u201d.\n4.\tTennessee\u2019s 2023 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Therefore, Table 3 does not include Tennessee\u2019s dually eligible enrollees enrolled in managed care by program type. \n5.\tWashington reported a number for total dually eligible individuals in \u201cBHO (PIHP and/or PAHP)\u201d that was greater than \u201cTotal Dually Eligible Individuals\u201d but did not provide an explanation for why this number was greater.\n\nNotes: \u201c--\u201d indicates the state or territory does not operate a specific program type or does not have a managed care program; this value could not be collected for FFS states and territories. \u201c0\u201d indicates that a state operated a program of this type in 2023 but reported 0 dually eligible individuals enrolled as of July 1, 2023. \u201c***\u201d indicates the state operated a program of this type in 2023 but was unable to provide an unduplicated count of enrollees for at least one of their managed care programs.\n\nBecause dually eligible individuals may be concurrently enrolled in more than one type of managed care program (e.g., a comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees. ",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-11T12:49:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-enrollment-by-program-and-population-duals-2024-table3.csv",
"format": "csv",
"keywords": [
"Managed Care Enrollment",
"Medicare",
"Behavioral Health Organization (BHO)",
"Medicaid",
"Prepaid Inpatient Health Plan (PIHP)",
"Primary Care Case Manager (PCCM)",
"Prepaid Ambulatory Health Plan (PAHP)",
"Program of All-Inclusive Care for the Elderly (PACE)",
"Managed Long-Term Services and Supports (MLTSS)",
"Managed Care Organizations (MCO)"
],
"theme": [
"Enrollment"
],
"notes": "MC enrollment specifically for dual-eligible populations by state and plan type.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Features By Enrollment Population",
"identifier": "927f4847-2c0a-50c1-8f50-9103de7d048b",
"description": "2024 Managed Care Features by Enrollment Population\n\nThe Managed Care Features by Enrollment Population table (Table 7 in the Enrollment Report) lists the total number of managed care programs in the country by type (comprehensive managed care, PCCM, dental, etc.) and lists the number of managed care programs by type that mandatorily or voluntarily enroll each population type which includes duals, children with special health care needs, and American Indians/Alaska Natives (AI/AN) population.\n\n1.\tIn some cases, the sum of mandatory and voluntary enrollment populations for any given program type is greater than the total number of programs of that type. That is because a state may treat individuals within a specific group differently. For example, a state can mandate enrollment for aged adults, while allowing blind and disabled adults to enroll voluntarily.\n2.\tCertain federal statutory authorities do not allow enrollment of individuals who are AI/AN or children receiving Foster Care and Adoption Assistance (FC/AA). Where states use these authorities to operate Medicaid managed care, AI/AN individuals or children receiving FC/AA are considered \"exempt.\"\n\n2023 Managed Care Features by Enrollment Population\n\nThe Managed Care Features by Enrollment Population table (Table 7 in the Enrollment Report) lists the total number of managed care programs in the country by type (e.g., Comprehensive MCO, PCCM, Dental) and lists the number of managed care programs by type that mandatorily or voluntarily enroll each population type which includes duals, children with special health care needs, and American Indians/Alaska Natives (AI/AN) population.\n\n1.\tIn some cases, the sum of mandatory and voluntary enrollment populations for any given program type is greater than the total number of programs of that type. That is because a state may treat individuals within a specific group differently. For example, a state can mandate enrollment for aged adults, while allowing blind and disabled adults to enroll voluntarily.\n2.\tCertain federal statutory authorities do not allow enrollment of individuals who are AI/AN or children receiving Foster Care and Adoption Assistance (FC/AA). Where states use these authorities to operate Medicaid managed care, AI/AN individuals or children receiving FC/AA are considered \"exempt.\"",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-12T12:55:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-features-by-enrollment-population.2024-table7.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Which populations each state's MC plans cover, with plan-level detail on covered services and populations.",
"relationships": []
},
{
"title": "Managed Care Features by Quality-related Requirements",
"identifier": "a6d2c261-210d-587c-8fa4-892444b7de42",
"description": "2024 Managed Care Features by Quality-related Requirements\n\nThe Managed Care Features by Quality Requirements and Performance Incentives table (Table 8 in the Enrollment Report) lists the total number of managed care programs by type (comprehensive managed care, PCCM, dental, etc.) and lists the number of managed care programs by type providing a variety of features, including quality and data collection, performance incentives, and provider value-based purchasing status.\n\n2023 Managed Care Features by Quality-related Requirements\n\nThe Managed Care Features by Quality Requirements and Performance Incentives table (Table 8 in the Enrollment Report) lists the total number of managed care programs by type (comprehensive managed care, PCCM, dental, etc.) and lists the number of managed care programs by type providing a variety of features, including quality and data collection, performance incentives, and provider value-based purchasing status.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-12T12:56:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-features-by-qa-and-performance-incentive.2024-table8.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Quality reporting and performance requirements imposed on MC plans by state.",
"relationships": []
},
{
"title": "Managed Care Information for Medicaid and CHIP Beneficiaries by Month",
"identifier": "89baf100-259b-4763-b9e2-337972f988c4",
"description": "This data set includes monthly enrollment counts of Medicaid and CHIP beneficiaries by managed care participation (comprehensive managed care, primary care case management, MLTSS, including PACE, behavioral health organizations, nonmedical prepaid health plans, medical-only prepaid health plans, and other).\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating these measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable or of high concern based on DQ Atlas thresholds for the topics Enrollment in CMC, Enrollment in PCCM Programs, and Enrollment in BHO Plans. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-20T13:11:00+00:00",
"download_url": "https://download.medicaid.gov/data/ManagedCare-montly-102025.csv",
"format": "csv",
"keywords": [
"Managed Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Monthly T-MSIS data on managed care enrollment status (comprehensive MC, limited benefit, PCCM, etc.) by state.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Information for Medicaid and CHIP Beneficiaries by Year",
"identifier": "c0bef49e-46ea-4b9d-9153-76b4078d58b7",
"description": "This data set presents annual enrollment counts of Medicaid and CHIP beneficiaries by managed care participation (comprehensive managed care, primary care case management, MLTSS, including PACE, behavioral health organizations, nonmedical prepaid health plans, medical-only prepaid health plans, and other). There are three metrics presented: (1) the number of beneficiaries ever enrolled in each managed care plan type over the year (duplicated count); (2) the number of beneficiaries enrolled in each managed care plan type as of an individual\u2019s last month of enrollment (duplicated count); and (3) average monthly enrollment in each managed care plan type. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some cells have a value of \u201cDS\u201d. Some states have serious data quality issues, making the data unusable for calculating these measures. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state and year are considered unusable or of high concern based on DQ Atlas thresholds for the topics Enrollment in CMC, Enrollment in PCCM Programs, and Enrollment in BHO Plans. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods.\n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-20T13:16:00+00:00",
"download_url": "https://download.medicaid.gov/data/ManagedCare-anul-102025.csv",
"format": "csv",
"keywords": [
"Managed Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Enrollment"
],
"notes": "Annual T-MSIS managed care enrollment status by state.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Care Programs by State",
"identifier": "0e112ea8-8e8e-5dee-a7e2-7ed551c3baa4",
"description": "Provides program names, program features, population enrolled, benefits covered, quality assurance and improvement, performance incentives, provider value-based purchasing, participating plans, regions served and program notes.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2025-10-17T20:42:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-care-programs-by-state.p9c7-tuup-updated-100825-101725.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Annual/current managed care program structures by state.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Managed Long Term Services and Supports (MLTSS) Enrollees",
"identifier": "5394bcab-c748-5e4b-af07-b5bf77ed3aa3",
"description": "2024 Managed Long-Term Services and Supports (MLTSS) Enrollment\n\nThe Managed Long-Term Services and Supports (MLTSS) Enrollment table (Table 6 in the Enrollment Report) displays the Medicaid LTSS users in comprehensive managed care and MLTSS-only program enrollees nationally, and by state both numerically and as a percentage of each state\u2019s total Medicaid managed care population.\n\n1.\tThe \u201cComprehensive Managed Care Including LTSS\u201d column does not include PACE programs.\nNotes: \"--\" indicates the state or territory does not operate a specific program type. \u201c0\u201d indicates that a state operated a program of this type in 2024, but had no enrollment to report as of July 1, 2024, or reported 0 LTSS enrollees within their Comprehensive Managed Care program. \n\nEnrollment and user counts include both Medicaid-only and dually eligible individuals. For both types of enrollees, Medicaid covers LTSS. For dually eligible individuals, Medicaid may also cover Medicare cost-sharing for acute, primary care, and specialty services covered by Medicare and other non-LTSS services that are not covered by Medicare.\n\n2023 Managed Long-Term Services and Supports (MLTSS) Enrollment\n\nThe Managed Long-Term Services and Supports (MLTSS) Enrollment table (Table 6 in the Enrollment Report) displays the Medicaid LTSS users in comprehensive managed care and MLTSS-only program enrollees nationally, and by state both numerically and as a percentage of each state\u2019s total Medicaid managed care population.\n\n1.\tThe \u201cComprehensive Managed Care Including LTSS\u201d column does not include PACE programs.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type. \u201c0\u201d indicates that a state operated a program of this type in 2023, but had no enrollment to report as of July 1, 2023, or reported 0 LTSS enrollees within their Comprehensive Managed Care program.\n\nEnrollment and user counts include both Medicaid-only and dually eligible individuals. For both types of enrollees, Medicaid covers LTSS. For dually eligible individuals, Medicaid may also cover Medicare cost-sharing for acute, primary care, and specialty services covered by Medicare and other non-LTSS services that are not covered by Medicare.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-11T12:53:00+00:00",
