Medicaid Analytic eXtract (MAX) General Information

What’s New in September 2012!

• A new report is now available, titled “Reporting Person-Level Separate CHIP Data to MSIS: A Guide for States, Programmer's Supplement.”  This report is a programmer’s guide that provides detailed technical guidance regarding how to map separate CHIP enrollment and claims data from source systems into the MSIS format. We anticipate that states will find it helpful as they prepare to report Children’s Health Insurance Program data to CMS. It is available through the links in the “Downloads” section of the CHIP Reporting Technical Assistance page.

What’s New in August 2012!

• A new report is now available, titled “Should You Use Beta-MAX for Medicaid Research?”  This report compares Beta-MAX data with MAX data for 2009 for 32 states with available data. The report updates the assessment of the reliability of Beta-MAX data from the pilot study on six states released in 2010. We find that overall Beta-MAX data were generally consistent with MAX data on estimates of key enrollee populations, expenditures, and service utilization. One source of some small differences between the two files resulted from Beta-MAX data that included only four quarters of other (OT) claims files.  It is available through links in the “Downloads” section of the Beta-MAX page.

What’s New in July 2012!

• A new Issue Brief is now available, titled “Assessing the Usability of MAX 2008 Encounter Data for Enrollees in Comprehensive Managed Care.”  This issue brief provides an assessment of the selected other services (OT), inpatient (IP), and prescription drug (RX) encounter data for enrollees in comprehensive managed care during 2008. This issue brief summarizes the availability, completeness, quality and usability of the encounter data for comprehensive managed care enrollees by basis of eligibility (BOE) category as well as gives specific information by state. It also examines the changes in the IP and RX encounter data from 2007 to 2008.  The results are encouraging for researchers and policymakers. Most states that have comprehensive managed care plans are reporting IP, RX, and OT encounter data. Of those data, the majority are usable. The number of states submitting usable encounter data is increasing.  It is available through links in the “Downloads” section of the MAX Technical Assistance to States for Managed Care Encounter Data page or the Issue Briefs page.
  
• A new Issue Brief is now available, titled “Migration Patterns for Medicaid Enrollees, 2005-2007.”  This issue brief presents an analysis of the migration patterns of Medicaid enrollees by eligibility group and state over the period January 2005 through December 2007.  The analysis focuses on two major topic areas.  The first one is a national analysis of migration that examines the number of enrollees by the number of moves, the number of states to which enrollees moved and the number of moves associated with enrollment gaps of varying lengths.  The second one is a state analysis presented in two parts.  The first part includes in-migration, out-migration,  net migration, along with a comparison to overall U.S. population migration.  The second part examines the number of enrollees who moved, the number of moves, and enrollment gaps for moves between pairs of states.  It and the full report on which it is based are available through the links in the “Downloads” section of the MAXEM page. The issue brief is also available through the links in the “Downloads” section of the Issue Briefs page.

What’s New in June 2012!

• A new Issue Brief is now available, titled “Medicaid Enrollment Gaps, 2005-2007.”  The Medicaid program provides health insurance coverage every year to more than 60 million Americans spanning all ages.  Eligibility is based on both categorical factors and income. Each can change, resulting in a potential loss of eligibility for an enrollee.  Prior research has established that the loss of Medicaid coverage, whether temporary or permanent, has consequences for both the individual and the community.  In this issue brief, which is based on a larger report, we use data from a source—Medicaid administrative records that have been unduplicated and linked over time—to investigate discontinuities in Medicaid enrollment by eligibility group over the period January 2005 through December 2007.  We focus on two areas:  (1) continuity of coverage and (2) the duration of enrollment gaps.  The Issue Brief and the full report on which it is based are available through links in the “Downloads” section of the MAXEM page. The Issue Brief is also available through the link on the Medicaid Issue Briefs page.
  
