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1、Preliminary Medicaid & CHIP Data Snapshot Services through May 31, 2020 Service use among Medicaid & CHIP beneficiaries age 18 and under during COVID-19 Medicaid & CHIP OverviewSlide 3 Children Covered by Medicaid & CHIPSlide 4 What You Should Know About the DataSlide 5 HighlightsSlide 6 Results for

2、 Medicaid & CHIP Beneficiaries under 18: Slides 7 鈥?14 Slides 13, 15 鈥?17 Forgone Care Telehealth Services COVID-Related TreatmentSlides 18 鈥?20 Appendix A: State Variation in IP Claims LagSlide 21 Appendix B: State Variation in OT Claims Lag Slide 22 Table of Contents 2 Medicaid and CHIP Population

3、: As of June 2020, over 91.8 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities, were enrolled across each state鈥檚 Medicaid or the Children鈥檚 Health Insurance Program for at least one day. About 42% of beneficiaries were children, which transla

4、tes to nearly 40 million beneficiaries. Approximately 55% of beneficiaries were female, 45% were male, and 9% were over the age of 65. 13% of the population is dually-eligible for Medicare and Medicaid. 34% of the population is white, 22% of the population is of unknown race, 21% is Hispanic, 17% is

5、 black, 4% is Asian, and less than 1 percent is American Indian and Alaska Native, Hawaiian/Pacific Islander, or multiracial. COVID-19 treatment rate: We use the following International Classification of Diseases (ICD), Tenth Revision (ICD-10), diagnosis codes to identify beneficiaries who received

6、treatment for COVID-19: 鈥97.29 (other coronavirus as the cause of diseases classified elsewhere) - before April 1, 2020 鈥07.1 (2019 Novel Coronavirus, COVID-19) 鈥?from April 1, 2020 onward. Although CMS does use lab claims for identifying COVID-19 treatment, CMS does not receive lab results from sta

7、tes and cannot determine whether a lab test was positive. Therefore, Medicaid & CHIP COVID-19 cases are only identifiable in TAF data when there is a corresponding COVID-19 related service. Medicaid and CHIP Data Processing: Medicaid and CHIP providers, managed care agencies, and Pharmacy Benefit Ma

8、nagers submit administrative claims data to state Medicaid and CHIP agencies for processing. Those agencies subsequently submit the data to CMS on a monthly basis via T-MSIS. These submissions have considerable variation in terms of completeness and quality. CMS processes states鈥? submissions and tr

9、ansforms them into the T-MSIS Analytic Files (TAF), which form the basis of this analysis. Given this process, there may be a significant 鈥渃laims lag鈥?between when a service occurs and when it is represented in TAF. Therefore, users should interpret the results with caution. Data Quality Concerns: T

10、he results for all slides except for the maps on slides 18 and 19 include services through the end of May 2020, while these maps include cumulative counts through the end of June 2020. California has not submitted its June T-MSIS data and has only submitted T-MSIS claims through the end of May. Beca

11、use of this, California鈥檚 data is not included on slides 18 and 19. This impacts national estimates and likely results in an undercount of testing and COVID-related services. For additional information regarding state variability in data quality, please refer to the Medicaid DQ Atlas. Medicaid & CHI

12、P Content Overview 3 1.Cornachione, Elizabeth, Robin Rudowitz, and Samantha Artiga. 2016. Children鈥檚 Health Coverage: The Role of Medicaid and CHIP and Issues for the Future. Kaiser Family Foundation. Available at: https:/www.kff.org/report- section/childrens-health-coverage-the-role-of-medicaid-and

13、-chip-and-issues-for-the-future-issue-brief/ 2.Musumeci, MaryBeth and Priya Chidambaram. 2019. Medicaid鈥檚 Role for Children with Special Health Care Needs: A Look at Eligibility, Services, and Spending. Kaiser Family Foundation. Available at: https:/www.kff.org/medicaid/issue-brief/medicaids-role-fo

14、r-children-with-special-health-care-needs-a-look-at-eligibility-services-and-spending/ 鈥?Nearly 40 million children are covered under Medicaid and CHIP 鈥?The programs cover three quarters of children living in poverty1 鈥?Approximately four in ten children covered under the programs have a special he

15、alth care need that requires health services2 Medicaid and CHIP Cover more than 4 in 10 Children Nationally and Provide Critical Services 4 Percent of Medicaid & CHIP claims received by months after service was delivered (based on March 2018 service date) Runout Month 123456912 Fee-for-service Claim

16、s Inpatient0.021.862.576.483.488.595.597.5 Long-term care 0.014.982.089.392.395.498.199.1 Other services 0.026.370.283.089.492.397.098.2 Prescription drug 0.064.097.998.598.898.999.199.2 Managed care encounters Inpatient 0.06.348.868.777.581.487.995.3 Long-term care 0.03.633.657.471.177.885.092.7 Ot

17、her services 0.09.855.877.685.388.493.196.5 Prescription drug0.034.683.693.296.397.497.998.8 Claims Lag: You should use caution when interpreting our data. We collect Medicaid and CHIP data for programmatic purposes, but not for public health surveillance. There will always be a delay or 鈥渃laims lag

18、鈥?between when a service occurs and when the claim or encounter for that service is reflected in our database. The length of the lag depends on the submitting state, claim type, and the delivery system. It is possible that there is a longer claims lag due to the pandemic. Historically, 90% of FFS cl

19、aims across all claims types are submitted within 7 months, while 90% of encounters across all claims types are submitted within 12 months. There is significant variation across states, with some states submitting 90% of all claims within only 4 months, while other states take nearly a year. On aver

20、age, states need 9 months to submit 95% of all claims. What You Should Know When Using The Data 5 Preliminary data suggest that, during the PHE: 鈥?Primary, preventive, and mental health services have declined among children 鈥?Service delivery via telehealth for children has increased dramatically, b