"download_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Enrollment in managed LTSS programs by state. Tracks the shift from FFS to managed LTSS.",
"relationships": [],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Share of Medicaid Enrollees in Managed Care",
"identifier": "79692ea5-21e1-56bf-8149-97d437120c4b",
"description": "2024 Share of Medicaid Enrollees in Managed Care\n\nThe Share of Medicaid Enrollees in Managed Care table (Table 4 in the Enrollment Report) displays the total number of Medicaid enrollees nationally, and by state and territory, as well as the number and percentage of the total in any type of managed care, and the number and percentage of the total enrolled in comprehensive managed care.\n\n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tThe \u201cTotal Medicaid Enrollment in Any Type of Managed Care: Number of Individuals\u201d column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM Entities.\n3.\tThe \u201cMedicaid Enrollment in Comprehensive Managed Care: Number of Individuals\u201d column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes individuals enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.\n4.\tTennessee\u2019s 2024 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d was used to populate \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d in Table 4.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type or does not have a managed care program.\n\nTen states (California, Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d but did not provide an explanation for why the number was greater.\n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of June 1, 2024, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.\t\n\n2023 Share of Medicaid Enrollees in Managed Care\n\nThe Share of Medicaid Enrollees in Managed Care table (Table 4 in the Enrollment Report) displays the total number of Medicaid enrollees nationally, and by state and territory, as well as the number and percentage of the total in any type of managed care, and the number and percentage of the total enrolled in comprehensive managed care.\n\n1.\tThe \u201cTotal Medicaid Enrollees\u201d column represents an unduplicated count of all enrollees in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing.\n2.\tThe \u201cTotal Medicaid Enrollment in Any Type of Managed Care: Number of Individuals\u201d column represents an unduplicated count of enrollees in any Medicaid managed care program, including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM Entities.\n3.\tThe \u201cMedicaid Enrollment in Comprehensive Managed Care: Number of Individuals\u201d column represents a count of Medicaid enrollees in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes individuals enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.\n4.\tTennessee\u2019s 2023 data submission indicated they were unable to provide an unduplicated count of enrollees in comprehensive MCO programs. Because Tennessee operates a comprehensive MCO program and a PACE program, their reported \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d was used to populate \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d in Table 4.\n\nNotes: \"--\" indicates the state or territory does not operate a specific program type or does not have a managed care program.\n\nNine states (Michigan, Minnesota, Missouri, New Jersey, Nevada, Ohio, Oregon, Virginia, Washington) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollment in Any Type of Managed Care\u201d but did not provide an explanation for why the number was greater. One of these states (Michigan) reported data for \u201cMedicaid Enrollment in Comprehensive Managed Care\u201d that was greater than \u201cTotal Medicaid Enrollees\u201d but did not provide an explanation for why the number was greater.\n\nAlaska, American Samoa, Connecticut, Guam, Northern Mariana Islands, and the U.S. Virgin Islands do not operate Medicaid managed care programs. For these states and territories, the \u201cTotal Medicaid Enrollees\u201d reported in this table is total Medicaid enrollment as of July 1, 2023, from the Medicaid Budget and Expenditure System, accessed on April 23, 2025. See https://data.medicaid.gov/dataset/6c114b2c-cb83-559b-832f-4d8b06d6c1b9/.",
"category": "Managed Care Programs",
"cadence": "Unknown",
"modified": "2026-02-12T13:25:00+00:00",
"download_url": "https://download.medicaid.gov/data/share-of-medicaid-enrollees-in-managed-care.2024-table5.csv",
"format": "csv",
"keywords": [
"Comprehensive Managed Care",
"Managed Care",
"Medicaid"
],
"theme": [
"Enrollment"
],
"notes": "Percentage of total Medicaid enrollment in managed care by state. Quick MC penetration metric.",
"relationships": [
{
"target_uuid": "52ed908b-0cb8-5dd2-846d-99d4af12b369",
"target_title": "Managed Care Enrollment Summary",
"join_key": "state + year",
"analysis": "MC penetration trends with absolute and relative enrollment"
}
],
"_category_conflict": {
"existing": "Managed Care Programs",
"classifier": "Enrollment"
}
},
{
"title": "Number and rate of NAS per 1,000 births in newborns whose deliveries were covered by Medicaid or CHIP, 2017 - 2021",
"identifier": "9c9ad0d1-c59b-4a25-9314-8e7e44e7f281",
"description": "This table presents the number of beneficiaries with NAS and the rate of neonatal abstinence syndrome per 1,000 newborns whose deliveries were covered by Medicaid or CHIP, 2017 - 2021.\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for identifying this population. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nData from Maryland, Tennessee, and Utah are omitted due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2024-01-05T18:31:22+00:00",
"download_url": "https://download.medicaid.gov/data/rate-of-nas-per-thous-in-newborns-2017-to-2021.csv",
"format": "csv",
"keywords": [
"Neonatal Abstinence Syndrome (NAS)",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Neonatal Abstinence Syndrome rates among Medicaid/CHIP-covered births by state. Key indicator of prenatal opioid exposure.",
"relationships": []
},
{
"title": "Number and rate of SMM among Medicaid- and CHIP-covered deliveries, 2017 - 2021",
"identifier": "a7cc2aff-8d01-4f68-9ef9-313693f90ce5",
"description": "This table presents the number of beneficiaries with a delivery, the number of beneficiaries with any SMM condition, and the rate of SMM conditions per 10,000 deliveries, 2017 - 2021.\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for identifying this population. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nData from Maryland, Tennessee, and Utah are omitted from the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2024-01-05T20:42:38+00:00",
"download_url": "https://download.medicaid.gov/data/num-rate-smm-med-chip-cov-deliveries-2017-to-2021.csv",
"format": "csv",
"keywords": [
"Maternal Health",
"Pregnancy",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Severe Maternal Morbidity rates among Medicaid/CHIP-covered deliveries by state. Tracks pregnancy complications.",
"relationships": []
},
{
"title": "Number of pregnant and postpartum Medicaid and CHIP beneficiaries, 2017-2021",
"identifier": "a4035a82-7433-4efb-985d-32a9ab8e5341",
"description": "This table presents the number of pregnant and postpartum Medicaid and CHIP beneficiaries, 2017-2021. It includes (1) the number and percentage of beneficiaries ever pregnant in the year; (2) the number and percentage of live births in the year; (3) the number and percentage of miscarriages, stillbirths, or terminations in the year; and (4) the number and percentage of births with an unknown delivery outcome in the year.\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues, making the data unusable for identifying this population. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nData from Maryland, Tennessee, and Utah are omitted from the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2024-01-05T18:30:59+00:00",
"download_url": "https://download.medicaid.gov/data/pregnent-postpartum-beneficiaries-2017to2021.csv",
"format": "csv",
"keywords": [
"Maternal Health",
"Pregnancy",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Longitudinal counts of pregnant/postpartum beneficiaries. Denominator for maternal health metrics.",
"relationships": []
},
{
"title": "Perinatal Care Services Provided to Medicaid and CHIP Beneficiaries ages 15 to 44",
"identifier": "ed67e610-aed3-4bed-842f-e6044511dd64",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of perinatal care, including prenatal visits, prenatal bundled payments, postpartum visits, and postpartum bundled payments, for female Medicaid and CHIP beneficiaries ages 15 to 44 (as of the first day of the month), by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating perinatal care measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2024-01-05T14:58:01+00:00",
"download_url": "https://download.medicaid.gov/data/Perinatal-Care-Services-Provided-to-MedicaidCHIP-Beneficiaries-ages-15-to-44.csv",
"format": "csv",
"keywords": [
"Perinatal Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "Prenatal and postpartum care utilization by state. Tracks adequacy of perinatal care.",
"relationships": []
},
{
"title": "Pregnancy Outcomes for Medicaid and CHIP Beneficiaries ages 15 to 44",
"identifier": "8dd46b48-f004-4245-a51d-a8d864ea586f",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of pregnancy outcomes, including (1) live births and (2) miscarriages, stillbirths, and terminations, for female Medicaid and CHIP beneficiaries ages 15 to 44 (as of the first day of the month), by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating pregnancy measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2024-01-05T15:03:12+00:00",
"download_url": "https://download.medicaid.gov/data/Pregnancy-Outcomes-for-MedicaidCHIP-Beneficiaries-ages-15-to-44.csv",
"format": "csv",
"keywords": [
"Pregnancy",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "Birth outcomes (live birth, stillbirth, miscarriage, abortion, ectopic) for Medicaid-covered pregnancies by state.",
"relationships": []
},
{
"title": "Prematurity and severe maternal morbidity among Medicaid- and CHIP-covered live births",
"identifier": "ee3b9534-0d19-4c1b-bf74-43f898d5de7c",
"description": "This data set includes annual counts and rates of Medicaid- and Children\u2019s Health Insurance Program (CHIP)-covered live-birth deliveries that were preterm or with a severe maternal morbidity (SMM) condition within six weeks before or after delivery. Results are shown overall; by state; and by four subpopulation topics: age group, race and ethnicity, disability-related eligibility category, and type of SMM condition (SMM category only). \nThese results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, who were ages 15 to 49 as of their delivery date, who were enrolled in Medicaid or CHIP at any point in the calendar year, and who had a live birth. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and select states with TAF data quality issues are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results for SMM are calculated per 10,000 Medicaid- and CHIP-covered live births. Results for states with TAF data quality issues in the year have a value of \"Unusable data.\" Some rows in the data set have a value of \"DS,\" which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services\u2019 Cell Suppression Policy for values between 1 and 10.\n\nThis data set is based on the brief: \"Prematurity and severe maternal morbidity among Medicaid- and CHIP-covered live births in 2021.\" Preterm birth is defined as a live birth that occurs before the 37th week of gestation. SMM deliveries are defined as live births with an SMM condition within six weeks before or after delivery (Identifying Severe Maternal Morbidity (SMM)). Enrollees are assigned to an age group subpopulation using age as of their delivery date. Enrollees are assigned to a race and ethnicity subpopulation using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG) (Race and ethnicity of the national Medicaid and CHIP population in 2020). Enrollees are assigned to a disability category subpopulation using their latest reported eligibility group code and age in the year (Medicaid enrollees who qualify for benefits based on disability in 2020). Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2025-01-17T15:41:00+00:00",