• A new guide is now available titled, “Reporting Person-Level Separate CHIP Data to MSIS: A Guide for States.”  There is a growing need for separate CHIP (S-CHIP) program data to examine program transitions, access to services, and quality of care, among other priorities.  However, standardized person-level data for separate CHIP programs has never been available at the national level.  Mathematica Policy Research, under contract with CMS, has been providing technical assistance to states to report S-CHIP data.  Seven states are now reporting this data.  This guide describes for state stakeholders the steps for successfully planning and implementing CHIP data reporting.  It is available through the links in the “Downloads” section of the Technical Assistance to States for separate Children’s Health Insurance Program (S-CHIP) Data page.  
  
• MAX 2009 data are now available for a total of 34 states; all states except for Arizona, District of Columbia, Hawaii, Idaho, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New York, North Dakota, Oklahoma, Rhode Island, Utah, Washington and Wisconsin.  In the “Downloads” section under “MAX Data 2005 and Later – General Information, Data Dictionaries, Data Element Lists, Data Anomalies, Validation Table Measures and SAS Loads,” please see the file “2009Files.zip” for detailed documentation.

What’s New in April and early May 2012!

• The MAX 2008 Medicaid Pharmacy Benefit Use and Reimbursement Chartbook and Compendium Tables are now available.  Please see the “Downloads” section of the Medicaid Pharmacy Benefit Use and Reimbursement – Introduction and Chartbooks Page for access to the Chartbook.   Please click Medicaid Analytic Rx eXtract (MAX Rx) Table Listing  for access to the compendium tables.
  
• The first version of the MAX managed care crosswalks is now available to accompany MAX 2009 data.  The managed care crosswalks provide information on each managed care plan:  Plan ID reported in MAX 2009, Plan Name (if available) and whether MAX 2009 included enrollment, capitation, and encounter payments with the Plan ID. The crosswalks include a summary table with reporting by type of plan across all states as well as state-specific crosswalks. The MAX crosswalks include comprehensive managed care (Plan Type 01 and 06) and pre-paid health plans (PHPs) (Plan Types 2-5, 8).  The crosswalks can be found by going to the “Downloads” section below, clicking on “MAX Data 2005 and Later” and opening the zipped file “2009Files.zip”.
  
• A new Issue Brief is now available, titled “Movement of Children between Medicaid and CHIP, 2005 to 2007”.  The Children’s Health Insurance Program (CHIP) provides health insurance coverage to millions of children whose families are unable to obtain employer-sponsored insurance or purchase private non-group coverage but whose incomes are above the limits that would qualify their children for Medicaid.  Family incomes are fluid, however, and many children who receive coverage through CHIP were covered by Medicaid earlier or will shift their coverage to Medicaid later.  This issue brief uses data from a source—Medicaid administrative records that have been unduplicated and linked over time—to examine the movement of children between Medicaid and CHIP from 2005 through 2007.  These findings provide perspective on potential transitions in coverage among low-income adults once the Affordable Care Act is fully implemented.  The Issue Brief and the full report on which it is based are available through links in the “Downloads” section of the MAXEM page. The Issue Brief is also available through the link on the Issue Briefs page.
  
• A new Issue Brief is now available, titled “Assessing the Usability of the MAX 2007 Inpatient and Prescription Encounter Data for Enrollees in Comprehensive Managed Care”.  As growing numbers of Medicaid enrollees receive health benefits through comprehensive managed care, the researchers and policymakers seeking to understand the service use of these enrollees must rely on encounter data that states receive from managed care plans.  Although encounter data provide insight into the service use of comprehensive managed care enrollees, not all states report encounter data, and little is known about the data’s usability.  This issue brief summarizes the availability, completeness, quality and usability of the MAX encounter data for comprehensive managed care enrollees in 2007 by basis of eligibility (BOE) category as well as gives specific information by state. The results are encouraging. Most states that have comprehensive managed care plans are reporting IP and RX encounter data. Of those data, the majority are usable. It is available through links in the “Downloads” section of the Technical Assistance to States for Managed Care Encounter Data page or at the Issue Briefs page.
  
