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Colorado’s Medicaid data on race and ethnicity deemed ‘poor’ quality by CMS

MM Curator summary

[MM Curator Summary]: The data can not be used for much; some call for a national survey to be done by CMS.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.





Boram Kim | Jun 2, 2022 | Colorado

CMS recently released its assessments of states’ Medicaid administrative data and Colorado is one of 17 states where race and ethnicity data were of “high concern” due to missing beneficiary information.




The agency reported that the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) race and ethnicity data were missing for more than 40% of beneficiaries in Colorado.


(Source: CMS –


CMS stated that these data were “unusable” in 5 other states and of “low concern” in 15 more.

The assessments were made based on the following criteria: (1) Percentage of beneficiaries missing race and/or ethnicity values in the T-MSIS Analytic Files (TAF) and (2) the number of race/ethnicity categories (out of 5) with a percentage point difference greater than 10 between the TAF and American Community Survey (ACS) data.

The Biden administration has made equity a central component of its policy agenda and health care disparities have been exacerbated and exposed by the pandemic.

Data on race and ethnicity for more than 90% of COVID-19 deaths reveals that the percentage of Hispanic or Latino, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native people who have died (red bars) is higher than the percentage of these racial and ethnic groups among the total US population (blue bars).


(Distribution of COVID-19 deaths and population distributions by race and ethnicity. Source: CDC)


This disparity is even greater when the percentages are age-standardized (adjusted for differences in the age distribution across racial and ethnic groups).

In Colorado, Hispanic or Latino (+1.73 distribution gap in COVID-19 deaths vs. population), non-Hispanic Black (also a +1.73 gap), and non-Hispanic American Indian or Alaska Native people (+4.8 gap) also have a disproportionate burden of COVID-19 deaths among specific age groups across the lifespan—children, youth, adults, and older adults. The distribution gap in percentage of COVID-19 deaths vs. population for non-white Hispanics was -1.35. 


“Because with COVID-19, we discovered that people who are Black and brown were exposed to a high percentage of deaths, just based on a variety of different circumstances. Maybe they’re frontline workers, maybe it’s because of the environment that they’re living in—condensed quarters and those kinds of things,” said Sen. Rhonda Fields (D – Aurora), Chair of the Senate Health & Human Services Committee, speaking to the importance of the Colorado Health Equity Plan during a State of Reform panel discussion in 2021. 

“We passed Senate Bill 181 to make sure that we create an equity lens and every department that reports to the governor, so that means labor, that means housing, that means public health, just everything everyone has to have a goal that addresses disparities as relates to health. So that’s important.” 


Medicaid enrollment forms pose race and ethnicity as optional fields for beneficiaries. Distrust over how agencies will use the information has prompted many enrollees to opt out of sharing this crucial health equity data.

Researchers at the University of Minnesota’s State Health Access Data Assistance Center have suggested three strategies to improve the country’s overall race and ethnicity data quality in the Medicaid program:

  • Communicate the importance of the data and how it will be used
  •  Work with community organizations to engage enrollees in improving data collection
  • Augment race and ethnicity data obtained via self-report with data from other sources such as vital records, EHRs, and other state-administered programs

According to a recent Health Affairs report, health policy experts suggest a national survey might be more effective at collecting better quality data and closing the gap on disparities.   


“A national Medicaid survey could help support more comprehensive monitoring of healthcare need relative to use, and if designed to oversample racial and ethnic minoritized populations, could also support more rigorous monitoring of quality of care and disparities within the program,” the report said.


CMS has not conducted a survey of Medicaid enrollees since 2014-2015, when the agency fielded its Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems (NAM CAHPS).

The authors suggest expanding on existing infrastructure and investing in a national survey would improve the evaluation and advancement of health equity in the Medicaid program. 