"download_url": "https://download.medicaid.gov/data/preterm-birth-and-smm-2020-2022-01172025.csv",
"format": "csv",
"keywords": [
"Medicaid",
"Children's Health Insurance Program (CHIP)",
"Maternal Health",
"Preterm Birth",
"Severe Maternal Morbidity",
"T-MSIS Analytic Files (TAF)"
],
"theme": [],
"notes": "Combined preterm birth and SMM rates. Summary maternal/infant risk indicator.",
"relationships": []
},
{
"title": "Rate of NAS per 1,000 births in newborns whose deliveries were covered by Medicaid or CHIP, 2017 - 2019",
"identifier": "0563d88c-8fe5-42a8-9d69-f67fd21c0e91",
"description": "This table presents the rate of neonatal abstinence syndrome per 1,000 newborns whose deliveries were covered by Medicaid or CHIP, 2017 - 2019.\n\nSome states have serious data quality issues, making the data unusable for identifying this population. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Data from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Values for Maryland were excluded due to unusable diagnosis codes in the IP file and the OT file in 2017. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2019. In addition, states with a high data quality concern on one or more measures are noted in the table with an asterisk (*). \n\nPlease refer to the DQ Atlas for more information about data quality assessment methods.",
"category": "Maternal & Child Health",
"cadence": "Unknown",
"modified": "2025-10-17T12:08:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/rate-of-nas-per-thous-in-newborns-2017-to-2019.csv",
"format": "csv",
"keywords": [
"Neonatal Abstinence Syndrome (NAS)",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Neonatal Abstinence Syndrome rates among Medicaid/CHIP-covered births by state. Key indicator of prenatal opioid exposure.",
"relationships": []
},
{
"title": "MMCC MCPAR PUF Data 2023",
"identifier": "69374797-d755-4903-bbe2-b84408501feb",
"description": "The Managed Care Program Annual Reports (MCPARs) provide data across key topics for each Medicaid managed care program. States are required to submit reports annually, aligning with state contract cycles (see 42 CFR 438.66(e)(1)).\nMCPAR PUF Read me 2023",
"category": "Other",
"cadence": "Unknown",
"modified": "2026-04-30T20:40:29+00:00",
"download_url": "https://download.medicaid.gov/data/mmcc-mcpar-puf-2023.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "",
"relationships": []
},
{
"title": "MMCC MCPAR PUF Data 2024",
"identifier": "66da70e7-228e-41aa-b041-6f9e433ff237",
"description": "The Managed Care Program Annual Reports (MCPARs) provide data across key topics for each Medicaid managed care program. States are required to submit reports annually, aligning with state contract cycles (see 42 CFR 438.66(e)(1)).\nMCPAR PUF Read me 2024\n\nTo view the previous performance year, please visit MCPAR PUF Data 2023.",
"category": "Other",
"cadence": "Unknown",
"modified": "2026-05-21T19:52:32+00:00",
"download_url": "https://download.medicaid.gov/data/mmcc-mcpar-puf-2024.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "",
"relationships": []
},
{
"title": "State Medicaid and CHIP- Map",
"identifier": "84922793-8c53-4e1a-8e4d-edf6d5e8bb3b",
"description": "Staging ",
"category": "Other",
"cadence": "Unknown",
"modified": "2026-08-28T16:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/pi-dataset-august-2026-release.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "",
"relationships": []
},
{
"title": "State Medicaid applications Test",
"identifier": "f4d28f75-63e5-4198-857f-6621afb23808",
"description": "Test",
"category": "Other",
"cadence": "Unknown",
"modified": "2026-05-20T14:37:00+00:00",
"download_url": "https://download.medicaid.gov/data/pi-dataset-may-2026-release.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "",
"relationships": []
},
{
"title": "2014 Child and Adult Health Care Quality Measures",
"identifier": "2b6a0ec0-efe6-5aec-9fe4-e168b8b6f553",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2014 reporting. Dataset contains both child and adult measures. Source: Mathematica analysis of FFY 2014 Child and Adult CARTS reports as of May 8, 2015, as published in the 2015 Secretary's Reports on the Quality of Care in Medicaid/CHIP.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2017-08-03T14:34:46+00:00",
"download_url": "https://download.medicaid.gov/data/2014-child-and-adult-health-care-quality-measures.7ycc-v6ew.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2015 Child and Adult Health Care Quality Measures",
"identifier": "45a28339-17a5-55e6-8e74-e9004fc703d8",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2015 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2015 reporting cycle. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2018-10-25T21:52:00+00:00",
"download_url": "https://download.medicaid.gov/data/2015-child-and-adult-health-care-quality-measures.7kj7-m9ih.csv",
"format": "csv",
"keywords": [
"Core Sets",
"Performance Rates",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2016 Child and Adult Health Care Quality Measures",
"identifier": "fc3c7c14-4b08-59c2-97db-0726e478dfdf",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2016 reporting.\n\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2016 reporting cycle. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2018-10-25T21:17:33+00:00",
"download_url": "https://download.medicaid.gov/data/2016-child-and-adult-health-care-quality-measures.vncf-b8xx.csv",
"format": "csv",
"keywords": [
"Core Sets",
"Performance Rates",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2017 Child and Adult Health Care Quality Measures",
"identifier": "c1028fdf-2e43-5d5e-990b-51ed03428625",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2017 reporting. Source: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2017 reporting cycle. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2019-08-05T17:33:44+00:00",
"download_url": "https://download.medicaid.gov/data/2017-child-and-adult-health-care-quality-measures.y7g4-qir6.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2018 Child and Adult Health Care Quality Measures",
"identifier": "229d6279-e614-5353-9226-f6a6f37d06c3",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2018 reporting.\n\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2018 reporting cycle. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2019-09-26T16:01:50+00:00",
"download_url": "https://download.medicaid.gov/data/2018-child-and-adult-health-care-quality-measures.2ir3-z9a8.csv",
"format": "csv",
"keywords": [
"Core Sets",
"Performance Rates",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2019 Child and Adult Health Care Quality Measures Quality",
"identifier": "e36d89c0-f62e-56d5-bc7e-b0adf89262b8",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2019 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2019 reporting cycle. Dataset revised October 2020. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2020-10-14T18:44:41+00:00",
"download_url": "https://download.medicaid.gov/data/2019-child-and-adult-health-care-quality-measures-quality.afrw-yks2.csv",
"format": "csv",
"keywords": [
"Core Sets",
"Performance Rates",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2020 Child and Adult Health Care Quality Measures Quality",
"identifier": "fbbe1734-b448-4e5a-bc94-3f8688534741",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2020 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2020 reporting cycle. Dataset revised September 2021. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2021-09-28T09:20:31+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2020-child-and-adult-health-care-quality-measures.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2021 Child and Adult Health Care Quality Measures Quality",
"identifier": "a058ef78-e18b-4435-94aa-b70ab6ce5904",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2021 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2021 reporting cycle. Dataset revised September 2023. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2023-09-11T14:26:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2021-child-and-adult-health-care-quality-measures_0.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2022 Child and Adult Health Care Quality Measures Quality",
"identifier": "dfd13757-d763-4f7a-9641-3f06ce21b4c6",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2022 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2022 reporting cycle. Dataset revised September 2023. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Annual",
"modified": "2023-09-11T14:18:29+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2022-child-and-adult-health-care-quality-measures_0.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2023 Child and Adult Health Care Quality Measures Quality",
"identifier": "e85033c7-367e-467e-9e81-8e85048102b8",
"description": "Performance rates on frequently reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for FFY 2023 reporting.\r\n\r\nSource: Mathematica analysis of MACPro and Form CMS-416 reports for the FFY 2023 reporting cycle. Dataset revised September 2024. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Unknown",
"modified": "2025-10-09T14:30:45+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2023-child-and-adult-health-care-quality-measures.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2024 Child and Adult Health Care Quality Measures Quality",
"identifier": "a5023394-ab10-465b-bb4a-7de5ac98d90c",
"description": "Performance rates on publicly reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for 2024 reporting.\r\n\r\nSources: Mathematica analysis of (1) Quality Measure Reporting (QMR) system reports, (2) Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data; and (3) National Core Indicators (NCI) data submitted by states to the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the Human Services Research Institute (HSRI) (The NCI National Team) through the Online Data Entry System (ODESA). Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS) analysis of the AHRQ CAHPS Database. Dataset revised September 2025. For more information, see the Children's Health Care Quality Measures and Adult Health Care Quality Measures webpages.",
"category": "Quality Measures",
"cadence": "Unknown",
"modified": "2025-09-22T14:26:03+00:00",
"download_url": "https://download.medicaid.gov/data/2024-child-and-adult-health-care-quality-measures.csv",
"format": "csv",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "Annual child and adult core set quality measure results by state. Covers preventive care, chronic disease management, and behavioral health measures.",
"relationships": []
},
{
"title": "2025 Child and Adult Health Care Quality Measures Quality",
"identifier": "14bc26c3-5584-4032-9175-f3a0399cb206",
"description": "Performance rates on publicly reported health care quality measures in the CMS Medicaid/CHIP Child and Adult Core Sets, for 2025 reporting.",
"category": "Quality Measures",
"cadence": "Unknown",
"modified": "2026-07-16T04:00:00+00:00",
"download_url": "https://data.medicaid.gov/sites/default/files/uploaded_resources/2025-child-and-adult-health-care-quality-measures.csv",
"format": "unknown",
"keywords": [
"Performance Rates",
"Core Sets",
"Quality Measures"
],
"theme": [
"Quality"
],
"notes": "",
"relationships": []
},
{
"title": "Medicaid and CHIP enrollees who received a well-child visit",
"identifier": "289182e5-44c8-4fcc-96c4-4af69be9863f",