• A new report is available on the MAX and MCBS survey linkage activities.  In the report, we detail the method used to link Medicare survey data from the Medicare Current Beneficiary Survey (MCBS) with Medicaid administrative data from the Medicaid Analytic eXtract (MAX) files, and assess the quality of the linked MCBS-MAX records. Although the MCBS contains information on all services covered by Medicare, it does not contain any information on benefits—particularly long-term care services—that are covered only by Medicaid. And although we can see service usage in MAX, the only health status information available in the data is based on the diagnosis codes for Medicaid-financed services. MCBS has information on the health conditions, health-related behaviors, and health status of enrollees, such as activities of daily living (ADLs) and instrumental activities of daily living (IADLs).  By linking the MCBS and MAX data, researchers can obtain a more complete picture of total Medicare and Medicaid expenditures for and service utilization by dually-enrolled beneficiaries, and get valuable insight into the health status of these dual enrollees.  It is available through a link in the “Downloads” section of MAX and Survey Linkages page. 
  
• A new report is available that evaluates the MAX Provider Characteristics (MAXPC) data.  In the report, we describe the motivation for creating the MAXPC file. We also describe its design and content and examine the quality and completeness of each of the six types of provider IDs in each of the 37 states. The quality and completeness varies substantially by state and by type of provider ID.

It is available through a link in the “Downloads” section of MAX Provider Characteristics page.  

• Additional documentation is available for the MAXPC 2009 data, including validation table specifications, SAS load statement, an updated data dictionary and updated validation tables.  This documentation is available through a link titled “General Information” in the “Downloads” section of the MAX Provider Characteristics page. 
  
• The first version of Mini-MAX is now available.  Mini-MAX is a five percent cross-sectional national sample of the MAX files.  The sample is stratified by 51 states and by basis of eligibility (aged, disabled, children, and adults) among full beneficiaries and separately for restricted beneficiaries. We oversampled smaller states and smaller subpopulations to increase the precision of their estimates.  We removed variables that were less commonly used, redundant, or unreliable to reduce the file size.  By reducing the volume of the data, we hope to expand the community of individuals capable of conducting Medicaid research.  Because Medicaid data can be challenging to understand and use, we created a Mini-MAX User’s Guide, which provides background information and practical guidance for conducting analyses with the Mini-MAX file.  The User’s Guide is available through a link in the “Downloads” section of the Mini-MAX – Medicaid Sample page. 

Highlights: The first Medicaid/CHIP Environmental Scanning and Program Characteristics (ESPC) database in Access format and accompanying User guide is now available.  Follow link in the "Related Links Inside CMS" below.

What's New in March 2012!

• Reporting of National Provider Identifiers (NPIs) in MSIS service records began in Fiscal 2009 which has made it feasible to begin production of a data set on Medicaid provider characteristics, known as the MAX Provider Characteristics (MAXPC) data. The first year of MAXPC production is 2009. MAXPC 2009 data are now available for 37 of the 51 Medicaid jurisdictions except the District of Columbia, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Hampshire, New York, North Dakota, Oklahoma, Pennsylvania, Utah, Washington and Wisconsin. These data are now available to all interested parties on this site. Please see the link within the box on the left side of this page "MAX Provider Characteristics".

What's New in February 2012!

• A new MAX Chartbook has just been released containing data for 2008. For those who are familiar with the two prior chartbooks in this series, the first six chapters of the new chartbook are comparable to those of the prior chartbooks. This new chartbook also includes a new chapter (Chapter 7) on Medicaid waiver enrollment and utilization. Please see the link within the box on the left side of this page "Medicaid Analytic eXtract (MAX) Chartbooks".
  
