Total Medicaid Enrollees - VIII Group Break Out Report Reported on the CMS-64 The enrollment information is a state-reported count of unduplicated individuals enrolled in the state’s Medicaid program at any time during each month in the quarterly reporting period. The enrollment data identifies the total number of Medicaid enrollees and, for states that have expanded Medicaid, provides specific counts for the number of individuals enrolled in the new adult eligibility group, also referred to as the “VIII Group”. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. This data includes state-by-state data for this population as well as a count of individuals whom the state has determined are newly eligible for Medicaid. All 50 states, the District of Columbia and the US territories are represented in these data. Notes: 1. “VIII GROUP” is also known as the “New Adult Group.” 2. The VIII Group is only applicable for states that have expanded their Medicaid programs by adopting the VIII Group. VIII Group enrollment information for the states that have not expanded their Medicaid program is noted as “N/A.”

Context

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarize counts of enrollees who are dually-eligible for both Medicare and Medicaid program, including those in Medicare Savings Programs. “Duals” represent 20 percent of all Medicare beneficiaries, yet they account for 34 percent of all spending by the program, according to the Commonwealth Fund . As a representation of this high-needs, high-cost population, these data offer a view of regions ripe for more intensive care coordination that can address complex social and clinical needs. In addition to the high cost savings opportunity to deliver upstream clinical interventions, this population represents the county-by-county volume of patients who are eligible for both state level (Medicaid) and federal level (Medicare) reimbursements and potential funding streams to address unmet social needs across various programs, waivers, and other projects. The dataset includes eligibility type and enrollment by quarter, at both the state and county level. These data represent monthly snapshots submitted by states to the CMS, which are inherently lower than ever-enrolled counts (which include persons enrolled at any time during a calendar year.) For more information on dually eligible beneficiaries

Querying BigQuery tables

You can use the BigQuery Python client library to query tables in this dataset in Kernels. Note that methods available in Kernels are limited to querying data. Tables are at bigquery-public-data.sdoh_cms_dual_eligible_enrollment.

Sample Query

In what counties in Michigan has the number of dual-eligible individuals increased the most from 2015 to 2018? Find the counties in Michigan which have experienced the largest increase of dual enrollment households

duals_Jan_2015 AS ( SELECT Public_Total AS duals_2015, County_Name, FIPS FROM bigquery-public-data.sdoh_cms_dual_eligible_enrollment.dual_eligible_enrollment_by_county_and_program WHERE State_Abbr = "MI" AND Date = '2015-12-01' ),

duals_increase AS ( SELECT d18.FIPS, d18.County_Name, d15.duals_2015, d18.duals_2018, (d18.duals_2018 - d15.duals_2015) AS total_duals_diff FROM duals_Jan_2018 d18 JOIN duals_Jan_2015 d15 ON d18.FIPS = d15.FIPS )

SELECT * FROM duals_increase WHERE total_duals_diff IS NOT NULL ORDER BY total_duals_diff DESC

Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using State-based Marketplaces (SBMs) that use their own eligibility and enrollment platforms Source: State-based Marketplace (SBM) operational data submitted to CMS. Each monthly reporting period occurs during the first through last day of the reported month. SBMs report relevant Marketplace activity from April 2023 (when unwinding-related renewals were initiated in most SBMs) through the end of a state’s Medicaid unwinding renewal period and processing timeline, which will vary by SBM. Some SBMs did not receive unwinding-related applications during reporting period months in April or May 2023 due to renewal processing timelines. SBMs that are no longer reporting Marketplace activity due to the completion of a state’s Medicaid unwinding renewal period are marked as NA. Some SBMs may revise data from a prior month and thus this data may not align with that previously reported. For April, Idaho’s reporting period was from February 1, 2023 to April 30, 2023. Notes: This table represents consumers whose Medicaid/CHIP coverage was denied or terminated following renewal and 1) whose applications were processed by an SBM through an integrated Medicaid, CHIP, and Marketplace eligibility system or 2) whose applications/information was sent by a state Medicaid or CHIP agency to an SBM through an account transfer process. Consumers who submitted applications to an SBM that can be matched to a Medicaid/CHIP record are also included. See the "Data Sources and Metrics Definition Overview" at http://www.medicaid.gov for a full description of the differences between the SBM operating systems and resulting data metrics, measure definitions, and general data limitations. As of the September 2023 report, this table was updated to differentiate between SBMs with an integrated Medicaid, CHIP, and Marketplace eligibility system and those with an account transfer process to better represent the percentage of QHP selections in relation to applicable consumers received and processed by the relevant SBM. State-specific variations are: - Maine’s data and Nevada’s April and May 2023 data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process. - Connecticut, Massachusetts, and Washington also report applications with consumers determined ineligible for Medicaid/CHIP due to procedural reasons. - Minnesota and New York report on eligibility and enrollment for their Basic Health Programs (BHP). Effective April 1, 2024, New York transitioned its BHP to a program operated under a section 1332 waiver, which expands eligibility to individuals with incomes up to 250% of FPL. As of the March 2024 data, New York reports on consumers with expanded eligibility and enrollment under the section 1332 waiver program in the BHP data. - Idaho’s April data on consumers eligible for a QHP with financial assistance do not depict a direct correlation to consumers with a QHP selection. - Virginia transitioned from using the HealthCare.gov platform in Plan Year 2023 to an SBM using its own eligibility and enrollment platform in Plan Year 2024. Virginia's data are reported in the HealthCare.gov and HeathCare.gov Transitions Marketplace Medicaid Unwinding Reports through the end of 2024 and is available in SBM reports as of the April 2024 report. Virginia's SBM data report all applications with Medicaid/CHIP denials or terminations, not only those part of the annual renewal process, and as a result are not directly comparable to their data in the HealthCare.gov data reports. - Only SBMs with an automatic plan assignment process have and report automatic QHP selections. These SBMs make automatic plan assignments into a QHP for a subset of individuals and provide a notification of options regarding active selection of an alternative plan and/or, if appli

The Medicaid Managed Care Enrollment Report profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts. Because Medicaid beneficiaries may be enrolled concurrently in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of Medicaid enrollees. Comprehensive MCOs cover acute, primary, and specialty medical care services; they may also cover behavioral health, long-term services and supports, and other benefits in some states. Limited benefit managed care programs, including PCCM, MLTSS only, BHO, Dental, Transportation, and Other cover a narrower set of services. The “Total Medicaid Enrollees” column represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and dually eligible individuals receiving full Medicaid benefits or Medicaid cost sharing. "--" indicates states that do not operate programs of a given type. 0 signifies that a state operated a program of this type in 2014, but it ended before July 1, 2014, or began after that date.

State-reported data on Medicaid and CHIP eligibility renewals that reflect the outcomes of previously pending renewals three months after the renewal was due and also any corrections to the original renewal data submitted to CMS. See here for original renewal data.
CMS renewal data specifications require states to update and submit to CMS their monthly renewal outcome metrics - metric 5 data and its submetrics (monthly metrics 5a, 5a(1), 5a(2), 5b, 5c, and 5d) - after the original monthly report submission. The “updated” renewal data reflect the outcomes of renewals previously reported as pending (monthly metric 5d of the original monthly report) as of three months after the renewal was due. For more information about this data set and considerations for users when reviewing, please see the Medicaid and CHIP Unwinding: Data Sources and Metrics Definitions Overview found here.
Sources:
(1) March 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in March 2023 as of June 2023. April 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in April 2023 as of July 2023. May 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in May 2023 as of August 2023. June 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in June 2023 as of September 2023. July 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in July 2023 as of October 2023. August 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on March 05, 2024, representing the updated disposition of renewals due in August 2023 as of November 2023. September 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 02, 2024, representing the updated disposition of renewals due in September 2023 as of December 2023. October 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 02, 2024, representing the updated disposition of renewals due in October 2023 as of January 2024. November 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on May 07, 2024, representing the updated disposition of renewals due in November 2023 as of February 2024. December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on June 11, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. New Hampshire’s December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 09, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. New York’s December 2023 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on April 22, 2024, representing the updated disposition of renewals due in December 2023 as of March 2024. January 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on July 02, 2024, representing the updated disposition of renewals due in January 2024 as of April 2024. February 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on August 06, 2024, representing the updated disposition of renewals due in February 2024 as of May 2024. March 2024 state Medicaid and CHIP Renewal and Termination Data for the Unwinding Data Report pulled on September 09, 2024, representing the updated disposition of renewals due in March 2024 as of June 2024.