"description": "This data set includes annual counts and percentages of Medicaid and Children\u2019s Health Insurance Program (CHIP) enrollees who received a well-child visit paid for by Medicaid or CHIP, overall and by five subpopulation topics: age group, race and ethnicity, urban or rural residence, program type, and primary language.\nThese results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, except where otherwise noted. Enrollees in Guam, American Samoa, and the Northern Mariana Islands are not included. Results include enrollees with comprehensive Medicaid or CHIP benefits for all 12 months of the year and who were younger than age 19 at the end of the calendar year. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. Some rows in the data set have a value of \"DS,\" which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services\u2019 Cell Suppression Policy for values between 1 and 10.\nThis data set is based on the brief: \"Medicaid and CHIP enrollees who received a well-child visit in 2020.\" Enrollees are identified as receiving a well-child visit in the year according to the Line 6 criteria in the Form CMS-416 reporting instructions. Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to a race and ethnicity subpopulation using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG) (Race and ethnicity of the national Medicaid and CHIP population in 2020). Enrollees are assigned to an urban or rural subpopulation based on the 2010 Rural-Urban Commuting Area (RUCA) code associated with their home or mailing address ZIP code in TAF (Rural Medicaid and CHIP enrollees in 2020). Enrollees are assigned to a program type subpopulation based on the CHIP code and eligibility group code that applies to the majority of their enrolled-months during the year (Medicaid-Only Enrollment; M-CHIP and S-CHIP Enrollment). Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.",
"category": "Quality Measures",
"cadence": "Unknown",
"modified": "2025-01-17T04:44:19+00:00",
"download_url": "https://download.medicaid.gov/data/well-child-visits-2020-2022-01162025.csv",
"format": "csv",
"keywords": [
"Medicaid",
"Children's Health Insurance Program (CHIP)",
"Well-Child Visits",
"T-MSIS Analytic Files (TAF)",
"Services",
"Early and Periodic Screening Diagnostic and Treatment (EPSDT)"
],
"theme": [],
"notes": "Well-child visit rates by state. Key pediatric preventive care quality measure.",
"relationships": []
},
{
"title": "NAM CAHPS 2014 Public Use",
"identifier": "2b18f2f7-d0f3-5efe-afc4-4881fcbdf200",
"description": "In fall 2014, the Center for Medicaid and CHIP Services (CMCS) conducted a Nationwide Adult Medicaid (NAM) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey of Medicaid enrollees to attain national and state-by-state measures of access, barriers to care, and experiences with care across delivery systems and major population subgroups. The survey interviewed a representative sample of adults ages 18 and older enrolled in Medicaid during October through December 2013.\nAdditional information, including a data dictionary and analysis guidance and downloadable SAS files are available on the NAM CAHPS webpage. Please note that all analyses must account for the survey\u2019s sample design and use weights and strata. Sample code is available in on the NAM CAHPS webpage.",
"category": "Quality Measures",
"cadence": "Unknown",
"modified": "2019-11-29T15:34:11+00:00",
"download_url": "https://download.medicaid.gov/data/nam-cahps-2014-public-use.dc57-m2ei.csv",
"format": "csv",
"keywords": [
"Medicaid"
],
"theme": [],
"notes": "National Adult Medicaid CAHPS survey results (2014). Beneficiary-reported experience of care.",
"relationships": []
},
{
"title": "Acute Care Services Provided to the Medicaid and CHIP Population",
"identifier": "d55e5ef5-9a2e-4d6c-884e-65a40a70756b",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of acute care services, including emergency department (ED) visits, inpatient stays, intensive care unit (ICU) stays, and ICU stays that include ventilator use, provided to Medicaid and CHIP beneficiaries, by state. Users can filter to acute care services for any reason, or acute care services for COVID-19. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating acute care services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T14:40:52+00:00",
"download_url": "https://download.medicaid.gov/data/Acute-Care-Services-Provided-to-the-MedicaidCHIP-Population.csv",
"format": "csv",
"keywords": [
"Acute Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "Monthly utilization counts for acute care (ED, inpatient, outpatient) by state from T-MSIS.",
"relationships": []
},
{
"title": "Behavioral Health Services\u00a0Provided to the Medicaid and CHIP Population",
"identifier": "f403f019-48f5-48f0-b0ce-c051cfe04a5e",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of behavioral health services, including emergency department services, inpatient services, intensive outpatient/partial hospitalizations, outpatient services, or services delivered through telehealth, provided to Medicaid and CHIP beneficiaries, by state. Users can filter by either mental health disorder or substance use disorder. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating behavioral health services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T14:43:09+00:00",
"download_url": "https://download.medicaid.gov/data/Behavioral-Health-Services-Provided-to-the-MedicaidCHIP-Population.csv",
"format": "csv",
"keywords": [
"Substance Use Disorder",
"Behavioral Health",
"Mental Health Disorder",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "",
"relationships": [
{
"target_uuid": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"target_title": "PI dataset",
"join_key": "state + month",
"analysis": "BH service intensity per enrollee by state"
}
]
},
{
"title": "Beneficiaries receiving a behavioral health service by behavioral health condition, 2017-2021",
"identifier": "bb4936ea-8adf-41a5-882b-786a0b3a8822",
"description": "This table presents beneficiaries who received at least one behavioral health service, by behavioral health condition, 2017-2021.\n\nSome states have serious data quality issues, making the data unusable for identifying this population. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional, Gender, Age, Zip code, Race and ethnicity, Eligibility group code, Enrollment in CMC Plans. \n\nData from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T17:45:02+00:00",
"download_url": "https://download.medicaid.gov/data/benf-recving-behav-health-serv-2017-2021.csv",
"format": "csv",
"keywords": [
"Behavioral Health Care",
"Integrated Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "BH service utilization broken out by condition type (depression, anxiety, SUD, SMI, etc.). Longitudinal 2017-2021.",
"relationships": []
},
{
"title": "Beneficiaries receiving a physical health service among beneficiaries receiving a SUD service by physical health cond, 2017-2021",
"identifier": "ac553cd4-63eb-44d4-9946-f29c0ccc1838",
"description": "This table presents beneficiaries who received a service for a physical health condition among beneficiaries who received a service for a substance use disorder, by physical health condition, 2017-2021.\n\nSome states have serious data quality issues, making the data unusable for identifying this population. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional, Gender, Age, Zip code, Race and ethnicity, Eligibility group code, Enrollment in CMC Plans. \n\nData from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T17:06:30+00:00",
"download_url": "https://download.medicaid.gov/data/benf-recvin-phys-health-among-ben-recv-sud-2017-2021.csv",
"format": "csv",
"keywords": [
"Substance Use Disorder Physical Health Condition",
"Behavioral Health Care",
"Integrated Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Physical health comorbidity patterns among SUD beneficiaries. Useful for integrated care analysis.",
"relationships": []
},
{
"title": "Beneficiaries receiving a physical hlth serv among beneficiaries receiving a mental hlth serv, by physical hlth cond, 2017-2021",
"identifier": "7db0e932-5275-4c3c-b4b6-8dc5f1520c3b",
"description": "This table presents beneficiaries who received a service for a physical health condition among beneficiaries who received a service for a mental health condition, by physical health condition, 2017-2021.\n\nSome states have serious data quality issues, making the data unusable for identifying this population. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional, Gender, Age, Zip code, Race and ethnicity, Eligibility group code, Enrollment in CMC Plans. \n\nData from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T17:47:01+00:00",
"download_url": "https://download.medicaid.gov/data/benf-rcving-phy-hlth-amg-ben-rcvin-mntl-hlth-serv-2017-2021.csv",
"format": "csv",
"keywords": [
"Mental Health Condition",
"Physical Health Condition",
"Behavioral Health Care",
"Integrated Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Physical health comorbidity patterns among mental health service users. Companion to the SUD version.",
"relationships": [],
"_category_conflict": {
"existing": "Service Utilization",
"classifier": "Other"
}
},
{
"title": "Beneficiaries who could benefit from integrated care, 2017-2021",
"identifier": "905e5046-5351-44e4-b65b-204bf684805c",
"description": "This table presents three populations of beneficiaries who could benefit from different levels of integrated care, 2017-2021: (1) beneficiaries who received services for a behavioral health (BH) condition; (2) beneficiaries who received services for a behavioral health condition who also received services for at least one of a number of select physical health (PH) conditions (a subset of population 1); and (3) beneficiaries prescribed medications for substance use disorders who do not have a medical claim for a behavioral health condition (a subset of population 1).\n\nSome states have serious data quality issues, making the data unusable for identifying this population. To assess data quality, analysts used measures featured in the DQ Atlas. Data for a state are considered unusable based on DQ Atlas thresholds for the following topics: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional, Gender, Age, Zip code, Race and ethnicity, Eligibility group code, Enrollment in CMC Plans. \n\nData from Maryland, Tennessee, and Utah are omitted for the tables due to data quality concerns. Maryland was excluded in 2017 due to unusable diagnosis codes in the IP file and the OT file. Tennessee was excluded due to unusable diagnosis codes in the IP file in 2017 - 2019. Utah was excluded due to unusable procedure codes on OT professional claims in 2017 - 2020. In addition, states with a high data quality concern on one or more measures are noted in the table in the \"Data Quality\" column. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. ",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T17:43:32+00:00",
"download_url": "https://download.medicaid.gov/data/benf-benft-frm-integr-care-2017-2021.csv",
"format": "csv",
"keywords": [
"Behavioral Health Care",
"Integrated Care",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Uncategorized"
],
"notes": "Estimates of beneficiaries with co-occurring physical and behavioral health conditions who would benefit from integrated care models.",
"relationships": []
},
{
"title": "Blood Lead Screening Services Provided to Medicaid and CHIP Beneficiaries Ages 1-2",
"identifier": "34fc0456-e28c-4762-91e1-49cd88462e7a",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of behavioral health services, including emergency department services, inpatient services, intensive outpatient/partial hospitalizations, outpatient services, or services delivered through telehealth, provided to Medicaid and CHIP beneficiaries, by state. Users can filter by either mental health disorder or substance use disorder. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating behavioral health services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2025-10-20T13:49:10+00:00",