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Texas Medicaid subcontractor dumped after data breach

MM Curator summary

Accenture dropped a subcontractor in TX after hackers were able to defeat security measures and expose data for 274,000 members.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



A Texas Medicaid contractor ended its contract with its billing and collection services provider following a malware attack last year that exposed the protected health information of nearly 275,000 patients, according to a March 5 Dallas Morning News report.

Nine details:

1. Texas’ IT services company Accenture nixed its relationship with Houston-based Benefit Recovery Specialists Inc. in October.

2. In July 2020, BRSI notified 274,837 patients and health plan members of the malware attack. In notices BRSI posted on its website and sent to media organizations, the company did not mention Medicaid or Texas as the main affected entity, according to the report.

3. The Texas Health and Human Services Commission, which runs Medicaid, did not learn that 98.5 percent of the nearly 275,000 Americans potentially affected by the breach were Medicaid patients until it received questions about the breach from Dallas Morning News.

4. When first communicating the breach to the state last year, Accenture described a multistate incident involving healthcare providers and insurance billing and collections for more health plans than just Medicaid. This matched the same notifications BRSI made to the government and public last summer, according to the report.

5. A Texas Health and Human Services Commission spokesperson told the publication that Accenture did not make HHSC aware that most of the clients affected by the breach were Texas Medicaid patients. BRSI CEO Anthony Stegman told Dallas Morning News he has “no comment” on the situation.

6. An Accenture spokesperson told the publication that the data breach was handled in compliance with state and federal regulations and there was no withholding of relevant information from HHSC. The spokesperson added that early explanations of the incident may have been incomplete only because the company lacked a full view into BRSI’s affairs.

“We shared all relevant information provided to us by BRSI with our client, Texas HHSC, as we learned about the incident from BRSI,” the spokesperson said. “However, due to client confidentiality, BRSI did not share their other impacted clients with us, nor did they share with us what percentage of the impact was represented by Texas Medicaid. We also were not informed by BRSI regarding the overall impacted population.”

7. Between April 20 and April 30, 2020, hackers used accounts within BRSI’s systems and deployed a malicious computer program called Osiris banking Trojan to steal certain files from the BRSI network and execute Maze ransomware on multiple systems.

8. BRSI paid the ransom, but Accenture said it doesn’t know the monetary amount.

9. Accenture has a $1.45 billion, 73-month contract with the Texas HHSC to enroll providers, pay claims in the fee-for-service portion of Medicaid, and manage Texas Medicaid members’ data.


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Florida Medicaid website hacked for 7 years, hundreds of thousands affected

MM Curator summary


The website that hosts the application for multiple Florida Medicaid programs had a data vulnerability for 7 years that exposed personal identity and financial information.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


Tallahassee-based children Medicaid health plan Florida Healthy Kids Corp. began notifying members Jan. 27 of a 7-year data breach that exposed the personal information of hundreds of thousands of  health plan applicants. 

The health plan was notified Dec. 9 of the security breach  and launched an investigation, which found there had been “significant vulnerabilities” since 2013 on its website and databases that support the online children health insurance application. The vulnerabilities lasted from November 2013 to December 2020, when the health plan temporarily shut down its website. 

The health plan said it discovered that several thousand applicants’ information was inappropriately accessed and tampered with as a result of the breach. Information of applicants and enrollees that was exposed included Social Security numbers, dates of birth, names, addresses and financial information. 

During the time of the breach, Jelly Bean Communications Design was maintaining the health plan’s website and databases. The health plan said it is  speeding efforts to move the website to a new vendor. The health plan incorporates four programs that offer health insurance for children from birth to age 18: Medicaid, MediKids, Florida Healthy Kids and the Children’s Medical Services program, according to local CBS affiliate WPEC

The health plan said it has not confirmed that  personal information was removed from the system as a result of the incident and recommended  that individuals who applied for or enrolled with the health plan between November 2013 and December 2020 set up fraud alerts or security freezes. 


