Information for Users of Medicaid Data
Monthly Expenditure Reports:
The current monthly Medicaid Expenditure Report replaces the former Table 11 of the NYS Department of Social Services Social Statistics Report. Both represent summary data from three data sources (MARS reports, Schedule E and SMI) but the new report is more comprehensive in the number of services included.
The Medicaid Expenditure Report data sources include:
- The MARS 72 report, which lists current Medicaid payments by source of funds.
- The MARS 73 report, which lists retro Medicaid payment by source of funds.
- The Schedule E report, which records off line payments made for various service categories by source of funds.
- The SMI report, which lists Supplementary Medical Insurance payments made for Medicare Part B.
The major difference in the two reports is in the service categories listed. This is reflected in the following chart:
|Current Medicaid Expenditure Report||Table 11|
|Total Medicaid Expenditures||Total Medicaid Expenditures|
|HMO Payments||Included in Other|
|LTC Managed Care||Included in Other|
|Prepaid Mental Health||Included in Other|
|Case Management||Included in Other|
|SMI||Included in Other|
|Third Party Health Insurance Payments||Included in Other|
|Hospital Inpatient||Hospital Inpatient|
|Hospital Outpatient||Hospital Outpatient|
|Free Standing Clinic||Free Standing Clinic|
|Child Care Per Diem||Included in Other|
|Drugs and Supplies||Drugs and Supplies|
|Personal Care||Personal Care|
|Home Health Services||Home Health Services|
|Waived Services||Included in Other|
|Assisted Living Program||Included in Other|
|Lab & X-Ray||Lab & X-Ray|
|Included in Other||Family Planning|
|Included in Other||Eye Appliance and DME||Included in Other|
|Included in Other||Hospice||Included in Other|
|Included in Other||PERS Total||Included in Other|
|Included in Other||Rehab & Therapy||Included in Other|
|Included in Other||Rehab Options||Included in Other|
|Included in Other||Other Practitioners||Included in Other|
|Included in Other||Other Services||Included in Other|
These eligibility reports replace Table 10 of Social Statistics, as published by the former State Department of Social Services.
With the advent of Welfare Reform as well as the revision in Medicaid funding through the Managed Care Waiver, there were major changes in eligibility beginning in October 1997. Unfortunately, due in part to concurrent work on Year 2000 initiatives, the changes to the new categories were not captured in the previous reporting system.
A different method of deriving the data was developed, using the same source (WMS) and comparable time frame. The changes in the new aid categories are reflected beginning with the May 1998 report.
Considerations in using these eligibility data are:
- County is the county of fiscal responsibility, which is not necessarily the same as the county of residence.
- Eligibles are individuals who applied for and were determined eligible for the Medicaid program.
- "TANF" stands for Temporary Assistance to Needy Families; "SSI" is Supplemental Security Income.
Quarterly Expenditure and Beneficiary Reports by Eligibility Grouping Reports:
These reports replace Tables 34, 35, and 36 of the Statistical Supplement to the Department of Social Services Annual Report.
The Medicaid reports showing expenses and beneficiaries by eligibility have the following considerations:
- The data for these tables are compiled from the MARS 36 reports, which are monthly date of payment reports, i.e. the report dates reflect the date of payment for the service, rather than the date the service was actually received. These reports do not include retroactive payments.
- Regions: "NYS Dept. of Health" includes data for all locally administered eligibles in New York City and the 57 other counties. "Rest of State" denotes the 57 county social service districts outside of New York City.
- Beneficiary counts are unduplicated within the county and aid category, and also for the grand and subtotals. However, if an individual changes aid category group and/or local district, s/he will be counted in the group according to the eligibility at the time the services were received. Thus the sum of detailed groupings will be greater than the total if payments are made in the same time period for services received by the same individual during different eligibility criteria.