"download_url": "https://download.medicaid.gov/data/Blood-Lead-Screening-Services-Provided-to-MedicaidCHIP-Beneficiaries-Ages-1-2-102025.csv",
"format": "csv",
"keywords": [
"Substance Use Disorder",
"Behavioral Health",
"Mental Health Disorder",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "Blood lead screening rates for ages 1-2 by state. Key EPSDT metric.",
"relationships": []
},
{
"title": "COVID Testing and Testing-Related Services Provided to Medicaid and CHIP Beneficiaries",
"identifier": "c1c4b0cf-c957-4b00-bcf4-c0905045a5b3",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of COVID-19 testing services provided to Medicaid and CHIP beneficiaries, by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating COVID-19 testing services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T14:54:21+00:00",
"download_url": "https://download.medicaid.gov/data/COVID-Testing-and-Testing-Related-Services-Provided-to-MedicaidCHIP-Beneficiaries.csv",
"format": "csv",
"keywords": [
"COVID-19",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "COVID-19 testing utilization by state from T-MSIS claims data.",
"relationships": []
},
{
"title": "Contraceptive Care Services Provided to Medicaid and CHIP Beneficiaries ages 15 to 44",
"identifier": "eb88943c-309d-440f-a2d5-ef93e066d83c",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of contraceptives, including any contraceptives and long-acting reversible contraceptives, provided to female Medicaid and CHIP beneficiaries ages 15 to 44 (as of the first day of the month), by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating contraceptive care services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T14:53:46+00:00",
"download_url": "https://download.medicaid.gov/data/Contraceptive-Care-Services-Provided-to-MedicaidCHIP-Beneficiaries-ages-15-to-44.csv",
"format": "csv",
"keywords": [
"Contraceptives",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "Contraceptive service utilization among reproductive-age Medicaid beneficiaries by state.",
"relationships": []
},
{
"title": "Dental Services Provided to Medicaid and CHIP Beneficiaries Under Age 19",
"identifier": "2aa0ed3d-6ef8-47a8-90b0-06b6d2fa3953",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of dental services provided to Medicaid and CHIP beneficiaries under the age of 19 (as of the first day of the month), by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating dental services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T15:46:02+00:00",
"download_url": "https://download.medicaid.gov/data/Dental-Services-Provided-to-MedicaidCHIP-Beneficiaries-Under-Age-19.csv",
"format": "csv",
"keywords": [
"Dental",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "Pediatric dental utilization by state. Any dental service and preventive dental visits separately.",
"relationships": []
},
{
"title": "Health Screenings Provided to Medicaid and CHIP Beneficiaries Under Age 19",
"identifier": "37b55242-7cd4-4818-b783-348adf39e50c",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of\u00a0health screenings provided to Medicaid and CHIP beneficiaries under the age of 19 (as of the first day of the month) by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating screening services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Diagnosis Codes - OT, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T14:54:00+00:00",
"download_url": "https://download.medicaid.gov/data/Health-Screenings-Provided-to-MedicaidCHIP-Beneficiaries-Under-Age-19.csv",
"format": "csv",
"keywords": [
"Screening",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "EPSDT and other preventive screening utilization for children by state.",
"relationships": []
},
{
"title": "Medicaid and CHIP enrollees who received mental health or SUD services",
"identifier": "8062e2f4-4c0a-41c9-8217-979468a80986",
"description": "This data set includes annual counts and percentages of Medicaid and Children\u2019s Health Insurance Program (CHIP) enrollees who received mental health (MH) or substance use disorder (SUD) services, overall and by six subpopulation topics: age group, sex or gender identity, race and ethnicity, urban or rural residence, eligibility category, and primary language.\nThese results were generated using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Release 1 data and the Race/Ethnicity Imputation Companion File. This data set includes Medicaid and CHIP enrollees in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, ages 12 to 64 at the end of the calendar year, who were not dually eligible for Medicare and were continuously enrolled with comprehensive benefits for 12 months, with no more than one gap in enrollment exceeding 45 days. Enrollees who received services for both an MH condition and SUD in the year are counted toward both condition categories. Enrollees in Guam, American Samoa, the Northern Mariana Islands, and select states with TAF data quality issues are not included. Results shown for the race and ethnicity subpopulation topic exclude enrollees in the U.S. Virgin Islands. Results shown for the primary language subpopulation topic exclude select states with data quality issues with the primary language variable in TAF. Some rows in the data set have a value of \"DS,\" which indicates that data were suppressed according to the Centers for Medicare & Medicaid Services\u2019 Cell Suppression Policy for values between 1 and 10.\nThis data set is based on the brief: \"Medicaid and CHIP enrollees who received mental health or SUD services in 2020.\" Enrollees are assigned to an age group subpopulation using age as of December 31st of the calendar year. Enrollees are assigned to a sex or gender identity subpopulation using their latest reported sex in the calendar year. Enrollees are assigned to a race and ethnicity subpopulation using the state-reported race and ethnicity information in TAF when it is available and of good quality; if it is missing or unreliable, race and ethnicity is indirectly estimated using an enhanced version of Bayesian Improved Surname Geocoding (BISG) (Race and ethnicity of the national Medicaid and CHIP population in 2020). Enrollees are assigned to an urban or rural subpopulation based on the 2010 Rural-Urban Commuting Area (RUCA) code associated with their home or mailing address ZIP code in TAF (Rural Medicaid and CHIP enrollees in 2020). Enrollees are assigned to an eligibility category subpopulation using their latest reported eligibility group code, CHIP code, and age in the calendar year. Enrollees are assigned to a primary language subpopulation based on their reported ISO language code in TAF (English/missing, Spanish, and all other language codes) (Primary Language). Please refer to the full brief for additional context about the methodology and detailed findings. Future updates to this data set will include more recent data years as the TAF data become available.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2025-01-17T04:48:55+00:00",
"download_url": "https://download.medicaid.gov/data/mh-and-sud-services-2020-2022-01162025.csv",
"format": "csv",
"keywords": [
"Medicaid",
"Children's Health Insurance Program (CHIP)",
"Mental Health Condition",
"Behavioral Health",
"Substance Use Disorder",
"T-MSIS Analytic Files (TAF)",
"Services"
],
"theme": [],
"notes": "High-level counts of BH service recipients by state. Simpler than the condition-level breakouts.",
"relationships": [],
"_category_conflict": {
"existing": "Service Utilization",
"classifier": "Other"
}
},
{
"title": "Respiratory Conditions in the Medicaid and CHIP Population",
"identifier": "ed35fa7f-279b-4d68-b624-b6ff32e956df",
"description": "This data set includes monthly counts and percentages of Medicaid and CHIP beneficiaries, by state, who received at least one service for each of the following conditions: acute bronchitis, acute respiratory distress, bronchitis not other specified (NOS), COVID-19 (based on the presence of diagnosis code U07.1), influenza, lower or acute respiratory infection, pneumonia, respiratory infection NOS, and suspected COVID-19 (based on the presence of diagnosis code B97.29).\n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating COVID-related conditions measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Claims Volume - IP, Diagnosis Code - IP, Diagnosis Code - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2025-10-20T12:00:00+00:00",
"download_url": "https://download.medicaid.gov/data/Respiratory-Conditions-in-the-MedicaidCHIP-Population10202025.csv",
"format": "csv",
"keywords": [
"COVID-19",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas"
],
"theme": [
"Uncategorized"
],
"notes": "Utilization related to respiratory conditions (asthma, COPD, respiratory infections) by state.",
"relationships": []
},
{
"title": "Telehealth Services Provided to the Medicaid and CHIP Population",
"identifier": "651fa253-4dd4-4867-8725-2b5ae1dd5ce9",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of\u00a0services provided via telehealth, including live audio video, remote patient monitoring, store and forward, and other telehealth, to Medicaid and CHIP beneficiaries, by state. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating telehealth services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - OT, Procedure Codes - OT Professional. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T15:04:11+00:00",
"download_url": "https://download.medicaid.gov/data/Telehealth-Services-Provided-to-the-MedicaidCHIP-Population.csv",
"format": "csv",
"keywords": [
"Telehealth",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "Telehealth utilization by state from T-MSIS. Tracks the post-COVID telehealth trajectory.",
"relationships": []
},
{
"title": "Vaccinations Provided to the Medicaid and CHIP Population under age 19",
"identifier": "43d419f9-f863-4f68-b622-311a8800100d",
"description": "This data set includes monthly counts and rates (per 1,000 beneficiaries) of vaccinations provided to Medicaid and CHIP beneficiaries under age 19 (as of the first day of the month), by state. The following vaccinations are included: Chickenpox, DTaP, HPV, Hepatitis A, Hepatitis B, Influenza, MMR, Meningococcal, Meningococcal B, Pneumococcal conjugate, Pneumococcal polysaccharide, Polio, Rotavirus, Tdap, and all vaccinations. \n\nThese metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating vaccination measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Procedure Codes - OT Professional, Claims Volume - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of \u201cDQ\u201d indicate that data were suppressed due to unusable data. \n\nSome cells have a value of \u201cDS\u201d. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.",
"category": "Service Utilization",
"cadence": "Unknown",
"modified": "2024-01-05T15:06:36+00:00",
"download_url": "https://download.medicaid.gov/data/Vaccinations-Provided-to-the-MedicaidCHIP-Population-under-age-19.csv",
"format": "csv",
"keywords": [
"Vaccination",
"Children's Health Insurance Program (CHIP)",
"Medicaid",
"T-MSIS Analytic Files (TAF)",
"DQ (Data Quality) Atlas",
"Services"
],
"theme": [
"Uncategorized"
],
"notes": "Pediatric vaccination rates by state from T-MSIS claims.",
"relationships": []
},
{
"title": "HealthCare.gov Marketplace Medicaid Unwinding Report",
"identifier": "9a83ba5e-05f5-47f5-82de-f3a59233a912",
"description": "Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using HealthCare.gov. As of August 2024, CMS is no longer releasing the \u201cHealthCare.gov\u201d metrics. Historical data between July 2023-July 2024 will remain available. The \u201cHealthCare.gov Transitions\u201d metrics, which are the CAA, 2023 required metrics, will continue to be released.