21、ut not enough to offset this decline in services 鈥?The COVID-19 treatment rate for children is low, with 0.1% receiving treatment for COVID-19 under Medicaid or CHIP and fewer than 1,000 hospitalizations Service use among children during COVID-19: Key highlights 6 9/23/2020 Notes: These data are pre

22、liminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each mo

23、nthly update. Because data for June are incomplete, results are only presented through May. Vaccination rates among beneficiaries up to age 2 dropped from nearly 700 vaccinations per 1,000 beneficiaries in January 2020 to about 460 vaccinations per 1,000 beneficiaries in May 2020 Preliminary data sh

24、ow vaccinations among beneficiaries up to age 2 declined through April, started to level in May, but are still substantially lower than prior years鈥?rates 7 22% fewer (1.7 million) vaccinations for children up to age 2 between March through May 2020, compared to March through May 2019 Notes: These d

25、ata are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results af

26、ter each monthly update. Because data for June are incomplete, results are only presented through May. There is significant variation in how quickly states submit claims to CMS. It is possible that this variation in claims lag is responsible for the differences in utilization across states. Please r

27、efer to Appendices A and B for additional information. AZ, CA, DC, HI, and VI had the lowest vaccination rates among children under 2 as of May 2020 (data incomplete) AL, CT, KY, NE, and NC had the highest vaccination rates among children under 2 as of May 2020 (data incomplete) Preliminary data sho

28、w trends in vaccination rates varies by state, with some states returning to February levels by May 8 9/23/2020 Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through

29、the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for June are incomplete, results are only presented through May. 44% fewer (3.2 million) child screening services between March through

30、May 2020, compared to March through May 2019 Screening rates among children dropped from nearly 68 screens per 1,000 beneficiaries to a low of 28 screens per 1,000 beneficiaries in April, back up to 35 screens per 1,000 beneficiaries in May. Preliminary data show the number of child screening servic

31、es declined substantially through April, started to rise in May, but is still substantially lower than prior years鈥?rates 9 Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with servi

32、ces through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for June are incomplete, results are only presented through May. There is significant variation in how quickly states submit

33、 claims to CMS. It is possible that this variation in claims lag is responsible for the differences in utilization across states. Please refer to Appendices A and B for additional information. CA, DC, HI, VI, and WI had the lowest screening rates as of May 2020 (data incomplete) AL, GA, ID, NC, and

34、TX had the highest screening rates as of May 2020 (data incomplete) Preliminary data show child screening rates declined in April and started to rise in May, but are still below January levels in nearly all states 10 9/23/2020 Notes: These data are preliminary. Data are sourced from the T-MSIS Analy

35、tic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for June are incomple

36、te, results are only presented through May. 69% fewer (7.6 million) dental services between March through May 2020, compared to March through May 2019 Dental service rates among children dropped from nearly 100 services per 1,000 beneficiaries to a low of 7 services per 1,000 beneficiaries in April,

37、 back up to 31 screens per 1,000 beneficiaries in May. Preliminary data show the number of dental services for children declined through April, started to rise in May, but are still substantially lower than prior years鈥?rates 11 9/23/2020 Notes: These data are preliminary. Data are sourced from the

38、T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for June

39、are incomplete, results are only presented through May. There is significant variation in how quickly states submit claims to CMS. It is possible that this variation in claims lag is responsible for the differences in utilization across states. Please refer to Appendices A and B for additional infor

40、mation. ID, MT, OK, TX, and WY had the highest dental service rates as of May 2020 (data incomplete) Preliminary data show dental service rates among children declined for all states through April, but there was considerable variation across states in May 12 CA, DC, MI, PR, and RI had the lowest den

41、tal service rates as of May 2020 (data incomplete) 9/23/2020 Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very

42、little time for claims runout and we expect large changes in the results after each monthly update. Because data for June are incomplete, results are only presented through May. 44% fewer (6.9 million) outpatient mental health services between March through May 2020, compared to March through May 20

43、19, accounting for telehealth visits Outpatient mental health service rates among children dropped from nearly 138 services per 1,000 beneficiaries in January 2020 to about 58 services per 1,000 beneficiaries in May 2020, including telehealth visits Preliminary data show outpatient mental health ser

44、vices for children declined through May. Telehealth increased starting in March, but not enough to offset this decline. 13 9/23/2020 Notes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions w

45、ith services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in the results after each monthly update. Because data for June are incomplete, results are only presented through May. There is significant variation in how quickly stat

46、es submit claims to CMS. It is possible that this variation in claims lag is responsible for the differences in utilization across states. Please refer to Appendices A and B for additional information. CO, HI, PR, RI and VI had the lowest outpatient mental health service rates as of May 2020 (data i

47、ncomplete) MT, NJ, OH, OK, and VT had the highest outpatient mental health service rates as of May 2020 (data incomplete) Preliminary data show outpatient mental health service use among children declined in nearly all states through April, but the rate of decline varied across states 14 9/23/2020 N

48、otes: These data are preliminary. Data are sourced from the T-MSIS Analytic Files v4 in AREMAC, using final action claims. They are based on July T-MSIS submissions with services through the end of June. Recent dates of service have very little time for claims runout and we expect large changes in t

49、he results after each monthly update. Because data for June are incomplete, results are only presented through May. There is significant variation in how quickly states submit claims to CMS. It is possible that this variation in claims lag is responsible for the differences in utilization across sta

50、tes. Please refer to Appendices A and B for additional information. AZ, FL, PA, RI, and VI had the lowest rates of mental health services delivered through telehealth as of May 2020 (data incomplete) CT, MD, MN, NE, and NH had the highest rates of mental health services delivered through telehealth