Dataset

This dataset was created by Deepika koche

Contents

Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq/index.html

Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. The data includes state, drug name, National Drug Code, number of prescriptions and dollars reimbursed. Data descriptions are available on Medicaid.gov: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/state-drug-utilization-data-faq

This data set includes monthly counts and rates (per 1,000 beneficiaries) of behavioral health services, including emergency department services, inpatient services, intensive outpatient/partial hospitalizations, outpatient services, or services delivered through telehealth, provided to Medicaid and CHIP beneficiaries, by state. Users can filter by either mental health disorder or substance use disorder. These metrics are based on data in the T-MSIS Analytic Files (TAF). Some states have serious data quality issues for one or more months, making the data unusable for calculating behavioral health services measures. To assess data quality, analysts adapted measures featured in the DQ Atlas. Data for a state and month are considered unusable if at least one of the following topics meets the DQ Atlas threshold for unusable: Total Medicaid and CHIP Enrollment, Claims Volume - IP, Claims Volume - OT, Diagnosis Code - IP, Diagnosis Code - OT. Please refer to the DQ Atlas at http://medicaid.gov/dq-atlas for more information about data quality assessment methods. Cells with a value of “DQ” indicate that data were suppressed due to unusable data. Some cells have a value of “DS”. This indicates that data were suppressed for confidentiality reasons because the group included fewer than 11 beneficiaries.

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately ** million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately ** percent of the total number of Medicaid enrollees nationwide (**** million). Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately **** billion U.S. dollars in FY2020. Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over **** million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was *** percent of the federal poverty level.

The Centers for Medicare and Medicaid Services (CMS) offers researchers and other health care professionals a broad range of quantitative information on their programs, from estimates of future Medicare and Medicaid spending to enrollment, spending, and claims data, and a broad range of consumer research to help its partners and staff. CMS also conducts demonstration projects to explore alternative policies of health care coverage and delivery. National health expenditure data not specific to the Medicare or Medicaid programs are also included.

There are four tiers of data access available to researchers through CMS:

• De-identified data which can be accessed at no cost via the CMS Data Navigator
• Non-Identifiable Data Files which may be requested for a fee and do not require completion of a Data Use Agreement
• Limited Data Set (LDS) Files which may be requested for a fee and includes individual health information but excludes specified direct identifiers as outlined by HIPAA. A signed Data Use Agreement is required.
• Identifiable Data Files (IDF) which are available to specific types of stakeholders and may be requested for a fee. These files include protected health information and/or personally identifiable information. IDF applications must include a research protocol and signed Data Use Agreement (DUA), and are reviewed by CMS’s Privacy Board.

Subsets of CMS data can be viewed in interactive visualizations or dashboards that are organized by topic. Users may use these tools to filter for variables and indicators of interest, then export the underlying data as as CSV files. Topics that are currently covered by these tools include: medicare enrollment, disparities and social determinants of health, Medicaid opioid prescribing rates, market saturation and utilization at the state and county levels, and the prevalence of 18 chronic conditions among beneficiaries enrolled in Medicare fee-for-service at the state and county levels.

These reports provide summary information about mental health service utilization funded through Medicaid for Local Fiscal Years, beginning in service year 2006 and updated yearly thereafter. Totals are based on date of service and data are refreshed on a monthly basis so values in the same report may change over time. Prepaid Mental Health Plan (PMHP) data are included in these reports as Recovery Services (RS); however, Medicaid Managed Care data are not included. Expenditures include Comprehensive Outpatient Program Services (COPS) and Community Support Program (CSP) add-on payments, where applicable.

Over ** million Americans were estimated to be enrolled in the Medicaid program as of 2024. After near continuous increase in Medicaid enrollment, especially during the pandemic, 2024 recorded the first deline in the number of enrollees. This is due to the ending of the COVID-19 continuous enrollment provision in April 2023. Since the 'unwinding', enrollees continue to decrease, but as of Spetember 2025 still stands higher than pre-pandemic figures. Medicaid is basically a joint federal and state health program that provides medical coverage to low-income individuals and families. Currently, Medicaid is responsible for ** percent of the nation’s health care bill, making it the third-largest payer behind private insurances and Medicare. From the beginning to ObamacareMedicaid was implemented in 1965 and since then has become the largest source of medical services for Americans with low income and limited resources. The program has become particularly prominent since the introduction of President Obama’s health reform – the Patient Protection and Affordable Care Act - in 2010. Medicaid was largely impacted by this reform, for states now had the opportunity to expand Medicaid eligibility to larger parts of the uninsured population. Thus, the percentage of uninsured in the United States decreased from over ** percent in 2010 to *** percent in 2024. Who is enrolled in Medicaid?Medicaid enrollment is divided mainly into four groups of beneficiaries: children, adults under 65 years of age, seniors aged 65 years or older, and disabled people. Children are the largest group, with a share of approximately ** percent of enrollees. However, their share of Medicaid expenditures is relatively small, with around ** percent. Compared to that, disabled people, accounting for ** percent of total enrollment, were responsible for ** percent of total expenditures. Around half of total Medicaid spending goes to managed care and health plans.

Context

How much each state in the US had paid for each drug over the course of different quarters in 2020.

Content

Data descriptions

Acknowledgements

Downloaded from Data.Medicaid.gov

Inspiration

Price transparency of medications in the US.

Wherry, Laura R., Miller, Sarah, Kaestner, Robert, and Meyer, Bruce D., (2018) “Childhood Medicaid Coverage and Later Life Health Care Utilization.” Review of Economics and Statistics 100:2, 287-302.

This dataset includes the number of people enrolled in DSS services by town and by race 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