\nSources: HealthCare.gov application and policy data through May 5, 2024, and T-MSIS Analytic Files (TAF) through March 2024 (TAF version 7.1 with T-MSIS enrollment through the end of March 2024). Data include consumers in HealthCare.gov states where the first unwinding renewal cohort is due on or after the end of reporting month (state identification based on HealthCare.gov policy and application data). State data start being reported in the month when the state's first unwinding renewal cohort is due. April data include Arizona, Arkansas, Florida, Indiana, Iowa, Kansas, Nebraska, New Hampshire, Ohio, Oklahoma, South Dakota, Utah, West Virginia, and Wyoming. May data include the previous states and the following new states: Alaska, Delaware, Georgia, Hawaii, Montana, North Dakota, South Carolina, Texas, and Virginia. June data include the previous states and the following new states: Alabama, Illinois, Louisiana, Michigan, Missouri, Mississippi, North Carolina, Tennessee, and Wisconsin. July data include the previous states and Oregon. All HealthCare.gov states are included in this version of the report.
\nNotes: \n\n- This table includes Marketplace consumers who: 1) submitted a HealthCare.gov application on or after the start of each state\u2019s first reporting month; and 2) who can be linked to an enrollment record in TAF that shows Medicaid or CHIP enrollment between March 2023 and the latest reporting month.
\n- Cumulative counts show the number of unique consumers from the included population who had a Marketplace application submitted or a HealthCare.gov Marketplace policy on or after the start of each state\u2019s first reporting month through the latest reporting month. Net counts show the difference between the cumulative counts through a given reporting month and previous reporting months.
\n- The data used to produce the metrics are organized by week. Reporting months start on the first Monday of the month and end on the first Sunday of the next month when the last day of the reporting month is not a Sunday. For example, the April 2023 reporting period extends from Monday, April 3 through Sunday, April 30.
\n- Data are preliminary and will be restated over time to reflect consumers most recent HealthCare.gov status. Data may change as states resubmit T-MSIS data or data quality issues are identified.
\n- Data do not represent Marketplace consumers who had a confirmed Medicaid/CHIP loss. Future reporting will look at coverage transitions for people who lost Medicaid/CHIP.
\n- See the data and methodology documentation for a full description of the data sources, measure definitions, and general data limitations.
\n
\nData notes: \n- Virginia operated a Federally Facilitated Exchange (FFE) on the HealthCare.gov platform during 2023. In 2024, the state started operating a State Based Marketplace (SBM) platform. This table only includes data on 2023 applications and policies obtained through the HealthCare.gov Marketplace. Due to limited Marketplace activity on the HealthCare.gov platform in December 2023, data from December 2023 onward are excluded. The cumulative count and percentage for Virginia and the HealthCare.gov total reflect Virginia data from April 2023 through November 2023.
\n- The report may include negative 'net counts,' which reflect that there were cumulatively fewer counts from one month to the next.\n
\n- Wyoming has negative \u2018net counts\u2019 for most of its metrics in March 2024, including 'Marketplace Consumers with Previous Medicaid or CHIP Enrollment.' Negative counts reflect that there were cumulatively fewer individual counts from one month to the next. The net percentages have been replaced with an asterisk for March 2024 due to the uninterpretable values.\n
\n
\nPercentages shown are of total Marketplace consumers with previous Medicaid or CHIP enrollment.
\nSome cells have a value of \"NR\" or not reported. State data starts being reported in the month when the state's first unwinding renewal cohort is due.
\t\t\t\t\nAPTC: Advance Premium Tax Credit; CHIP: Children's Health Insurance Program; NR: Not reported; QHP: Qualified Health Plan",
"category": "Unwinding",
"cadence": "Unknown",
"modified": "2024-08-30T12:51:10+00:00",
"download_url": "https://download.medicaid.gov/data/healthcare.gov-data-july-2024-release.csv",
"format": "csv",
"keywords": [
"Marketplace",
"Coverage Transitions"
],
"theme": [
"Unwinding"
],
"notes": "Tracks Medicaid-to-Marketplace transitions during unwinding via HealthCare.gov states.",
"relationships": [
{
"target_uuid": "e6205a51-e6d7-4849-9882-4483b8a28c41",
"target_title": "Medicaid and CHIP Updated Renewal Outcomes",
"join_key": "state + period",
"analysis": "Coverage loss tracking: Medicaid disenrollment vs. Marketplace transitions"
}
]
},
{
"title": "HealthCare.gov Transitions Marketplace Medicaid Unwinding Report",
"identifier": "5636a78c-fe18-4229-aee1-e40fa910a8a0",
"description": "Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using HealthCare.gov.
\nSources: HealthCare.gov application and policy data through October 6, 2024, HealthCare.gov inbound account transfer data through November 7, 2024, and T-MSIS Analytic Files (TAF) through July 2024 (TAF version 7.1). The table includes states that use HealthCare.gov.
\nNotes: \n\n- This table includes Marketplace consumers who submitted a HealthCare.gov application from March 6, 2023 - October 6, 2024 or who had an inbound account transfer from April 3, 2023 - November 7, 2024, who can be linked to an enrollment record in TAF that shows a last day of Medicaid or CHIP enrollment from March 31, 2023 - July 31, 2024. Beneficiaries with a leaving event may have continuous coverage through another coverage source, including Medicaid or CHIP coverage in another state. However, a beneficiary that lost Medicaid or CHIP coverage and regained coverage in the same state must have a gap of at least 31 days or a full calendar month.
\n- This table includes Medicaid or CHIP beneficiaries with full benefits in the month they left Medicaid or CHIP coverage.
\n- \u2018Account Transfer Consumers Whose Medicaid or CHIP Coverage was Terminated\u2019 are consumers 1) whose full benefit Medicaid or CHIP coverage was terminated and 2) were sent by a state Medicaid or CHIP agency via secure electronic file to the HealthCare.gov Marketplace in a process referred to as an inbound account transfer either 2 months before or 4 months after they left Medicaid or CHIP. 'Marketplace Consumers Not on Account Transfer Whose Medicaid or CHIP Coverage was Terminated' are consumers 1) who applied at the HealthCare.gov Marketplace and 2) were not sent by a state Medicaid or CHIP agency via an inbound account transfer either 2 months before or 4 months after they left Medicaid or CHIP.
\n- Marketplace consumers counts are based on the month Medicaid or CHIP coverage was terminated for a beneficiary. Counts include all recent Marketplace activity.
\n- HealthCare.gov data are organized by week. Reporting months start on the first Monday of the month and end on the first Sunday of the next month when the last day of the reporting month is not a Sunday. HealthCare.gov data are through Sunday, October 6.
\n- Data are preliminary and will be restated over time to reflect consumers most recent HealthCare.gov status. Data may change as states resubmit T-MSIS data or data quality issues are identified.
\n- See the data and methodology documentation for a full description of the data sources, measure definitions, and general data limitations.
\n
\t\t\t\nData notes: \n- The percentages for the 'Marketplace Consumers Not on Account Transfer whose Medicaid or CHIP Coverage was Terminated' data record group are marked as not available (NA) because the full population of consumers without an account transfer was not available for this report.
\n- Virginia operated a Federally Facilitated Exchange (FFE) on the HealthCare.gov platform during 2023. In 2024, the state started operating a State Based Marketplace (SBM) platform. This table only includes data about 2023 applications and policies obtained through the HealthCare.gov Marketplace. Due to limited Marketplace activity on the HealthCare.gov platform in November 2023, data from November 2023 onward are excluded. The cumulative count and percentage for Virginia and the HealthCare.gov total reflect Virginia data from April 2023 through October 2023.
\t\n
\t\t\t\t\nAPTC: Advance Premium Tax Credit; CHIP: Children's Health Insurance Program; QHP: Qualified Health Plan; NA: Not Available",
"category": "Unwinding",
"cadence": "Unknown",
"modified": "2024-12-27T18:54:00+00:00",
"download_url": "https://download.medicaid.gov/data/healthcare.gov-transitions-data-december-2024-release.csv",
"format": "csv",
"keywords": [
"Marketplace",
"Coverage Transitions"
],
"theme": [
"Unwinding"
],
"notes": "Detailed transition data for HealthCare.gov states showing movement from Medicaid to QHP coverage.",
"relationships": []
},
{
"title": "Medicaid and CHIP CAA Reporting Metrics",
"identifier": "ebcfc16f-8291-4c61-82a4-055846d72f3a",
"description": "State-reported data on Medicaid and CHIP eligibility renewals conducted during the reporting period and call center operations\n
Sources:
(1) March and April 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of June 13, 2023. Florida's March and April 2023 Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of June 05, 2023. May 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of July 12, 2023. Florida's May 2023 Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of July 03, 2023. June 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of August 16, 2023. Florida's June 2023 Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of July 31, 2023. July 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of September 12, 2023. August 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of October 23, 2023. September 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of November 07, 2023. Delaware\u2019s September state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of November 28, 2023. October 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of December 05, 2023. November 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of January 05, 2024. December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of February 08, 2024. January 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of March 05, 2024. February 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of April 02, 2024. The total number of Medicaid and CHIP beneficiaries for whom a renewal was initiated in the reporting month (metric 4) for Idaho and Nebraska as of April 12, 2024. March 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of May 07, 2024. April 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of June 11, 2024. May 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of July 02, 2024. June 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of August 06, 2024. July 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report as of September 09, 2024. (2) Call Center Data from the Medicaid and CHIP Eligibility and Enrollment Performance Indicator Data as of September 10, 2024.