• The MAX Data of Death (DOD) auxiliary file for 2008 and the accompanying report are now available. For 2008, the MAX DOD auxiliary file is a single file that contains a record for each person in the MAX PS files 1999–2008 for all 51 states that linked to SSA DMF and had a non-missing date of death. It includes deaths, as reported in the DMF through October 29, 2011, even if those dates of death occurred after December 31, 2008. Please see the link within the box on the left side of this page "MAX DOD".

What's New in the Fall of 2011!

• MAX 2008 data are now available for all states. Please see the MAX availability document in the "Downloads" section under "MAX Data 2005 and later".
  
• A new Medicaid Issue Brief has been released titled, "Prescription Drug Use and Cost Among Medicaid Beneficiaries with Disabilities and Chronic Illness." This Issue Brief is available on the Mathematica Policy Research, Inc. website. A link to that web page is located below in the "Related Links Outside CMS" section.
  
• A new report has been released titled, "Collecting, Using, and Reporting Medicaid Encounter Data: A Primer for States." Please see the link "Technical Assistance to States for Managed Care Encounter Data"' within the box on the left side of this page.
  
• MAX 1999-2007 has now been linked to selected records from surveys administered by the National Center for Health Statistics (NCHS). Surveys included in the new linked data files include the 1994-2005 National Health Insurance Survey (NHIS), the 1999-2004 National Health and Nutrition Examination Survey (NHANES), and the 2004 National Nursing Home Study (NNHS). Please see the link "MAX and NCHS Survey Linkage" within the box on the left side of this page. For additional information, including instructions for requesting access to the linked files, see the NCHS website in the "Related Links Outside CMS" section below.
  
• New "Frequently Asked Questions" have been added on the following topics:

Accuracy of date of death reporting in Medicaid,

Availability of information on living arrangements for Medicaid and CHIP enrollees,

Availability of Medicaid provider characteristics data

Availability of data on CHIP enrollees

Information on Medicaid and CHIP program characteristics

Medicaid enrollees with Restricted Benefits

Identifying types of dual enrollees (Medicare and Medicaid)

Identifying American Indian or Alaskan Native (AIAN) enrollees

Efforts to identify enrollee duplication and un-duplicate enrollees

Work to provide an early-release version of MAX, known as Beta-MAX

The difference between inpatient hospital stays and discharges in MAX

Please see the first link in "Related Links within CMS" below.

Description

The Medicaid Analytic eXtract (MAX) data is a set of person-level data files on Medicaid eligibility, service utilization, and payments. The MAX data are created to support research and policy analysis. The MAX data are extracted from the Medicaid Statistical Information System (MSIS). The MAX development process combines MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events. Unlike fiscal-based MSIS quarterly files, MAX data are organized into annual calendar year files. There are a number of other "value added" enhancements to the MAX data for users as described below.

Availability

MAX data are derived from MSIS, and because it is necessary to allow for the delay between service delivery dates and claims adjudication dates, the availability of MAX data for a particular time period lags behind that of the MSIS data.

Since the MAX data contain individually identifiable data, they are protected under the Privacy Act. They are available for approved research activities only through a Data Use Agreement (DUA) with the Centers for Medicare & Medicaid Services (CMS). Note that only approved academic research projects and certain government agencies are entitled to a DUA to obtain MAX data. For help in preparing data requests (including DUAs), technical assistance with the data or to report data problems, please contact the Research Data Assistance Center (ResDAC) Help Desk, toll-free at 888-973-7322. You may also reach the ResDAC staff  via the web at www.resdac.umn.edu, via email at resdac@umn.edu or via FAX at 612-378-4866.  For further information on applying for a DUA, see the "Related Links" at the bottom of this page.

Introduction

An "Introduction to Medicaid Analytic eXtract (MAX) Data" is available via the download listed at the bottom of this page. The presentation should answer a number of basic questions about MAX, in that it:

• Presents the source and an overview of MAX data;
• Describes five types of MAX data sets;
• Explains the need for MAX data;
• Reviews a number of MAX data enhancements for Eligibility, Service use and payment;
• Provides linkages to other data sources;
• Describes related MAX data products; and
• Identifies Medicaid data limitations.

