SDRC

State Data
Resource Center

Resources for States Integrating Medicare and Medicaid Data

In 2011, the Centers for Medicare & Medicaid Services (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 to improve how they manage care for dual-eligible beneficiaries. Under this arrangement, the Medicare-Medicaid Coordination Office (MMCO) limited state Medicaid agency use of Medicare Parts A, B, and D data to care coordination purposes only.

At the end of fiscal year 2014, CMS established a process to expand the permissible use of the same Medicare data provided to states for care coordination to also include program integrity purposes. The data provide state Medicaid agencies with Medicare claims information for dual-eligible 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. The Center for Program Integrity (CPI) enables states to access Medicare data for program integrity purposes while receiving technical assistance from the State Data Resource Center (SDRC) Support Team and CMS.

For more information, please visit the CPI website .