Maryland Medicaid DataPort

Notes

HIPAA

Health Insurance Portability and Accountability Act

HITECH

Health Information Technology for Economic and Clinical Health

MMIS2

Medicaid Management Information System, version 2

Calendar Year (CY) vs. Fiscal Year (FY)

A calendar year (CY) begins on January 1 and ends on December 31. For instance, CY 2021 began on January 1, 2021, and ended on December 31, 2021. This is the traditional year observed on calendars.

A fiscal year (FY) begins on July 1 and ends on June 30. For instance, FY 2021 began on July 1, 2020, and ended on June 30, 2021. Many businesses, governments, and other organizations operate on a fiscal year basis.

Managed Care

Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. To learn more about managed care, please visit the Managed Care page on Medicaid.gov.

Maryland Medicaid’s managed care program is called HealthChoice.

Managed Care Organization (MCO)

An MCO is a healthcare organization that provides services to Medicaid recipients by contracting with a network of licensed/certified healthcare providers. There are nine MCOs that participate in HealthChoice.

Participating HealthChoice MCOs

Aetna Better Health
CareFirst BlueCross Blue Shield Community Health Plan Maryland
Jai Medical Systems
Kaiser Permanente
Maryland Physicians Care
MedStar Family Choice
Priority Partners
UnitedHealthcare
Wellpoint Maryland

For more information about HealthChoice and MCOs, please visit the Maryland HealthChoice Program website.

MCO Changes

The DataPort shares data from January 2013 to the present. During that time, some MCOs have joined HealthChoice, others have departed. Some MCOs have changed names. Here is a summary of MCO changes during the period covered by the DataPort.

  • January 2023 – Amerigroup Community Care becomes Wellpoint Maryland
  • January 2021 – University of Maryland Health Partners becomes CareFirst BlueCross Blue Shield Community Health Plan Maryland
  • November 2017 – Aetna Better Health joins HealthChoice
  • January 2016 – Riverside becomes University of Maryland Health Partners
  • June 2014 – Kaiser Permanente joins HealthChoice
  • October 2013 – Coventry leaves HealthChoice
  • February 2013 – Riverside joins HealthChoice

HealthChoice Coverage Categories

Affordable Care Act Expansion:

This category contains enrollees who were determined eligible based on their income, as established by the Affordable Care Act (ACA) Medicaid expansion.

Disabled:

This category contains enrollees who were determined eligible for Medicaid based on their disability or their eligibility for other programs such as Supplemental Security Income (SSI).

Families and Children:

This is a broad category that includes a range of enrollees. Some in this category were determined eligible for Medicaid based on their income, some based on their life circumstances (e.g. formerly in foster care, refugees), and others based on a combination of income and health needs (e.g. pregnant women).

Maryland Children’s Health Program:

This category contains children whose household income qualifies them for coverage. The income guidelines in Maryland Children’s Health Program (MCHP) are higher than in Medicaid Families & Children, and may not extend coverage to adults in the household.

Other: 

This category consists of enrollees who are not in any of the other categories above. Enrollees in partial-benefit Medicaid programs such as the Family Planning Program and Emergency Services for Undocumented or Ineligible Aliens are included in this category, as well as those eligible for Medicaid through the Women’s Breast & Cervical Cancer Program.

Unknown Coverage Category: 

This category contains enrollees for whom the coverage category is missing or blank.

HealthChoice MCO vs. Fee-For-Service Medicaid

Most Marylanders in Medicaid are enrolled in HealthChoice, where the Medicaid program pays MCOs, who then compensate the health care providers. Some individuals are ineligible for enrollment in a HealthChoice MCO and are instead served under Fee-For-Service Medicaid, where the Medicaid program pays the health care providers directly.

Cell Suppression

In accordance with The Hilltop Institute’s cell suppression policy, the DataPort sometimes displays an asterisk (*) instead of a number. This is cell suppression. Data privacy standards require that any cell with a value between 1 and 10 must be suppressed. In addition, any cell that can be used to mathematically derive the value must be suppressed. In cases where only one cell in a table must be suppressed, the DataPort also suppresses the cell with the next highest value, even if that value is greater than 10.

Primary Adult Care Program (PAC)

PAC was a program to extend limited Medicaid benefits to adults who would not otherwise qualify. The program ended after 2013, when the Affordable Care Act Medicaid expansion went into effect.

To find the number of individuals who were enrolled in PAC during 2013, you will need three separate numbers:

  • The total when selecting “All Medicaid” from the Medicaid Enrollment drop-down list.
  • The total when selecting “HealthChoice: All MCOs” from the Medicaid Enrollment drop-down list.
  • The total when selecting “Fee-for-Service Medicaid” from the Medicaid Enrollment drop-down list.

Subtract the “HealthChoice: All MCOs” and “Fee-for-Service Medicaid” totals from the “All Medicaid” total. The number that remains is the PAC population.

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