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Info of hundreds of Wisconsin Medicaid members may have been exposed

MM Curator summary

A data breach in Wisconsin may have revealed personal health information of 1,200 members.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



MADISON, Wis. (WBAY) – The personal information of hundreds of Wisconsin Medicaid participants may have been exposed.

Gainwell Technologies LLC has announced that an “unauthorized individual” gained access to an account on Oct. 29, 2020. The tech firm says that may have exposed names, member identification numbers and billing codes.

Gainwell provides services to the Wisconsin Department of Health Services Medicaid Program.

On Jan. 15, notifications were sent to 1,281 Wisconsin Medicaid members who may have had their information exposed.

These members are being offered free credit monitoring for one year.

The hack was discovered on Nov. 16. Gainwell says it has been working with DHS to prevent future incidents.


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Artificial intelligence machine was able to dupe

MM Curator summary

A bot submitted half the public comments on a proposed Medicaid program change.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Deepfake text manipulation has the power to throw governmental agencies off, a Harvard medical student has shown.

Public feedback is a crucial element of shaping and carrying out state and federal level programs. Your responses, as a civilian, inform how these governmental agencies go forward (or not) with policy decisions. At least, that’s what the idea of public feedback is based on. But deepfake text manipulation — just like deepfake videos and photos — has the ability to dupe even the smartest of observers, Wired reports.

A Harvard medical student named Max Weiss proved this in 2019. Back then, Idaho had plans to change its Medicaid program. It needed federal approval to do so, which required public input fed into The state government sought public responses and became Weiss’ little science experiment, in which he used an OpenAI program, GPT-2, to generate nearly-believable responses on the issue. Out of approximately 1,000 comments put into that round, half of them came from Weiss’ artificial intelligence machine. When he asked volunteers to differentiate between the real and fake ones, Wired says the volunteers “did no better than random guessing.”

The nightmare of automated responses — With its sophisticated and advanced language system, Weiss’ bot created responses that had no problem sneaking under’s radar.

It’s not a particularly difficult undertaking. The bot is repeatedly trained on human speech, phrasing, grammar, and syntax. It then tries to emulate that speech and create its own iterations in real-time. In response to the experiment of being duped by artificial intelligence, the Centers for Medicare and Medicaid Services assured the public that the agency had implemented security programs to block such manipulation.

The need for manipulated text-detection tools — Image and text generation by artificial intelligence can be hit or miss. Sometimes the results are odd and creepy (like this bot that took captions and tried to create photos from them). Other times, these experiments can lead to silly or cute results. But deepfake text manipulation opens a host of security and privacy threats for not only governments but also everyday internet users.

Automated text campaigns have caused headaches for the federal government even before Weiss. In 2017, the Federal Communications Commission found that more than a million responses sent over net neutrality weren’t real.

As these bots get more advanced with intensive training, cybersecurity analysts will have to work on manipulated text-detection tools and programs that can spot the real input from the fake entries. In the era of political misinformation that has led to mass polarization and people believing conspiracy theories, these agencies can’t afford the potential pitfalls of not getting out in front of this problem.


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Data Set Review- 2020 MACStats Data Book


While MACPA puts out a Medicaid and CHIP data book each year, this one is especially important because it is the first one to use the T-MSIS data. If you watch throughout the year, you will have seen much of the components of this compilation.

What’s in it

166 pages of charts and key statistics about all aspects of the Medicaid and CHIP programs, including data on:

  • Enrollment (including demographics trends)
  • Spending (health services and administrative)
  • Eligibility levels by state
  • Utilization

A detailed explanation of methodology used by the research team, including specifics on:

  • The use of the T-MSIS data
  • Adjustments for spending data
  • A section on understanding managed care enrollment and spending data

Data sources included

National Health Interview Survey (NHIS)

The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957. NHIS data on a broad range of health topics are collected through personal household interviews. Survey results have been instrumental in providing data to track health status, health care access, and progress toward achieving national health objectives.

The Medical Expenditure Panel Survey (MEPS)

The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.

