Medicaid and CHIP Data Collection Systems

Medicaid and the Children's Health Insurance Program (CHIP) are changing and will continue to change moving forward. With the implementation of the Affordable Care Act, Medicaid and CHIP enrollment has grown to over 72 million beneficiaries. This exceeds enrollment in Medicare. The Centers for Medicaid and CHIP Services (CMCS) manages billions of federal dollars granted to states for their information technology (IT) expenditures to modernize state systems to meet growing demands.

In 2010 CMS initiated the Medicaid and CHIP Business Information Solution (MACBIS) to meet mandates requiring reliable, comprehensive, and timely Medicaid and CHIP operational and programmatic data supported by leading edge technology and analytics solutions.Realizing the MACBIS Vision Infographic MACBIS is an enterprise-wide initiative to ensure the Medicaid and CHIP data infrastructure and technology are commensurate to the programs’ role in evolving health care delivery reforms, access to coverage, and to enable proper monitoring and oversight. Aside from data needs to support the multi-billion dollar waiver negotiations, CMS will use MACBIS data for program integrity, evaluation of demonstrations, actuarial analysis, quality of care analysis, and to share this rich data set with states, stakeholders, and the research community. MACBIS currently consists of three major projects: Medicaid and CHIP Program (MACPro), the Transformed Medicaid Statistical Information System (T-MSIS) and the Medicaid Drug Rebate (MDR) program, which is planned for development starting FY2016.

Medicaid and CHIP Program (MACPro)

The Centers for Medicaid and CHIP Services and the CMS Regional Offices adjudicate over 2,000 actions (State Plan Amendments, Waiver applications, Advanced Planning Documents, etc.) annually. CMCS also engages in extensive work in the oversight of current programs, the development of new policy (regulations, State Medicaid Letters, on-going technical assistance to States, etc.) to keep pace with state and industry innovations. Unlike Medicare where requirements and systems are federally driven, Medicaid and CHIP represent a federal and state partnership. Therefore as part of MACBIS, CMS has built a new state-facing system to capture states’ submissions of State Plan Amendments, Waivers, Quality Measures, Advanced Planning Documents, etc. This system, MACPro is live as of December 2015 and continues to expand to include new authorities and state actions for CMS review.

Transformed Medicaid Statistical Information System (T-MSIS)
With the on-going changes to the national health care environment, CMS has made significant investments to meet the organizational and information technology (IT) infrastructure to adequately represent CMS’ role in the healthcare marketplace. T-MSIS is a critical data and systems component of the CMS Medicaid and CHIP Business Information Solution (MACBIS). In anticipation of health marketplace reforms, CMS has been working with states to transform our MSIS system, which was used to collect utilization and claims data as well as other key Medicaid and CHIP program information, to keep pace with the data needed to improve beneficiary quality of care, assess beneficiary to care and enrollment, improve program integrity, and support our states, the private market, and stakeholders with key information. The T-MSIS data set contains enhanced information about beneficiary eligibility, beneficiary and provider enrollment, service utilization, claims and managed care data, and expenditure data for Medicaid and CHIP. Find out more in the TMSIS State Medicaid Director's Letter and T-MSIS Data Dictionary.

What’s Changing with T-MSIS and MACPro?
As-Is To-Be
  • 17+ separate legacy systems with Medicaid and CHIP data 
  • No Unified Data Model 
  • No Enterprise Change Control 
  • No Medicaid/CHIP Data Owner 
  • Prod and data storage: Baltimore Data Center/Virtual Data Center 
  • No data quality checks at the front end 
  • Custom development 
  • Waterfall development
  • 4 systems: T-MSIS, MACPro, Pharmacy, MBES 
  • Unified Medicare/Medicaid Data Model 
  • MACBIS Change Control 
  • MACBIS Data Owner 
  • Prod and storage: Amazon Cloud 
  • Data validation rules engine 
  • Heavy reliance upon COTS 
  • Agile development

Note: Most, if not all states and territories, will transition from MSIS to T-MSIS throughout 2017.

T-MSIS data will be made public to states and stakeholders via different data products in 2017. For more information, please see State Medicaid/CHIP Data Sharing Fact Sheet.

MACBIS Resource Center
This resource center is designed to support users of MACBIS analytic data and data tools. In addition to providing comprehensive documentation and easily accessible training resources, the MACBIS Resource Center also provides contact information for addressing issues, fulfilling requests, and answering questions.

Medicaid Statistical Information System (MSIS)
The MSIS gathers key eligibility, enrollment, program, utilization, and expenditure data for Medicaid and CHIP. This data provides a dataset of all those eligible and receiving services for every state and territory. The last quarter a state can report to CMS in MSIS is July-October 2015.

Medicaid Analytic Extracts (MAX)
MAX data sets are created to support research and policy analysis and are extracted from MSIS. MAX data is organized into annual calendar year files and combine MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events.

Medicaid Budget and Expenditure System (MBES)
The MBES is a web-based application that reports budgeted and actual expenditures. States submit forms CMS-64, CMS-37, and CMS-21 electronically. Summarized statistical data is available for download.