NC Medicaid
Description
Medicaid is a health insurance program for lower-income people, and in some states, people with severe mental illness, medically fragile children, and those in nursing homes and adult care homes. It is jointly funded by federal and state governments. States administer their own programs, generating considerable across-state coverage and claims variation.
Through a Memorandum of Agreement (MOA) between the Department of Population Health Sciences and the North Carolina Department of Health and Human Services (NCDHHS), DPHS receives a limited dataset of NC Medicaid data for the conduct of research, audit, and evaluation activities.
The latest claims data available can be found in our Data Catalog.
Key Considerations
Data include enrollment periods and programs, beneficiary demographics, healthcare services (e.g., diagnoses, procedure codes, payments, provider information), and prescription drug fills.
Beneficiaries may have multiple periods of enrollment and disenrollment over time.
NC Medicaid data files contain PHI (i.e., dates of health services, date of birth) and are considered a limited dataset.
Beneficiaries are identified across time using encrypted identification numbers
DataShare has NC Medicaid claims beginning July 1, 2013. New claims are processed quarterly and existing claims are refreshed for two years.
While we have 2013 data, it is recommended to not use that year of data due to quality concerns from NCDHHS.
NC Medicaid added managed care (MC) encounter data starting July 1, 2021.
North Carolina Medicaid claims from NCDHHS are structured differently than those available from CMS (i.e., TAF RIFs). A comparison is here.
In addition to processing the NC Medicaid data, DataShare also creates convenience tables to improve the efficiency of working with these data (see Data Tables link, below)
Governance
NC Medicaid data are subject to cell-size suppression policies (cell counts <11) for beneficiary-level data; 0 is permissible to show.
See the Cell Size Suppression Requirements for more information.
Before submitting a grant application, obtain permission from the NC Medicaid liaison to include feasibility assessment results. Permission is granted if they are generalized. (e.g., "more than 1000"). NCDHHS must review and approve the inclusion of detailed results (e.g., demographic table with exact counts).
New studies must submit a proposal to the PopHealth NC Medicaid committee and NCDHHS for approval. Forms will be provided to applicants as they progress through the process.
Studies may request access to claims that have been released but not processed locally (up to one month earlier than the present time), but may not request data that will be released in the future.
Teams have post-approval responsibilities to maintain their NC Medicaid applications. See NC Medicaid Application: Post-approval Maintenance Requirements.
Manuscripts and conference materials must be approved by NCDHHS before publication.
The MOA between DPHS and NCDHHS does not permit direct person-level linkages between the NC Medicaid data and other data sources. However, other higher-level linkages (such as area-level and provider-level linkages) are allowed.
There is not currently a path for studies to make a deidentified NC Medicaid dataset publicly available. However, sharing analytic code is an option and interested researchers may acquire raw data by establishing their own NC Medicaid applications.
For those interested in using data from Local Management Entity-Managed Care Organizations (LME-MCOs): NCDHHS does not permit LME-MCOs to share NC Medicaid claims or eligibility data, but they may provide marketing data that is not person-level. However, NCDHHS is generally amenable to creating crosswalks that identify LME-MCO cohorts in the claims available through DataShare.
Email submissions and governance questions to the NC Medicaid liaison (dphsmedicaid@dm.duke.edu).
NC Medicaid Wiki Content
Most content is access-restricted to NC Medicaid DataShare users. Click content to request access.
More Information
Data Documentation (authorized users)
NC Medicaid Data Dashboards and Monthly Enrollment Reports from NCDHHS (external sites)
NC Medicaid Clinical Coverage Policies (external site)
NC Medicaid Fact Sheets from NCDHHS (external sites)
NC Medicaid bulletins describe policy and covered code changes, with the exception of pharmacy changes (external site)
The NC Medicaid Outpatient Pharmacy page includes the approved formulary and pharmacy newsletters that describe drug coverage changes (external sites)