Notes: States report updated renewal outcomes for a cohort as of three months after the month renewals are scheduled for completion, unless otherwise noted. In the March 2023 – October 2023 reporting periods, Oklahoma included outcomes for some individuals who returned their renewal form during the reconsideration period. See the Data Sources and Definitions Overview document for a full description of the metric definitions and how they relate to each other.
April 2023: Ohio reported updated renewal outcomes for the cohort as of 10/31/2023. Arkansas and Pennsylvania reported the eligibility status of the cohort, and data may include outcomes of eligibility actions that occurred after the renewal.
May 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Ohio (outcomes as of 10/31/2023), Rhode Island (outcomes as of 11/1/2023), South Carolina (outcomes as of 12/20/2023), and Texas (outcomes as of 9/8/2023). Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
June 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Kansas (outcomes as of 8/31/23), Minnesota (outcomes as of 12/2023), Ohio (outcomes as of 10/31/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 11/1/2023), and South Carolina (outcomes as of 12/20/2023). Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
July 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 12/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 11/1/2023), and Texas (outcomes as of 11/9/2023). California, Pennsylvania, and Rhode Island updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
August 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 12/2023), North Carolina (outcomes as of 12/1/2023), Rhode Island (outcomes as of 12/4/2023), and South Carolina (outcomes as of 12/20/2023). California, Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
September 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 1/8/2024), North Carolina (1/2/2024), Rhode Island (1/1/2024), and South Carolina (outcomes as of 1/8/2024). California, Pennsylvania, Rhode Island, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Vermont excluded renewal outcomes for some individuals who requested voluntary terminations or who were deceased.
October 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 2/12/2024), North Carolina (outcomes as of 2/1/2024), Rhode Island (outcomes as of 2/15/2024), and South Carolina (outcomes as 2/1/2024). California, Pennsylvania, and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Rhode Island’s updated data includes some individuals reported as pending whose renewal was completed.
November 2023: The following states reported updated renewal outcomes for the cohort as of a different date: Minnesota (outcomes as of 3/4/2024), New York (outcomes as of 3/31/2024), North Carolina (outcomes as of 3/1/2024), Rhode Island (outcomes as of 4/1/2024), and South Carolina (outcomes as of 3/1/2024). Pennsylvania and South Carolina updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. Rhode Island’s updated data includes some individuals reported as pending whose renewal was completed. California included outcomes for some individuals whose eligibility was redetermined based on a change in circumstances after the renewal was processed.
December 2023: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 4/1/2024) and Minnesota (outcomes as of 4/2/2024). Pennsylvania updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal. California included outcomes for some individuals whose eligibility was redetermined based on a change in circumstances after the renewal was processed.
January 2024: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 5/1/2024) and Minnesota (outcomes as of 5/6/2024). Pennsylvania updated the eligibility status of the cohort, and data may include eligibility actions that occurred after the renewal.
February 2024: The following states reported updated renewal outcomes for the cohort as of a different date: North Carolina (outcomes as of 6/3/2024) and Minnesota (outcomes as of 6/5/2024). Pennsylvania and Wyoming

Context

The CMS National Plan and Provider Enumeration System (NPPES) was developed as part of the Administrative Simplification provisions in the original HIPAA act. The primary purpose of NPPES was to develop a unique identifier for each physician that billed medicare and medicaid. This identifier is now known as the National Provider Identifier Standard (NPI) which is a required 10 digit number that is unique to an individual provider at the national level.

Once an NPI record is assigned to a healthcare provider, parts of the NPI record that have public relevance, including the provider’s name, speciality, and practice address are published in a searchable website as well as downloadable file of zipped data containing all of the FOIA disclosable health care provider data in NPPES and a separate PDF file of code values which documents and lists the descriptions for all of the codes found in the data file.

Content

The dataset contains the latest NPI downloadable file in an easy to query BigQuery table, npi_raw. In addition, there is a second table, npi_optimized which harnesses the power of Big Query’s next-generation columnar storage format to provide an analytical view of the NPI data containing description fields for the codes based on the mappings in Data Dissemination Public File - Code Values documentation as well as external lookups to the healthcare provider taxonomy codes . While this generates hundreds of columns, BigQuery makes it possible to process all this data effectively and have a convenient single lookup table for all provider information.

Fork this kernel to get started.