\t\nNotes: For all states, data may be affected by mitigation strategies in place, such as those related to ex parte functionality. Georgia reported data for individuals who continue to be eligible following a change in circumstances and were granted a new 12-month eligibility period during the April - July 2024 reporting periods, along with data on individuals due for renewal in these months. South Dakota did not initiate or complete renewals in the March - July 2024 reporting period due to a mitigation strategy for ex parte functionality. South Dakota did not initiate renewals in the February 2024 reporting period due to a mitigation strategy for ex parte functionality. Due to temporary renewal process changes, most renewals due in Iowa, including ex parte renewals, were not completed by the end of the reporting month for the December 2023 - February 2024 reporting periods. Hawaii and Vermont experienced a natural disaster, and the number of renewals initiated and completed in the reporting period were impacted due to the disaster response efforts in the month of August 2023. South Carolina does not have renewal outcomes to report in the month of July 2023. Massachusetts reports the dispositions of renewals completed in the reporting period. Therefore, the state is unable to report the number of pending renewals to CMS, and Massachusetts\u2019 data are excluded from the national totals for the May - July 2023 reporting periods. Vermont experienced a natural disaster, and the number of renewals initiated and completed in the July 2023 reporting period were impacted due to the disaster response efforts. Texas does not have renewal outcomes to report in the month of June 2023. For the May 2023 reporting period, Texas\u2019 renewal disposition data include actions completed after the end of the reporting period. For the April 2023 reporting period, Iowa's renewal disposition data include actions completed after the end of the reporting period. States report renewal outcomes for a cohort in the month renewals are scheduled for completion. States that held procedural terminations reflect these data in metric 5d as pending renewals along with renewals that were due but not completed by the end of the reporting period. See the Data Sources and Metrics Definitions Overview document for a full description of the metric definitions and how they relate to each other.
\nStarting in the February 2024 reporting period, state-specific data may vary depending on states' unwinding timelines. State-specific data may include both unwinding renewals, or renewals conducted following the end of the continuous enrollment condition, and \"regular\", or non-unwinding renewals.\n
Metric summation note: Total number of beneficiaries due for renewal in the reporting month (Metric 5) = Total number of beneficiaries due for renewal in the reporting month whose coverage was renewed (Metric 5a) + Total beneficiaries determined ineligible for Medicaid and CHIP based on the return of a renewal form (Metric 5b) + Total beneficiaries whose coverage was terminated for a procedural or administrative reason (Metric 5c) + Total number of beneficiaries due for renewal in the reporting month whose renewal was pending at the end of the month (Metric 5d); Total number of beneficiaries due for renewal in the reporting month whose coverage was renewed (Metric 5a) = Total beneficiaries renewed on an ex parte basis (i.e., based on available information) (Metric 5a1) + Total beneficiaries renewed based on the return of a renewal form (Metric 5a2).
\t\nData notes: \n(C1) Callbacks are included
\n(C2) Call centers offer callbacks
\n(C3) Does not include all calls received by call centers
\n(C4) Does not include all calls received after business hours
\n(C5) Includes calls for other benefit programs
\n(C6) Includes only calls transferred to a live agent
\n(C7) Includes state-based marketplace (SBM) data
\n(C8) New call center added in reporting period
\n(C9) Wait times for callbacks are included but reported separately from live calls
\n(C10) Does not operate a call center
\n(C11) Calls handled to completion by the automated system are counted as abandoned calls
\n(C12) Did not report data because of technical reasons
\n(C13) Wait time reflects time spent on hold after the call is answered by a live agent
\n(R1) Initiated two months' renewals due to delayed system modifications
\n(R2) Data do not reflect all Medicaid and CHIP enrollees with renewal actions in the reporting period
\n(R3) Reporting renewals at case level, as opposed to individual level
\n(R4) State held some or all procedural and/or other terminations for the report month
\n(R5) State implemented other mitigation strategies related to submission of renewal forms
\n(R6) Data reflect renewals and other eligibility and enrollment actions
\n(R7) Data represent Medicaid and CHIP enrollees whose renewal was completed in the reporting month \n rather than the cohort due for renewal in the reporting month
\n(R8) Data undercount renewals and reflect these outcomes in another metric in the data set
\n(R9) Data include renewals held and reassigned to a future month
\n(R10) State only processed renewals in the report month that could be completed on an ex parte basis\n
\nThis document includes Medicaid and CHIP data submitted to CMS by states regarding the number of renewals initiated and monthly renewal outcomes from the Unwinding Data Report and call center data from the Medicaid and CHIP Performance Indicator data set. These data include reporting metrics consistent with section 1902(tt)(1) of the Social Security Act and additional state-submitted renewal metrics.",
"category": "Unwinding",
"cadence": "Unknown",
"modified": "2024-10-31T17:25:00+00:00",
"download_url": "https://download.medicaid.gov/data/medicaid-chip-caa-reporting-metrics-long-table-october-2024-release.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Unwinding",
"Enrollment"
],
"notes": "State-reported metrics on renewal processing during the unwinding period. Covers renewals initiated, completed, and outcomes.",
"relationships": []
},
{
"title": "Medicaid and CHIP Updated Renewal Outcomes",
"identifier": "e6205a51-e6d7-4849-9882-4483b8a28c41",
"description": "State-reported data on Medicaid and CHIP eligibility renewals that reflect the outcomes of previously pending renewals three months after the renewal was due and also any corrections to the original renewal data submitted to CMS. See here for original renewal data.
\nCMS renewal data specifications require states to update and submit to CMS their monthly renewal outcome metrics - metric 5 data and its submetrics (monthly metrics 5a, 5a(1), 5a(2), 5b, 5c, and 5d) - after the original monthly report submission. The \u201cupdated\u201d renewal data reflect the outcomes of renewals previously reported as pending (monthly metric 5d of the original monthly report) as of three months after the renewal was due. For more information about this data set and considerations for users when reviewing, please see the Medicaid and CHIP Unwinding: Data Sources and Metrics Definitions Overview found here.\n
Sources:
(1) March 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in March 2023 as of June 2023. April 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in April 2023 as of July 2023. May 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in May 2023 as of August 2023. June 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in June 2023 as of September 2023. July 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in July 2023 as of October 2023. August 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in August 2023 as of November 2023. September 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 02, 2024, representing the updated disposition of renewals due in September 2023 as of December 2023. October 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 02, 2024, representing the updated disposition of renewals due in October 2023 as of January 2024. November 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on May 07, 2024, representing the updated disposition of renewals due in November 2023 as of February 2024. December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on June 11, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. New Hampshire\u2019s December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 09, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. New York\u2019s December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 22, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. January 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on July 02, 2024, representing the updated disposition of renewals due in January 2024 as of April 2024. February 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on August 06, 2024, representing the updated disposition of renewals due in February 2024 as of May 2024. March 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on September 09, 2024, representing the updated disposition of renewals due in March 2024 as of June 2024.
\t\nNotes: States report updated renewal outcomes for a cohort as of three months after the month renewals are scheduled for completion, unless otherwise noted. In the March 2023 \u2013 October 2023 reporting periods, Oklahoma included outcomes for some individuals who returned their renewal form during the reconsideration period. See the Data Sources and Definitions Overview document for a full description of the metric definitions and how they relate to each other.
\t\nApril 2023: Ohio reported updated renewal outcomes for the cohort as of 10/31/2023. Arkansas and Pennsylvania reported the eligibility status of the cohort, and data may include outcomes of eligibility actions that occurred after the renewal.
\nMay 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Ohio (outcomes as of 10/31/2023), Rhode Island (outcomes as of 11/1/2023), South Carolina (outcomes as of 12/20/2023), and Texas (outcomes as of 9/8/2023). Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nJune 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Kansas (outcomes as of 8/31/23), Minnesota (outcomes as of 12/2023), Ohio (outcomes as of 10/31/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 11/1/2023), and South Carolina (outcomes as of 12/20/2023). Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nJuly 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 12/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 11/1/2023), and Texas (outcomes as of 11/9/2023). California, Pennsylvania, and Rhode Island updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nAugust 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 12/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 12/4/2023), and South Carolina (outcomes as of 12/20/2023). California, Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nSeptember 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 1/8/2024), North Carolina (1/2/2024), Rhode Island (1/1/2024), and South Carolina (outcomes as of 1/8/2024). California, Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Vermont excluded renewal outcomes for some individuals who requested voluntary terminations or who were deceased.
\nOctober 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 2/12/2024), North Carolina (outcomes as of 2/1/2024), Rhode Island (outcomes as of 2/15/2024), and South Carolina (outcomes as 2/1/2024). California, Pennsylvania, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Rhode Island\u2019s updated data includes some individuals reported as pending whose renewal was completed.
\nNovember 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 3/4/2024), New York (outcomes as of 3/31/2024), North Carolina (outcomes as of 3/1/2024), Rhode Island (outcomes as of 4/1/2024), and South Carolina (outcomes as of 3/1/2024). Pennsylvania and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Rhode Island\u2019s updated data includes some individuals reported as pending whose renewal was completed. California included outcomes for some individuals whose eligibility was redetermined based on a change in circumstances after the renewal was processed.
\nDecember 2023: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 4/1/2024) and Minnesota (outcomes as of 4/2/2024). Pennsylvania updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. California included outcomes for some individuals whose eligibility was redetermined based on a change in circumstances after the renewal was processed.