Transformed Medicaid Statistical Information System (T-MSIS)

The T-MSIS data set contains:

  • Enhanced information about beneficiary eligibility
  • Beneficiary and provider enrollment
  • Service utilization
  • Claims and managed care data
  • Expenditure data for Medicaid and CHIP

Key implications of this data set

The trends section allows for some macro observations:

  1. The percent of Aged, blind or disabled members of the program was 28% in 1975. In 2018 it was 18%- giving credibility to the argument that the Medicaid program has experienced significant mission drift over the past 40 years or so.
  2. The financial burden of Medicaid on states has doubled in the past twenty years, despite unprecedented levels of federal funding under the Affordable Care Act enhanced reimbursement for Medicaid expansion. In 1992, states spent 10% of their own money on Medicaid (as a percent of their entire state budget). In other words, 1 out of every 10 state dollars went to Medicaid. In 2018, it was 20%. Meaning 1 out of every 5 state dollars now must be spent on Medicaid.
  3. While trending data is not provided, it is interesting to see the percentages of Medicaid funds spent by benefit type. In descending order:
    1. Fee for service / direct payments
      1. Facilities – 22.5%
        1. Hospitals (13%)
        2. LTSS (“nursing homes”)- Institutional (9.5%)
        3. Clinics and health centers (2%)
      2. Providers – 14%
        1. Physicians (1.3%)
        2. Dentists (0.007%)
        3. Other practitioners (0.003%)
        4. LTSS- Home and Community Based (13%)
      3. Other acute services (7%)
      4. Drugs (0.008%)
    2. Managed Care – 50%
    3. Medicare Premiums – 3%
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Georgia is not reporting adequate Medicaid, PeachCare data

MM Curator summary- Georgia has gone from reporting 75% of CMS program measures to only 25%.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

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ATLANTA — Nine years ago, Georgia reported ample data to the feds on the health care quality of its Medicaid and PeachCare programs.

In fact, a federal report at that time praised Georgia’s “proactive role in designing its data systems to support quality measurement.”

For seven more years, Georgia continued to be near the top of the data-reporting charts for what’s called the Core Set. It consistently submitted information about how its Medicaid program and its children’s health insurance, or CHIP program (known as PeachCare in Georgia), were delivering care.

No matter how well or poorly the state performed during those years, it submitted the data under the voluntary set-up.

But according to a Georgia Health News analysis, for the last two years, Georgia reported only a fraction of the information the federal Core Set requested.

Among the items not reported are rates of timely post-natal care, blood-sugar testing rates for diabetes, rates of patients using opioids at high doses, rates of hypertension control, and most mental health measures.

With 59 metrics, the Core Set aims to help states “monitor and improve the quality of health care” for Medicaid and CHIP plans, according to a 2018 press release from Seema Verma, administrator of the federal Centers for Medicare & Medicaid Services.

The Core Set is part of a push to improve transparency and accountability for states’ health insurance programs.

Medicaid and PeachCare cover about 2 million Georgians, mostly children. Those kids and some adults are part of a Georgia Families program that has been served by four insurance companies – Amerigroup, CareSource, Peach State and WellCare – which the government pays a total of $4 billion annually.

In 2011, the first year of the Core Set program, Georgia submitted the most performance measures of any state, 18 out of 24 requested.

For the latest data submission, GHN found that the state reported only eight of the 33 performance measures requested for adult measures, and just 13 of the 25 children’s measures.

When asked about the change in approach to reporting, Georgia’s Department of Community Health said the federal methodology was not sound because each state’s reporting method could vary.

States may use different methods in preparing the data, a weakness that the Core Set’s own documents acknowledge.

“In 2018, DCH reviewed the existing set of measures and determined that we needed a method that would allow us to benchmark ourselves to other Medicaid plans across the nation,” DCH Press Secretary Fiona Roberts said via email. “It was imperative that the benchmark was based on measures that were uniformly defined and populated for all Medicaid plans.”

