SDRC

State Data
Resource Center

Resources for States Integrating Medicare and Medicaid Data

MMCO has established a free-of-charge process for state Medicaid agencies to request timely access to certain Medicare data to coordinate the care of Medicare-Medicaid enrollees and to help ensure the integrity of the state's Medicaid program.

A state Medicaid agency may request the following data, subject to procedural limitations:

  • 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.

These data include summary files, which contain summary-level information on Medicare beneficiary demographic and claims data, and claims/event/eligibility files, which contain information on the services paid for by Medicare as well as demographic and service-level identifiers. State Medicaid agencies can find additional information on Medicare data options for care coordination and program integrity in the document entitled, Requesting and Using Medicare Data for Medicare-Medicaid Care Coordination and Program Integrity: An Overview .

In addition to the document referenced above, there are a number of data resources available to state Medicaid agencies that explain the variables and layouts of these data. Learn More >

Additional Information

Additional information on coordinating care for Medicare-Medicaid enrollees can be found on the About Care Coordination for Medicare-Medicaid Enrollees page.

More information about CMS support of state program integrity activities can be found on the About Program Integrity page.