Maryland Medicaid DataPort

Viewing the Data

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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

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).

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.

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.

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.