Acknowledgements

https://bigquery.cloud.google.com/dataset/bigquery-public-data:nppes?_ga=2.117120578.-577194880.1523455401

https://console.cloud.google.com/marketplace/details/hhs/nppes?filter=category:science-research

Dataset Source: Center for Medicare and Medicaid Services. This dataset is publicly available for anyone to use under the following terms provided by the Dataset Source - http://www.data.gov/privacy-policy#data_policy — and is provided "AS IS" without any warranty, express or implied, from Google. Google disclaims all liability for any damages, direct or indirect, resulting from the use of the dataset.

Banner Photo by @rawpixel from Unplash.

Inspiration

What are the top ten most common types of physicians in Mountain View?

What are the names and phone numbers of dentists in California who studied public health?

This dataset includes the total number of individuals enrolled in Medi-Cal by eligibility group: Modified Adjusted Gross Income (MAGI), non-MAGI, and Children’s Health Insurance Program (CHIP). The groups are defined by the Centers for Medicare and Medicaid Services (CMS) Performance Indicators (CMSPI) reporting requirements. The Department of Health Care Services (DHCS) submits eligibility and enrollment data regarding Medicaid and CHIP monthly to CMS. The enrollment data represents enrollment totals as of 60 days after the eligibility month (indicated as “Reporting Period” in the dataset). CMS publishes the state total enrollments on the CMSPI website. The total enrollment comprises of individuals who are eligible for full scope Medi-Cal by MAGI – Child, MAGI – Adult, Non-MAGI Child, Non-MAGI Adult, and CHIP eligibility groups. DHCS does not report to CMS the total enrollment in limited scope Medi-Cal or state-only funded programs (indicated as the “Non-CMSPI” in the dataset).

This dataset includes total enrollment in separate CHIP (S-CHIP) programs by month and state from April 2023 forward. Sources: T-MSIS Analytic Files (TAF) and state-submitted enrollment totals. The data notes indicate when a state’s monthly total was a state-submitted value, rather than from T-MSIS. Methods: Enrollment includes individuals enrolled in S-CHIP at any point during the coverage month, excluding those enrolled in dental-only coverage. The S-CHIP enrollment in this report also excludes enrollees covered by Medicaid expansion CHIP, a program in which a state receives federal funding to expand Medicaid eligibility to optional targeted low-income children that meets the requirements of section 2103 of the Social Security Act. If an individual is enrolled in both Medicaid or Medicaid-expansion CHIP and S-CHIP in a given month, TAF picks the program in which they were last enrolled. Unless S-CHIP enrollment counts are replaced with a state-submitted value, each state's monthly S-CHIP enrollment is equal to the number of unique people in TAF with a CHIP_CODE = 3 (S-CHIP) and ELGBLTY_GRP_CD not equal to ‘66’ (Children Eligible for Dental Only Supplemental Coverage). More information about TAF is available at https://www.medicaid.gov/medicaid/data-systems/macbis/medicaid-chip-research-files/transformed-medicaid-statistical-information-system-t-msis-analytic-files-taf/index.html. Note: A historic dataset with S-CHIP enrollment by month and state from April 2023 to June 2024 is also available at: https://data.medicaid.gov/dataset/d30cfc7c-4b32-4df1-b2bf-e0a850befd77. This historic dataset was created to fulfill reporting requirements under section 1902(tt)(1) of the Social Security Act, which was added by section 5131(b) of subtitle D of title V of division FF of the Consolidated Appropriations Act, 2023 (P.L. 117-328) (CAA, 2023). Please note that the methods used to count S-CHIP enrollees differ slightly between the two datasets; as a result, data users should exercise caution if comparing S-CHIP enrollment across the two datasets. State notes: Alaska, District of Columbia, Hawaii, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, South Carolina, Vermont, and Wyoming do not have S-CHIP programs. Maryland has an S-CHIP program for the from conception to end of pregnancy group that began in July 2023; April 2023 - June 2023 data for Maryland represents retroactive coverage. Oregon moved all its S-CHIP enrollees, other than those in the from conception to the end of pregnancy group, to a Medicaid-expansion CHIP program effective January 1, 2024. CHIP: Children's Health Insurance Program

This dataset includes the number of people enrolled in DSS services by town and by ethnicity from CY 2015-2024. To view the full dataset and filter the data, click the "View Data" button at the top right of the screen. More data on people served by DSS can be found here.

About this data