\nJanuary 2024: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 5/1/2024) and Minnesota (outcomes as of 5/6/2024). Pennsylvania updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nFebruary 2024: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 6/3/2024) and Minnesota (outcomes as of 6/5/2024). Pennsylvania and Wyoming updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
\nMarch 2024: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 7/1/2024) and Texas (outcomes as of 7/1/2024). Pennsylvania and Wyoming updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.\n
Metric summation note: Total number of beneficiaries due for renewal in the reporting month (Metric 5) = Total number of beneficiaries due for renewal in the reporting month whose coverage was renewed (Metric 5a) + Total beneficiaries determined ineligible for Medicaid and CHIP based on the return of a renewal form (Metric 5b) + Total beneficiaries whose coverage was terminated for a procedural or administrative reason (Metric 5c) + Total number of beneficiaries due for renewal in the reporting month whose renewal was pending at the end of the month (Metric 5d); Total number of beneficiaries due for renewal in the reporting month whose coverage was renewed (Metric 5a) = Total beneficiaries renewed on an ex parte basis (i.e., based on available information) (Metric 5a1) + Total beneficiaries renewed based on the return of a renewal form (Metric 5a2).
\nThis document includes state updates to their monthly Medicaid and CHIP renewal outcome data submitted to CMS from the Unwinding Data Report. These data include updates to reporting metrics required under section 1902(tt)(1) of the Social Security Act and additional state-submitted renewal metrics.",
"category": "Unwinding",
"cadence": "Unknown",
"modified": "2024-11-01T00:05:00+00:00",
"download_url": "https://download.medicaid.gov/data/updated-renewal-outcomes-october-2024-releasefinal.csv",
"format": "csv",
"keywords": [
"Program Enrollment",
"Child Enrollment",
"Eligibility Determinations",
"Applications",
"Children's Health Insurance Program (CHIP)",
"Medicaid"
],
"theme": [
"Unwinding",
"Enrollment"
],
"notes": "Updated renewal outcome data showing procedural vs. eligibility-based disenrollment during unwinding.",
"relationships": [
{
"target_uuid": "50a46484-9a54-42d0-8da6-509a8b5656c0",
"target_title": "PI dataset",
"join_key": "state + month",
"analysis": "Unwinding disenrollment impact on total enrollment trends"
},
{
"target_uuid": "9a83ba5e-05f5-47f5-82de-f3a59233a912",
"target_title": "HealthCare.gov Marketplace Medicaid Unwinding Report",
"join_key": "state + period",
"analysis": "Coverage loss tracking: Medicaid disenrollment vs. Marketplace transitions"
}
]
},
{
"title": "State-based Marketplace (SBM) Medicaid Unwinding Report",
"identifier": "5670e72c-e44e-4282-ab67-4ebebaba3cbd",
"description": "Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using State-based Marketplaces (SBMs) that use their own eligibility and enrollment platforms
\nSource: State-based Marketplace (SBM) operational data submitted to CMS. Each monthly reporting period occurs during the first through last day of the reported month. SBMs report relevant Marketplace activity from April 2023 (when unwinding-related renewals were initiated in most SBMs) through the end of a state\u2019s Medicaid unwinding renewal period and processing timeline, which will vary by SBM. Some SBMs did not receive unwinding-related applications during reporting period months in April or May 2023 due to renewal processing timelines. SBMs that are no longer reporting Marketplace activity due to the completion of a state\u2019s Medicaid unwinding renewal period are marked as NA. Some SBMs may revise data from a prior month and thus this data may not align with that previously reported. For April, Idaho\u2019s reporting period was from February 1, 2023 to April 30, 2023.
\t\t\nNotes:\n\n- This table represents consumers whose Medicaid/CHIP coverage was denied or terminated following renewal and 1) whose applications were processed by an SBM through an integrated Medicaid, CHIP, and Marketplace eligibility system or 2) whose applications/information was sent by a state Medicaid or CHIP agency to an SBM through an account transfer process. Consumers who submitted applications to an SBM that can be matched to a Medicaid/CHIP record are also included. See the \"Data Sources and Metrics Definition Overview\" at http://www.medicaid.gov for a full description of the differences between the SBM operating systems and resulting data metrics, measure definitions, and general data limitations. As of the September 2023 report, this table was updated to differentiate between SBMs with an integrated Medicaid, CHIP, and Marketplace eligibility system and those with an account transfer process to better represent the percentage of QHP selections in relation to applicable consumers received and processed by the relevant SBM. State-specific variations are: \n- Maine\u2019s data and Nevada\u2019s April and May 2023 data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process. \n- Connecticut, Massachusetts, and Washington also report applications with consumers determined ineligible for Medicaid/CHIP due to procedural reasons.\n- Minnesota and New York report on eligibility and enrollment for their Basic Health Programs (BHP). Effective April 1, 2024, New York transitioned its BHP to a program operated under a section 1332 waiver, which expands eligibility to individuals with incomes up to 250% of FPL. As of the March 2024 data, New York reports on consumers with expanded eligibility and enrollment under the section 1332 waiver program in the BHP data.\n- Idaho\u2019s April data on consumers eligible for a QHP with financial assistance do not depict a direct correlation to consumers with a QHP selection.\n- Virginia transitioned from using the HealthCare.gov platform in Plan Year 2023 to an SBM using its own eligibility and enrollment platform in Plan Year 2024. Virginia's data are reported in the HealthCare.gov and HeathCare.gov Transitions Marketplace Medicaid Unwinding Reports through the end of 2024 and is available in SBM reports as of the April 2024 report. Virginia's SBM data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process, and as a result are not directly comparable to their data in the HealthCare.gov data reports.\n- Only SBMs with an automatic plan assignment process have and report automatic QHP selections. These SBMs make automatic plan assignments into a QHP for a subset of individuals and provide a notification of options regarding active selection of an alternative plan and/or, if applicable, making the first month\u2019s premium payment.
\n\n- SBMs report on all applicable applications received and not on the Medicaid-defined cohorts of individuals whose renewal is due in a given month. The data in this table are not cumulative and count unique Marketplace activities during the reporting period month in which the relevant activity occurs. As such, activities by any one consumer may be included across reporting months. For example, a consumer who submits an application and receives a determination of QHP eligibility may be counted in one month but his/her plan selection could be counted in a later month. Thus, the percentages do not necessarily depict a direct correlation to the count of consumers on applications received during the current reporting month. Total counts represent activity across the reporting months and are not cumulative as of the latest reporting month. Updated applications in the reporting month are only counted once. Updated applications in a following month may be counted again in that applicable month only if the consumer obtains a new Medicaid/CHIP renewal.
\n\n- SBMs have different operational processes and eligibility systems for handling QHP, Medicaid and CHIP eligibility determinations. While CMS works with SBMs to align the metric definitions across the Marketplaces there can be limitations and anomalies among the SBM data due to different SBM system capabilities. Additionally, variances in the data may be attributable to differences in how states are conducting unwinding renewals including processing timelines and whether states are staging applications for population cohorts (e.g., over age 65).
\t\nPercentages shown are of consumers on applications whose Medicaid/CHIP coverage was denied or terminated following renewal during the reporting period month.
\nPercentages shown are of consumers on account transfers whose Medicaid/CHIP coverage was denied or terminated following renewal during the reporting period month. The percentages for SBMs with integrated eligibility systems and the SBM Total - Integrated and SBM Total data record groups are marked as not available (NA) because SBMs with integrated eligibility systems do not receive account transfers. Additionally, some SBMs with account transfer processes adjusted, with guidance from CMS, the count of \"Consumers on Account Transfers Associated with a Medicaid/CHIP Coverage Denial or Termination Following Renewal\" to include all consumers on applications who are associated with a Medicaid/CHIP coverage denial or termination following renewal for purposes of calculating the Percent - Account Transfer data record group. For example, Pennsylvania conducts automatic QHP eligibility determinations for Marketplace plans for some account transfers and as of the December 2023 report, revised its data to report those consumers in the account transfer and application metrics. As of the April 2024 report, New Jersey revised its data to report consumers on account transfers and direct applications in the account transfer and application metrics to reflect overall SBM activity in the Percent - Account Transfer data record group.\n
APTC: Advance Premium Tax Credit; CHIP: Children's Health Insurance Program; QHP: Qualified Health Plan; BHP: Basic Health Program",
"category": "Unwinding",
"cadence": "Unknown",
"modified": "2024-12-27T18:51:00+00:00",
"download_url": "https://download.medicaid.gov/data/sbm-marketplace-december-2024-release.csv",
"format": "csv",
"keywords": [
"Marketplace",
"Coverage Transitions"
],
"theme": [
"Unwinding"
],
"notes": "Same as HealthCare.gov unwinding report but for state-based marketplace states.",
"relationships": []
},
{
"title": "NADAC",
"identifier": "c5bd69ae-7c98-4787-beb6-cb347ebf329f",
"description": "test",
"category": "Drug Pricing & Utilization",
"cadence": "Unknown",
"modified": "2022-04-05T18:51:24+00:00",
"download_url": "https://download.medicaid.gov/data/national-average-drug-acquisition-cost-04-06-2022.csv",
"format": "csv",
"keywords": [
"medicaid"
],
"theme": [],
"notes": "Current cumulative National Average Drug Acquisition Cost file. Pharmacy invoice-based pricing benchmark. Compare with SDUD reimbursement amounts to identify over/under-payment.",
"relationships": [
{
"target_uuid": "f7162680-b174-48b4-b3e3-3f0f735264ab",
"target_title": "SDUD",
"join_key": "NDC",
"analysis": "Drug acquisition cost vs. Medicaid reimbursement spread"
}
],
"_removed_from_source": true
},
{
"title": "Medicaid Enterprise System Datatable",
"identifier": "13a06cdb-6bbb-4f86-bba7-9d6f3db41090",
"description": "Medicaid Enterprise System Datatable",
"category": "Other",
"cadence": "Unknown",
"modified": "2025-05-21T17:30:00+00:00",
"download_url": "https://download.medicaid.gov/data/data-analysis-table-for-medcaid-05132025.csv",
"format": "csv",
"keywords": [
"medicaid"
],
"theme": [],
"notes": "Inventory of state Medicaid IT systems (MMIS, E&E, pharmacy, etc.) with vendor and module information.",
"relationships": [],
"_removed_from_source": true
}
]