Some Medicaid LTSS expenditures are not included in MAX:
Managed Care. LTSS utilization and expenditures reported here reflect FFS use and expenditures only.20 In the past, LTSS rarely was covered under managed care arrangements, with Arizona's program a notable exception. However, managed care now also covers all elderly in Minnesota and most LTSS users in New Mexico and is growing in other states.
Bulk Payments. Because MAX contains only person-level data, services paid (or debited) for multiple individuals in lump sum -- for example, HCBS waiver, some capitated payments, and disproportionate-share hospital payments -- are not included in the files.
Services Not Covered by Medicaid. Medicaid premium payments paid on behalf of dual Medicare and Medicaid enrollees are not included in MAX. Co-insurance payments for duals are included in MAX only if Medicaid made payments for such services.
Because these data are not included in MAX, statistics for states with a significant portion of their LTSS expenditures paid in bulk or with extensive LTSS managed care programs cannot be compared directly with statistics computed for other states using MAX.
20 Expenditures for any institutional or community-based LTC services provided under managed care are subsumed into managed care capitated payments. Services covered under managed care (including any for LTC) generally cannot be identified in MAX as they are reported in "encounter records," which are incomplete for many states in MSIS and MAX (Borck et al. 2013).