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Resources for States Integrating Medicare and Medicaid Data

Medicare-Medicaid Coordination Office - Advancing Care for People With Medicaid and Medicare

The Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office [MMCO]) serves people who are enrolled in both Medicare and Medicaid. MMCO's goal is to ensure that Medicare-Medicaid enrollees, also known as dual-eligible beneficiaries, have full access to seamless, high-quality healthcare and to make the system as cost-effective as possible.

MMCO works with the Medicaid and Medicare programs, and across federal agencies, states Medicaid agencies, and stakeholders to align and coordinate benefits between the two programs effectively and efficiently. MMCO also partners with states to develop new care models and improve the ways that dual-eligible beneficiaries receive healthcare.

Medicare Data Available to States

State Medicaid agencies may request timely access to certain Medicare data for Medicare-Medicaid enrollees to support care coordination. Having access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for dual eligible beneficiaries. Data that may be requested, subject to procedural limitations, are:

  • Medicare Parts A and B claims and Part D prescription drug event data;
  • Medicare Parts A, B, C, and D eligibility and enrollment data;
  • Assessments data including Minimum Data Set (MDS), Outcome and Assessment Information Set (OASIS), Swing Bed, and Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI); and
  • Medicare Provider and Analysis Review (MedPAR) and Medicaid Enrollee Supplemental File (MESF) data.

Additional information on MMCO can be found on the MMCO website .

For background information on the Medicare data available to states for care coordination for dual-eligible beneficiaries, please download the Access to Medicare Data to Coordinate Care for Dual-Eligible Beneficiaries memorandum.

Additional information on Medicare data available to states for care coordination for Medicare-Medicaid enrollees can be found at the Integrated Care Resource Center (ICRC) website .