Neighboring Southeastern states such as Alabama, South Carolina and Tennessee continue to lead in reporting the Core Set, while Georgia is now at the bottom of the data charts alongside Nebraska and South Dakota.

“Not reporting [the data] publicly, to me, is kind of a red flag,” David Machledt, senior policy analyst at the National Health Law Program, which aims to increase health care access, said. “Why should that not be open to public scrutiny?

“In general, almost every other state is on a trajectory where they’re reporting more measures [to the Core Set], not fewer, over time.”

Currently, reporting the federal core set is voluntary, although reporting all children’s health measures and adult mental health measures will become mandatory in 2024.

“If there are quality metrics that aren’t being met and we as the public can look and see where Georgia is falling short, we can hold our state decision-makers accountable,” Laura Colbert, executive director of the consumer advocacy group Georgians for a Healthy Future, said. “The greater the state reports, the better.”

Erica Fener Sitkoff, executive director of Voices for Georgia’s Children, an advocacy organization, said Medicaid and PeachCare cover half the children in the state.

“There needs to be some public accountability for the outcomes of those programs so that advocates, parents, and health care providers have visibility into how well they’re operating and can advocate for change,” Sitkoff said.

Jesse Weathington, executive director of the Georgia Quality Healthcare Association, an industry trade group, said that the four managed care companies “report reams of data on our performance to DCH on a consistent basis.”

Aside from the Core Set, DCH continues to publish performance data on its website each year, but the information is difficult to find. This year’s annual report on each of the four managed care companies included only 20 health indicators, compared to last year’s 49. These annual charts allow policymakers to view how each of the four companies delivered health care.

“For the 2019 reporting period, we reported on 20 measures total, 17 of which were Core Set measures,” Roberts said. “We are able to compare our performance on these measures to nationally recognized benchmarks and appropriately align them with internal performance efforts.”

The 2020 report omitted key data on lead exposure screening for children, opioid use, post-partum care, eye exams for diabetics, and hypertension control rates, among other indicators. Prior annual reports included easy-to-use comparative tables with star ratings based on national benchmarks for each of these health metrics.

This year the only way to find most of the data is by searching five different lengthy PDFs, found two-thirds of the way down the DCH’s Medicaid Quality webpage, and then compiling the data.

“Shining a light on where the program is meeting the mark and where it’s fallen short and still needs some improvement would actually be important for helping folks understand why the Medicaid program needs to exist,” said Colbert.

Georgia has cut from nine to three the number of maternal health care indicators it publishes in its internal Medicaid quality reports. Medicaid covers about half of births in Georgia, a state with a well-known maternal mortality crisis.

Georgia changed its approach to reporting Medicaid quality data within its own documents and to the federal government two years ago. Georgia’s most recent annual state reports published information on only three maternal health indicators:

♦ Timeliness of prenatal care;

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♦ Percentage of infants with low birthweight;

♦ Timeliness of post-natal care.

♦ The first two measures are featured in the state’s annual reports, but this year, for the first time, finding information about timeliness of post-natal care requires digging through five separate PDFs.

Missing entirely from the most recent annual reports are indicators the state formerly reported on, such as:

♦ Caesarean and elective delivery rates;

♦ Rates of mental health evaluation for pregnant women;

♦ Use of steroids during pregnancy;

♦ Frequency of post-partum care.

“These indicators that are no longer being publicly made available are really good at helping us figure out how we got there,” said Amber Mack, a research and policy analyst at Healthy Mothers, Healthy Babies Coalition of Georgia, referring to the state’s maternal mortality crisis.

Earlier this year, the state approved extending Medicaid coverage for low-income new mothers from two to six months after delivery.

“How are we going to track and see if timeliness of post-partum care has improved … especially compared to other states?” Mack said.

The maternal health measures Georgia does report show that the insurance companies delivering care to Medicaid and PeachCare members are behind national quality benchmarks for maternal care. The companies’ performance on timeliness of prenatal care ranks in the 49th percentile or below, according to a national health care quality measure the state uses.

