1. Enrollment includes both Medicaid-only and Medicare-Medicaid (“dual”) enrollees. For both types of enrollees, Medicaid covers LTSS. For dual enrollees, Medicaid may also cover Medicare cost-sharing for acute, primary care, and specialty services covered by Medicare, and other non-LTSS services that are not covered by Medicare.
2. Some comprehensive managed care programs enroll beneficiaries who may be at risk of needing LTSS but do not receive any LTSS. These counts only include individuals that receive LTSS. Moreover, states differ in their ability to report individuals who use MLTSS versus those who are enrolled (and may or may not be using LTSS). This table reports MLTSS users unless otherwise noted.
3. Comprehensive Managed Care Including LTSS does not include PACE programs.
4. MLTSS Only programs cover LTSS under capitation; acute, primary, and specialty care services for these enrollees may be covered by another Medicaid MCO, Medicaid FFS, or by Medicare for dual enrollees. These data include states that provide MLTSS plus other benefits in a package that does not include inpatient medical care.
5. The indicated territory was not able to supply data for this report. The Northern Mariana Islands reported that they have no Medicaid managed care enrollment, but they did not report total Medicaid enrollees.
6. Enrollment and user counts include both Medicaid-only enrollees and dually eligible individuals. For both types of enrollees, Medicaid covers LTSS. For dually eligible individuals, Medicaid may also cover Medicare cost-sharing for acute, primary care, and specialty services covered by Medicare, and other non-LTSS services that are not covered by Medicare.

Number of Managed Care Programs Enrolling Certain Populations on a Mandatory or Voluntary Basis at any point in 2016

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The Minimum Data Set (MDS) Frequency data summarizes health status indicators for active residents currently in nursing homes. The MDS is part of the Federally-mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. Care Area Assessments (CAAs) are part of this process, and provide the foundation upon which a resident's individual care plan is formulated. MDS assessments are completed for all residents in certified nursing homes, regardless of source of payment for the individual resident. MDS assessments are required for residents on admission to the nursing facility, periodically, and on discharge. All assessments are completed within specific guidelines and time frames. In most cases, participants in the assessment process are licensed health care professionals employed by the nursing home. MDS information is transmitted electronically by nursing homes to the national MDS database at CMS.

 

When reviewing the MDS 3.0 Frequency files, some common software programs e.g., ‘Microsoft Excel’ might inaccurately strip leading zeros from designated code values (i.e., "01" becomes "1") or misinterpret code ranges as dates (i.e., O0600 ranges such as 02-04 are misread as 04-Feb). As each piece of software is unique, if you encounter an issue when reading the CSV file of Frequency data, please open the file in a plain text editor such as ‘Notepad’ or ‘TextPad’ to review the underlying data, before reaching out to CMS for assistance.

The Medicaid by Drug dataset presents information on spending for covered outpatient drugs prescribed to beneficiaries enrolled in Medicaid by physicians and other healthcare professionals. 

 

The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. Units refer to the drug unit in the lowest dispensable amount. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications.

 

Drug spending metrics for Medicaid represent the total amount reimbursed by both Medicaid and non-Medicaid entities to pharmacies for the drug. Medicaid drug spending contains both the Federal and State reimbursement and is inclusive of any applicable dispensing fees. In addition, this total is not reduced or affected by Medicaid rebates paid to the states.

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