Using MSIS Data to Analyze Medicaid Eligibility and Managed Care Enrollment Patterns in 1999. Appendix B. Comparison of MSIS Managed Care Data to CMS Data

02/01/2003

To assess the validity of the managed care data in Medicaid Statistical Information System (MSIS), MSIS data on enrollment in comprehensive managed care plans and primary care case management (PCCM) plans for June 1999 were compared with information from the Centers for Medicare & Medicaid Services (CMS). The CMS information can be found at the CMS website on managed care: http://www.cms.hhs.gov/medicaid/managedcare/cover99.asp. Both MSIS and CMS report the number of Medicaid managed care enrollees in comprehensive managed care plans and primary care case management (PCCM) plans in June, 1999. 1999 MSIS data could not be compared to data from the National Academy for State Health Policy (NASHP) because NASHP only reports Medicaid managed care enrollment data biannually in even-numbered years.

Tables 1 and 2 present Medicaid managed care enrollment numbers for comprehensive managed care plans and PCCMs by state for June, 1999. In each table, columns 1 and 2 show the enrollment numbers for MSIS and CMS, respectively. Columns 3 and 4 then show the actual and percent difference between MSIS and CMS. When one source showed enrollment for a type of managed care for a state but the other source did not show any enrollment, the percent difference is reported as +/-100.00 percent. For example, MSIS reported that Georgia had 19,725 enrollees in a comprehensive managed care plan in June 1999 while CMS data did not have any enrollees in this plan type; therefore, MSIS is reported to be +100.00 percent different relative to CMS.

For a majority of states, MSIS data on enrollment in comprehensive and PCCM plans for 1999 were within 10 percent of the CMS data. Since 1999 was the first year all states were reporting into MSIS, this result was encouraging. For the 19 states where the difference was greater than 10 percent for at least one of the managed care plan types, Table 3 provides available information on why the difference occurred. This information is also included in the footnotes for each state. There were many explanations for the disparities between MSIS and CMS numbers. In some instances, state Medicaid officials acknowledged a problem of undercounting managed care in MSIS data. In other instances, Medicaid officials believed the CMS data to be in error. For several states, plans were reported into one type of managed care plan in the MSIS data and another type in the CMS data. In a few instances, information was not available on why differences occurred.

Both MSIS and CMS reported national Medicaid enrollment in comprehensive plans of about 11.6 million. Of interest, both sources appear to have had some problems of undercounting this type of managed care. The national totals for PCCM enrollment were not as close, with CMS reporting 4.3 million Medicaid enrollees in PCCMs, compared to 3.6 million for MSIS. Some, but not all, of the differences in PCCM reporting occurred because of differences between CMS and MSIS in whether hybrid PCCM plans were classified as PCCMs.

The MSIS and CMS data sets also provide counts for other types of managed care. Limited resources prevented staff from reconciling these numbers on a state by state basis. In addition, there are definitional differences across the three sources for the less common forms of managed care. For example, MSIS reports the following managed care plan types separately: behavioral managed care plans, dental plans, long-term care plans, prenatal/delivery plans, Programs for All-Inclusive Care for the Elderly (PACE) and other. CMS reports these types of managed care into two broad groupings --PHPs and other.

The state footnotes also mention any known problems with MSIS data for these less common types of managed care. In addition, when a state reported enrollment into the "other" grouping in MSIS, the footnotes explain what types of plans were reported. Finally, the footnotes mention any information on changes in a state's monthly managed care enrollment patterns during 1999, such as a new type of managed care plan being reported, or the termination of a large managed care plan.

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