The numbers the state reports to the federal Core Set also reflect a downward trend. The most recent report to the federal government stated that 67 percent of Georgia Medicaid members were getting timely prenatal care, in contrast to the 81 percent reported four years ago.

Georgia’s rates of low-birthweight deliveries appear to be rising, according to an analysis of the state’s data. The latest state data show the weighted average for the four companies at 9.45 percent, compared to 8.74 percent two years ago.

Only about two-thirds of Georgia mothers on Medicaid are getting timely post-natal care. For the first time this year, data on post-partum care was not included in the state annual report.

Asked why Georgia reported only two maternal health measures to the latest federal Core Set, Roberts said the agency is prioritizing prenatal care, which “provides a sizable opportunity to improve care for both the mother and the infant.”

“It is our hope that these upstream efforts will help to reduce the percentage of live births that weighed less than 2,500 grams [roughly 5 pounds 8 ounces],” Roberts said in her email.

Georgia has cut back on mental health reporting within its state reports. Georgia’s Core Set data left out at least 10 other mental health measures that neighboring states reported. The reduction in reporting is concerning because the state faces “a behavioral crisis for our children,” said Sitkoff of Voices for Georgia’s Children.

Alabama, Florida, Tennessee, South Carolina and North Carolina reported almost all mental health measures to the latest data set, while Georgia reported only on depression screening.

Georgia’s Core Set report did not include data about Medicaid and CHIP that most other states’ reports did, such as:

— Antidepressant medication management;

— Whether adults and children seen at hospitals for substance abuse or mental illness received timely follow-up;

— How many children are prescribed multiple antipsychotics at the same time;

— How many children get treatments such as counseling for behavioral health issues when they are also prescribed an antipsychotic drug;

— Opioid use rates.

In the mental health category, Georgia’s latest state and federal annual reports included data only on screening for depression in adults and children. Detailed mental health performance data is available on the DCH website, but it is split across five separate PDFs, in contrast to prior years. These separate reports lack national benchmarks.

Finding information about how state insurance plans provide care to people with diabetes is also more difficult this year. Georgia reported only one of six requested diabetes or weight-related measures to the federal Core Set.

The state’s annual reports also cut from 12 to two the diabetes health measures it presented. Though the additional information is available this year, it is difficult to find and lacks national benchmarks, in contrast with past reports.

The state did not report information to the feds about rates of blood-sugar testing this year, although last year’s report showed a testing rate of 66.6 percent, third-lowest in the nation.



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Tennessee Medicaid plan’s vendor mails PHI to wrong members, exposes 3,300 individuals’ info

MM Curator summary:

Tennessee reported a data breach for members that occurred when mailings were sent to the wrong address by Axis Direct.



The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




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TennCare, Tennessee’s state Medicaid health plan, recently notified 3,300 members that their protected health information may have been exposed due to a misaddressed mailing incident on behalf of its vendor, according to a Dec. 21 WKRN report. 

Gainwell, which runs the state’s Medicaid Management Information System, alerted TennCare of the breach in October. An investigation of the incident found that about 3,300 mailings sent out in late 2019 and 2020 may have been misaddressed and delivered to the wrong person. 

The mailings, managed by the state’s vendor Axis Direct, contained protected health information of TennCare members. In a statement to the network, Gainwell said it is not aware of any members’ personal information having been misused as a result of the incident. The state is now offering free credit monitoring to the impacted members. 

“TennCare is committed to safeguarding the information of our members. We have confidence in Gainwell and the process undertaken to identify the error that impacted certain members and correct it,” said TennCare Director Stephen Smith, according to the report. 


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2020 MACStats Released by MACPAC

MM Curator summary


The first MacPac data book with T-MSIS data is now available.



