There are several data and systems initiatives that can currently be accessed through Medicaid.gov. Browse our topic areas below to navigate to the information you need.

Medicaid Statistical Information System (MSIS)

The primary data sources for Medicaid statistical data are the Medicaid Statistical Information System (MSIS), the Medicaid Analytic eXtract (MAX) files, and the CMS-64 reports. MSIS is the basic source of state-submitted eligibility and claims data on the Medicaid population, their characteristics, utilization, and payments.

Medicaid Managed Care Enrollment Report

The Medicaid Managed Care Enrollment Report profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts as of July 1,2010.

Medicaid Information Technology Architecture (MITA)

The Medicaid Information Technology Architecture (MITA) is intended to foster integrated business and IT transformation across the Medicaid enterprise to improve the administration of the Medicaid program.

Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Since this program combines the Medicaid and Medicare programs, the information will remain on CMS.gov.

International Statistical Classification of Diseases and Related Heath Problems, 10th Revision (ICD-10)

The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The ICD-10 code sets are considered classification code sets and are an updated version of the ICD-9 code sets.

National Correct Coding Initiative

The National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and controls improper coding leading to inappropriate payments in Medicare Part B claims.

Medicaid Management Information System (MMIS)

The Medicaid Management Information System (MMIS) is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. For Medicaid purposes, the mechanized claims processing and information retrieval system which states are required to have, unless this requirement is waived by the Secretary, is the MMIS.

Medicaid Analytic eXtract (MAX)

The Medicaid Analytic eXtract (MAX) data – formerly known as State Medicaid Research Files (SMRFs) – are a set of person-level data files derived from MSIS data on Medicaid eligibility, service utilization and payments. The data are available for all states and the District of Columbia beginning with calendar year 1999. The data are available for selected states prior to 1999. These data are developed to support research and policy analysis initiatives for Medicaid and other low-income populations.

The MAX data for 1999 have been used to develop a series of research products related to pharmacy benefit use and reimbursement in Medicaid. These products include a Statistical Compendium of detailed statistics, by state; a Chartbook of Medicaid pharmacy benefit use and reimbursement; and a summary of major Medicaid pharmacy benefit features for 1999, by state.

CMS Reports

The CMS-64, CMS-37, and CMS-21 reports are products of the Medicaid and CHIP Budget and Expenditure Systems (MBES/CBES), the financial budget and grant systems. A more detailed description of these reports, along with summary data available as downloadable spreadsheet files, is available in other sections on this site. The Net Expenditure report is most likely the most comprehensive report generated by the MBES system.  In one file, we have data ranging from FY 1997 through FY 2001, while the other report captures data ranging from FY 2002 through FY 2011.  

Users of Medicaid data may note apparent inconsistencies which are primarily due to the difference in the information captured in MSIS, or the former HCFA-2082, versus CMS-64 reports. The most substantive difference is due to payments made to "disproportionate share hospitals." Disproportionate share hospitals receive higher Medicaid reimbursement than other hospitals because they treat a disproportionate share of Medicaid patients. States determine if hospitals meet the criteria to be considered a "disproportionate share hospital" and establish a formula used to calculate the amount of the payment, subject to certain minimum standards under the law. States claim the federal match for payments to disproportionate share hospitals on the CMS-64. States combine this claim either with other inpatient hospital services claims or with mental health facility claims. However, payments to disproportionate share hospitals do not appear in MSIS since states directly reimburse these hospitals and there is no fee-for-service billing.

Other less significant differences between MSIS and the CMS-64 occur because adjudicated claims data are used in MSIS versus the reporting of actual payments reflected in the CMS-64. Differences also may occur because of internal state practices for capturing and reporting these data through two separate systems. Finally, national totals for the CMS-64 are different because they include other jurisdictions, such as the Northern Mariana Islands, and American Samoa.

Additional information regarding the Medicaid program and Medicaid expenditures is available through the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation.