Maryland Medicaid DataPort
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During the federal public health emergency (PHE), all state Medicaid programs kept participants enrolled, even if they were no longer eligible. The Consolidated Appropriations Act of 2023 ended this requirement on April 1, 2023. Now states must review participants’ eligibility again, also called a renewal or redetermination (redet). Below you can track the progress of this effort in Maryland. If you are a Maryland Medicaid member with questions about your renewal, please visit this link.
Data Notes
The data used here are constantly changing. The DataPort uses data from a particular point in time—the last day of the previous month.
The MMIS2 data used here are as of the last day of the month. MDH public reporting may follow a different schedule and use additional data sources, causing the most recent data to differ from public reporting.
Participants who are listed as “Pending” in public reporting will show as “Coverage Extended on Redet” here. Many of these participants will have a different status after their renewal is completed.
For Non-MAGI (modified adjusted gross income) participants, the data used here are at the individual level. MDH uses Non-MAGI data at the household level in public reporting.
The MAGI population are eligible for Medicaid based on their “modified adjusted gross income”. Non-MAGI participants are eligible for other reasons.
Data showing participants who transitioned to qualified health plans (QHPs) through Maryland Health Connection are not currently available here.
Participants whose renewal takes place outside their Scheduled Redet Month are listed in public reporting as “New Applications.” Here, those participants are listed with the outcome of their renewal (e.g., Coverage Extended on Redet, Disenrolled-Non-Procedural).
Some participants’ renewals were set for May 2023 but were completed in April 2023 ahead of schedule and are not yet shown here. The data will soon be updated to include those renewals.
User Tips
Viewing the Data
For the optimal viewing experience, please ensure that third-party cookies are allowed.
Data will only appear in the output if it exists. For example, if you are reviewing data by county and one county does not appear in the output, it is because no records for that county match your selected display criteria.
Annual/Monthly View
Annual:
- Only full years of data are included in the Annual view. If you select an incomplete year, you will not see the data in the Annual view. For partial years of data, use the Monthly view.
Monthly:
- Individuals are only counted once in the Annual view. However, they may be counted more than once in the Monthly view if they match more than one filter you selected.
Download Options
- Select the download button
from the Tableau bar at the bottom of the page to download a .PNG image, PDF, or PowerPoint visual.
- Downloading Data or Crosstab (Excel or CSV files) is not an option.
Additional Data
For questions, please complete the Contact Us form.
For Medicaid research data, please visit: Requesting Maryland Medical Assistance Data
General
Calendar Year (CY) vs. Fiscal Year (FY)
A calendar year (CY) begins on January 1 and ends on December 31. For instance, CY 2021 began on January 1, 2021, and ended on December 31, 2021. This is the traditional year observed on calendars.
A fiscal year (FY) begins on July 1 and ends on June 30. For instance, FY 2021 began on July 1, 2020, and ended on June 30, 2021. Many businesses, governments, and other organizations operate on a fiscal year basis.
Cell Suppression
In accordance with The Hilltop Institute’s cell suppression policy, the DataPort sometimes displays an asterisk (*) instead of a number. This is cell suppression. Data privacy standards require that any cell with a value between 1 and 10 must be suppressed. In addition, any cell that can be used to mathematically derive the value must be suppressed. In cases where only one cell in a table must be suppressed, the DataPort also suppresses the cell with the next highest value, even if that value is greater than 10.
HIPAA
Health Insurance Portability and Accountability Act
HITECH
Health Information Technology for Economic and Clinical Health
MMIS2
Medicaid Management Information System, version 2
Race & Ethnicity
The DataPort allows users to view data by race and ethnicity. Race and ethnicity data for Medicaid enrollees comes from three sources: Medicaid’s MMIS2, the Maryland Health Benefit Exchange (Maryland’s state-based marketplace), and the Chesapeake Regional Information System for our Patients (CRISP - Maryland’s health information exchange).
Medicaid
HealthChoice
HealthChoice is the name of Maryland’s Medicaid managed care program. For more information about HealthChoice, please visit the Maryland HealthChoice Program website.
HealthChoice Managed Care Organization (MCO) vs. Fee-For-Service (FFS) Medicaid
Most Marylanders in Medicaid are enrolled in HealthChoice, where the Medicaid program pays MCOs, who then compensate the health care providers. However, some individuals are ineligible for enrollment in a HealthChoice MCO and are instead served under FFS Medicaid, where the Medicaid program pays the health care providers directly.
HealthChoice Coverage Categories
Affordable Care Act Expansion
This category contains enrollees who were determined eligible based on their income, as established by the Affordable Care Act (ACA) Medicaid expansion.
Aged, Blind, or Disabled
This category contains enrollees who were determined eligible for Medicaid based on their disability or their eligibility for other programs such as Supplemental Security Income (SSI).
Families and Children
This is a broad category that includes a range of enrollees. Some in this category were determined eligible for Medicaid based on their income, some based on their life circumstances (e.g. formerly in foster care, refugees), and others based on a combination of income and health needs (e.g. pregnant women).
Maryland Children’s Health Program
This category contains children whose household income qualifies them for coverage. The income guidelines in Maryland Children’s Health Program (MCHP) are higher than in Medicaid Families & Children, and may not extend coverage to adults in the household.
Other
This category consists of enrollees who are not in any of the other categories above. Enrollees in partial-benefit Medicaid programs such as the Family Planning Program and Emergency Services for Undocumented or Ineligible Aliens are included in this category, as well as those eligible for Medicaid through the Healthy Babies Act of 2023.
Unknown Coverage Category
This category contains enrollees for whom the coverage category is missing or blank.
Managed Care
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. To learn more about managed care, please visit the Managed Care page on Medicaid.gov.
Maryland Medicaid’s managed care program is called HealthChoice.
Managed Care Organization (MCO)
An MCO is a health care organization that provides services to Medicaid recipients by contracting with a network of licensed/certified health care providers. There are nine MCOs that participate in HealthChoice.
Participating HealthChoice MCOs
Aetna Better Health
CareFirst BlueCross Blue Shield Community Health Plan Maryland
Jai Medical Systems
Kaiser Permanente
Maryland Physicians Care
MedStar Family Choice
Priority Partners
UnitedHealthcare
Wellpoint Maryland
For more information about HealthChoice and MCOs, please visit the Maryland HealthChoice Program website.
MCO Changes
The DataPort shares data from January 2010 to the present. During that time, some MCOs have joined HealthChoice, some have departed, and some have changed names. Here is a summary of MCO changes during the period covered by the DataPort.
- January 2023 – Amerigroup Community Care becomes Wellpoint Maryland
- January 2021 – University of Maryland Health Partners becomes CareFirst BlueCross Blue Shield Community Health Plan Maryland
- November 2017 – Aetna Better Health joins HealthChoice
- January 2016 – Riverside becomes University of Maryland Health Partners
Medicaid Regions
The DataPort offers the ability to divide the state into regions.
Baltimore City
Baltimore Suburban
Includes Anne Arundel County, Baltimore County, Carroll County, Harford County, and Howard County.
Eastern Shore
Includes Caroline County, Cecil County, Dorchester County, Kent County, Queen Anne’s County, Somerset County, Talbot County, Wicomico County, and Worcester County.
Out of State
Includes any Medicaid enrollee whose county is listed as residing outside of Maryland.
Southern Maryland
Includes Calvert County, Charles County, and St. Mary’s County.
Washington Suburban
Includes Montgomery County and Prince George’s County.
Western Maryland
Includes Allegany County, Frederick County, Garrett County, and Washington County.
Primary Adult Care Program (PAC)
PAC was a program to extend limited Medicaid benefits to adults who would not otherwise qualify. The program ended after 2013, when the Affordable Care Act Medicaid expansion went into effect.
To find the number of individuals who were enrolled in PAC during 2010, 2011, 2012, or 2013, you will need three separate numbers:
- The total when selecting “All Medicaid” from the Medicaid Enrollment drop-down list.
- The total when selecting “HealthChoice: All MCOs” from the Medicaid Enrollment drop-down list.
- The total when selecting “Fee-for-Service Medicaid” from the Medicaid Enrollment drop-down list.
Subtract the “HealthChoice: All MCOs” and “Fee-for-Service Medicaid” totals from the “All Medicaid” total. The number that remains is the PAC population.
