SDRC

State Data
Resource Center

Resources for States Integrating Medicare and Medicaid Data

In 2011, CMS launched a process that permits state access to Medicare Parts A, B and D data in response to several state requests for claims information in order to improve how they manage care for dual eligible beneficiaries. Under this arrangement, the Medicare-Medicaid Coordination Office (MMCO) limited the State Medicaid Agency’s use of Medicare Parts A, B, and D data to care coordination purposes only.

At the end of FY 2014, CMS established a process to expand the permissible use of Medicare data provided to states for care coordination to include program integrity purposes. The data provide State Medicaid programs with Medicare claims information for dual coverage beneficiaries to prevent duplicate payments by Medicare and Medicaid as well as other overpayments such as Medicaid payment for home health services during Medicare-paid institutionalizations. CPI participation provides MMCO to manage state requests for access to Medicare data for program integrity purposes and provide technical assistance to states.

For more information, please visit the Center for Program Integrity website .