Medicaid Analytic eXtract (MAX) Data Element Dictionary Changes 2005 to 2009

The MAX data dictionaries have been changed after 2004 to include new data elements that are being collected through MSIS and new data elements that have been added to MAX:

New Eligibility Data Elements

• Improved verification of Social Security Numbers (SSNs)
• Expanded detail on enrollee race and ethnicity
• Monthly dual Medicare and Medicaid enrollment (earlier years were reported quarterly)
• Waiver plan identifier and waiver type enrollment in up to three waivers per month
• Enrollment in 1915(c) waivers on an annual basis

New Service Data Elements

• Expenditures for 21 categories of community-based long-term care
• National Provider Identifier (available in 2009)
• Provider Taxonomy (available in 2009)

Medicaid Analytic eXtract (MAX) Data 1999 to 2009

The separate downloads listed at the bottom and in the box on the left side of this page provide technical information regarding more current MAX data (2005 to 2008) and earlier MAX data (1999 to 2004). Please note that the data dictionaries and data element lists have included new data elements for 2005-2008, compared to 1999-2004. These downloads include:

General information
(1) MAX Data Availability by year and State.
(2) Record Counts by State and file type.
(3) SAS Load Statements - For users of the Statistical Analysis System - SAS, we have prepared a sample of the SAS load statements that can be used for each of the MAX types of files. While these load statements do not include all data elements for each file, they include most of the frequently used MAX data elements and examples of the various data formats present in the MAX data, including zoned decimal formats.
(4) Data dictionaries – These downloads include the data dictionaries for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) MAX files.  The record lengths and variable locations have not changed from 2005 through 2008, but there are definitional and coding changes that have occurred in each of these years.  For this reason, new data dictionaries are being prepared for each year, starting with 2005.  The format of these dictionaries is in three parts:  a. Changes from the previous year, b. Data element lists, and c.The full data dictionary.
(5) Data element lists – These separate documents for years before 2005 include the data element lists for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) MAX files.  As noted above, the data element lists for years after 2005 are included in the data dictionaries.
(6) Data Anomalies Reports and Tables –These documents include reports and/or tables on the MAX Eligibility and Claims Anomalies.
(7) Definitions of Analytic Measures - for all Validation Reports
(8) MAX Validation Reports - These reports are prepared for each of the 50 states and the District of Columbia. The reports provide a wealth of high level statistical summary data information on the data contained in the MAX files, including enrollment, utilization and Medicaid payments. These reports are accessible by clicking on "MAX Validation reports" in the margin on the left of this page. After you have clicked on this link, you will have a list of state reports from which you can select.

Medicaid Analytic eXtract (MAX) Archive Data 1998 and Earlier

The Download listed at the bottom of this page for 1998 and earlier provides technical information regarding archive State Medicaid Research Files (SMRF) data for 1996-1998. CMS is no longer filling requests for these data files from outside parties.

• General information: This download includes information regarding what SMRF data are available and the record counts by state for 1996-1998.
• Data dictionaries: These downloads include the SMRF data dictionaries for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) files for 1996-1998.
• Data element lists: These documents include the SMRF data element lists for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) files for 1996-1998.
• Validation Reports: These documents contain the SMRF data validation reports for the 31 states available for 1996-1998.
• Data Anomalies Report: These documents contain the data anomalies report on the SMRF data for 1996-1998.

The download listed at the bottom of this page for 1998 and earlier provides technical information regarding archive SMRF data for the years 1998 and earlier.

• General information: This download includes information regarding what SMRF data are available for 1995 and earlier.
• Data dictionaries: These downloads include the SMRF data dictionaries for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) files from 1995 and earlier.
• Data element lists: These documents include the SMRF data element lists for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) files from 1995 and earlier.