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Databases for Estimating Health Insurance Coverage for Children: A Workshop Summary
Social Security Administration High Group List. CMS is exploring more complete verification in concert with the Social Security Administration, the Census Bureau, and the states.
Duplication in the count of enrollees across the states and over time is an issue for CMS and data users. Baugh estimated that about 1 million of the 60 million Medicaid/CHIP enrollees are duplicates. The duplicates will be reduced by creation of a MAX Enrollee Master file (MAXEM), on which work is now under way.
Lastly, he reported that under the umbrella of the MAX expansion project, funded by ARRA, there is increased coordination between CMS and State Technical Advisory Groups to describe CHIPs, identify their issues, challenges, and concerns, and develop criteria for selecting volunteers. As part of this initiative, CMS is working to develop state-specific technical assistance plans in 10 to 15 pilot states, which include regular communications and working closely with data task teams, with the objective of improving MSIS reporting. However, at this time, state participation in these quality improvement programs is voluntary, regulations have yet to be promulgated, and states have limited resources to make improvements that have been identified.
In summarizing his views on the status of administrative records for estimating children’s health insurance coverage, Rousseau observed that administrative data are a good resource for research and benchmarking, but they are not a perfect gold standard. For one thing, the data are collected for other purposes (e.g., CMS-64) and not for specific research questions, so they may not be able to fully illuminate some key issues, such as the lack of managed care information in MSIS. However, they are increasingly available and researchers can and do use them for a variety of purposes. Despite their limitations, administrative data complement survey data and are a critical component in all work of CHIP and Medicaid researchers.
Administrative data are critical for state-level analysis of subpopulations for which surveys are often limited by sample size and other methodological issues. Real-time administrative data on enrollment are critical to decision makers and analysts. CMS has made great strides in improving the availability and timeliness of administrative data, but more work needs to be done to ensure data quality and make enrollment data contemporary with spending. The new health reform legislation increases the need for timely, high-quality administrative and survey data.