Long-Term Services and Support (LTSS)
LTSS HCBS Programs
Maryland Medicaid’s long-term services and supports include home and community-based services (HCBS) offered through the regular Medicaid program and special Medicaid programs called “waivers”. Each waiver has a different eligibility criteria and target population, such as older adults or individuals with a specific disability.
Autism Waiver
Brain Injury Waiver
Community Options Waiver
Community Pathways Waiver
Community First Choice
Community Personal Assistance Services
Community Supports Waiver
Family Supports Waiver
Increased Community Services Program
Medical Day Care Waiver
Model Waiver
1915(c) Waivers include: Autism, Brain Injury, Community Options, Community Pathways, Community Supports, Family Supports, Medical Day Care, and Model.
Developmental Disabilities Administration (DDA) Operated Medicaid Waivers include the Community Pathways, Community Supports, and Family Supports.
Community First Choice (CFC) is a 1915(k) state plan program that provides community-based services to Medicaid-eligible individuals residing in the community that meet an institutional level of care.
Community First Choice–Only (CFC-Only) is a CFC service user that receives only CFC services and has no other LTSS HCBS program enrollment.
Community First Choice Total Participation is the unduplicated count of all CFC service users, including CFC-only service users and CFC service users that receive CFC services while also enrolled in another LTSS HCBS program.
Community Personal Assistance Services (CPAS) is a state plan personal assistance program that provides community-based services to Medicaid-eligible individuals residing in the community. Participants must require assistance with at least one activity of daily living.
Increased Community Services Program allows eligible individuals in nursing facilities, whose income is too high for participation in the Medicaid Home and Community-Based Options Waiver, to return to the community and receive services and supports in their homes. The program operates under the Maryland §1115 Waiver.
Rare and Expensive Case Management (REM) Program is a case managed fee for service alternative to HealthChoice MCO participation for recipients with specified rare and expensive conditions.
Dual Status
Individuals who are dually eligible for both Medicare and Medicaid fall into two categories: (1) full benefit dual eligibles (“full duals”) and (2) partial benefit dual eligibles (“partial duals”). Full duals qualify for full Medicaid benefits, which include services not traditionally covered by Medicare. Maryland’s partial duals are not eligible for Medicaid benefits; instead, they receive assistance with Medicare premiums and cost-sharing through Maryland’s Medicare Savings Program (MSP). Examples of partial dual eligibles include Qualified Medicare Beneficiaries (QMBs) and Specified Low Income Medicare Beneficiaries (SLMBs).
Participant
A participant is an individual who is enrolled (began a new program span) in a HCBS program at any point in a given time frame. A participant is counted only once and is included in the count even if the individual has not received a HCBS service.
Newly Enrolled Participant Count
This is the unduplicated count of participants who are enrolled (began a new HCBS program span) during a given time frame. Newly enrolled participants are counted only once and are included in the count even if they have not received a HCBS program service.
Participant Count vs. Service User Count
Participant count is the total unduplicated number of unique HCBS program participants during a given time frame. Participants are counted only once and are included in the count even if they have not received a HCBS program service during that period.
Service user count is the total unduplicated number of unique HCBS program participants during a given time frame who received at least one HCBS program service. Participants are counted only once and are not included if they have not received a HCBS program service.
Service Category
Service category refers to all Medicaid services, both non-HCBS program and HCBS program.
Service Type
Service type is a dichotomous category that includes non-HCBS program and HCBS program services.
Payments
The payments shown reflect claims submitted for services rendered to enrollees and are not the amounts approved in enrollees’ plans of service.
Waiver Service Type
Waiver service type refers to whether the service is traditional/agency or self-directed. Currently, only the DDA operated Medicaid waivers offer self-directed services.
Nursing Facility Services
Nursing facility service users include Medicaid beneficiaries who had at least one Medicaid-paid day in a nursing facility. Nursing facility service payments are Medicaid payments to a nursing facility for Medicaid beneficiaries with at least one Medicaid-paid nursing facility day, a bed hold, or a Medicaid cost-sharing payment (premiums, co-payments, etc.). Service users and payments are displayed by Medicaid recipients’ geographic information.