Using Medicaid Claims to Measure Chronic Condition Prevalence in Maryland Full-Benefit Dual Eligibles

Abstract

The Maryland Department of Health maintains near real-time Medicaid data on enrollees, which is used to analyze patterns in population health, track service utilization, and support program oversight efforts, many of which require examining subgroups, including those with chronic conditions. Among enrollees dually eligible for Medicare and Medicaid, Medicare serves as the primary payer for Medicare-covered items and services, while states cover Medicare premiums and in some cases cost sharing or services not covered by Medicare. Nonetheless, states’ access to Medicare Research Identifiable Files can be lagged by years, delaying access to critical data on dual eligibles.