of Children’s Health (NSCH), the National Survey of Children with Special Health Care Needs (NS-CSHCN), and the National Survey of Early Child Health (NSECH). The NSCH is the most far-reaching of the three MCHB surveys in terms of the population covered, the sample size, and the topics covered.
THE MEDICAID STATISTICAL INFORMATION SYSTEM
The MSIS is a national database of Medicaid claims and eligibility data that is maintained by the Centers for Medicare and Medicaid Services (CMS) and consists of an aggregation of individual state-level claims databases. Reporting by states to the MSIS is mandatory for state Medicaid agencies. Thus, the MSIS contains data on all Medicaid children and Children’s Health Insurance Program (CHIP) children who are part of Medicaid expansions (although not children in separate CHIP programs). The state-level data reported to CMS for the MSIS provide a base that is useful for some measures, although it has some major limitations.
On the positive side, state-level files contain data on claims and encounters for services, which include data on health insurance, diagnoses, and the services or procedures provided as core data elements. The records contain a state-assigned unique personal identifier; this identifier can be used consistently to identify a given individual across different years and different enrollment periods, making it possible to track Medicaid beneficiaries over time within that state (MacTaggart, 2010).
The major weakness of the state-level data reported to the MSIS lies in its nature as a claims-based system. In most states, claims for services rendered under Medicaid primary care case management and fee-for-service care show a complete record of the services provided and generate a reimbursement for those services. However, contractors with managed care organizations may receive a capitated payment for beneficiaries. In such cases, their claims data may not necessarily describe the actual services provided. Managed care organizations may submit encounters or “shadow claims,” which, because they do not actually generate reimbursement, may be incomplete. CMS has indicated it is working with states to improve encounter data (MacTaggart, 2010). Furthermore, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) requires the Department of Health and Human Services (HHS) to collect and analyze the MSIS data from states within 6 months. MSIS data have not been used as a source of reporting in the past (MacTaggart, 2010; Simpson et al., 2009), but the new federal reporting requirements, combined with federal efforts to improve state claims/encounter databases, may lead to more usable data in those databases. In the interim, states may combine the use of their claims/encounter databases with chart audits for a sample of children to report