CMS Needs Better Medicaid Data Quality to Support Health Equity

Poor data quality is limiting the ability of CMS to measure health equity in the Medicaid program, according to a HealthAffairs article.

CMS has made efforts to improve Medicaid administrative data through the new Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). However, the agency recently reported that TAF race and ethnicity data were missing for more than 10 percent of enrollees in most states.

CMS stated that these data were “unusable” in five states and of “high concern” in 17 more. Only 15 states exhibited TAF race and ethnicity data that was of “low concern.”

Questions regarding enrollee race and ethnicity are optional fields on Medicaid enrollment forms, so some enrollees may opt-out of sharing this information due to distrust of how agencies will use it.  

Researchers at the University of Minnesota’s State Health Access Data Assistance Center have suggested three strategies to improve race and ethnicity data quality in the Medicaid program.

“First, since questions about race and ethnicity are optional on Medicaid enrollment forms, states, through their Medicaid application forms and intake processes, should take additional steps to explain the importance of the data and how they will be used,” the HealthAffairs authors wrote.

Second, states should work with community organizations to engage enrollees in improving data collection and communicating how the data will help ensure health equity in the Medicaid program.

Lastly, states should explore augmenting race and ethnicity data obtained via self-report with data from other sources such as vital records, EHRs, and other state-administered programs like the Supplemental Nutrition Assistance Program.

However, even if race and ethnicity data quality is improved, the ability to measure health equity in the Medicaid program requires the ability to identify patients in need, the authors noted.

To measure need, analysts often rely on claims-based diagnosis codes that stakeholders enter after individuals use care. However, since minority groups face care access barriers, claims data underestimate disease prevalence for these populations.

“Additionally, these data include little information about a patient’s health or social history, missing essential information for identifying the most vulnerable patient populations,” the authors wrote. “This results in a data paradox: Medicaid enrollees with the greatest unmet need may be the most difficult to identify.”

“A national Medicaid survey could help support more comprehensive monitoring of healthcare need relative to use, and if designed to oversample racial and ethnic minoritized populations, could also support more rigorous monitoring of quality of care and disparities within the program,” they continued.

While Medicaid managed care plans often collect patient experience data, CMS has not conducted a national survey of Medicaid enrollees since 2014-2015, when the agency fielded a Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems (NAM CAHPS).

“This stands in contrast to the Medicare program, where the Medicare CAHPS and Medicare Current Beneficiary Survey are fielded annually,” the article pointed out. “While data from the latter surveys can be used to assess equity among Medicare enrollees dually eligible for Medicaid, they cannot inform assessments of health equity in the Medicaid population at large.”

Population surveys provide a representative sample of individuals regardless of whether or not they access care.

“By expanding on existing survey infrastructure and investing in a national Medicaid survey, CMS has a clear path for evaluating and advancing health equity in the Medicaid program,” the authors wrote. “A new data collection effort could strengthen monitoring of equitable care by both oversampling certain populations to obtain more precise estimates of patient experience and enhancing the set of questions asked about patient access to care.”