The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




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On December 16, 2020, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its annual MACStats: Medicaid and CHIP Data Book for 2020.  This document contains a wealth of information about the Medicaid and CHIP programs and it is the primary source of information about these two important public health insurance programs.  You can access MACStats here.

This is the first MACStats to derive information from the Transformed Medicaid Statistical Information System (T-MSIS).  CMS has worked with states for many years to transform the prior Medicaid Statistical Information System.  The new data set contains enhanced information about Medicaid eligibility; beneficiary and provider enrollment; service utilization; claims and managed care data; and expenditure data for the two programs.  As CMS noted in March of 2019, “access to high-quality, timely data is essential for ensuring robust monitoring and oversight of the Medicaid and CHIP programs.”  The T-MSIS data set contains that quality and timely data.

Want to know how many people were ever enrolled in Medicaid or CHIP in 2018?  The answer is 96.1 million, or 29.3% of the U.S. population (see Exhibit 1, page 3).  Want to know how much Florida Medicaid spent on disproportionate share hospital payments in 2019?  The answer is $236.8 million (see Exhibit 24, page 63).  Want to know how much the state of Maine spent on Medicaid benefits in 2019?  The answer is $2.9 billion (See Exhibit 23, page 60).  Want to know how much Massachusetts received in § 1115 waiver payments in 2019?  The answer is $831.2 million (see Exhibit 24, page 63).  Ever wondered what percentage of Wyoming residents receive their Medicaid benefits through managed care?  The answer is a minuscule 0.2%, as opposed to Tennessee’s 91.8%.  (see Exhibit 29, page 78).

All this and more is available in MACPAC’s helpful, detailed and thoughtful analysis of the Medicaid an CHIP programs.  The MACStats guidebook is a key data source for those who care about these important public health programs.



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Medicaid and CHIP enrollment grew 5.6% since last year


MM Curator summary


COVID and unemployment drove most of the 5.6% increase in the Medicaid rolls seen from July 2019 to July 2020. Early talks of a Medicaid bailout via an additional FMAP increase have begun.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.




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Enrollment in Medicaid and the Children’s Health Insurance Program increased by 5.6% from July 2019 to July 2020, according to the Medicaid and CHIP Payment and Access Commission on Wednesday.

The expert panel said the economic fallout of the COVID-19 pandemic drove most of the increase. All states saw their Medicaid rolls grow except Montana and the District of Columbia, ranging from 0.2% in South Carolina to 30.2% in Idaho, which expanded its Medicaid program in 2020.

“The COVID-19 pandemic and related unemployment have major implications for Medicaid and CHIP,” MACPAC Chair Melanie Bella said in a statement.

The Families First Coronavirus Response Act temporarily raised Medicaid’s federal matching percentage—FMAP—by 6.2% until the public health emergency ends, granting states some much-needed fiscal relief. But states can’t curb eligibility, disenroll beneficiaries or raise premiums if they want the additional federal money. They also must cover all COVID-19 testing and treatment costs and can’t force local governments to pay a higher share of the state’s nonfederal Medicaid spending.

With Medicaid enrollment on the rise and tax revenue slipping thanks to the pandemic, many states are slashing their Medicaid spending to balance their budgets. They’re increasingly turning to provider rate cuts to make the numbers work. Experts say another FMAP increase could protect beneficiaries’ access to care by enabling safety-net providers to keep their doors open. But Congress seems unlikely to boost the federal match for Medicaid anytime soon.

According to MACPAC, Medicaid accounted for 9.2% of the federal budget in 2019. Medicaid and MACPAC accounted for 16.9% of national health expenditures in 2020.

More than 40% of people enrolled in Medicaid and CHIP in 2018 had family incomes less than 100% of the federal poverty, according to new MACPAC data. Enrollees were more likely to have fair or poor health than people with private coverage or no insurance.

In addition, drug rebates lowered gross drug spending by more than half in 2019. Medicaid managed care plans made up over 63% of Medicaid’s gross spending on drugs.