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FAQ Data Description Recipients
FAQ Data Description Recipients
Select the Frequently Asked Question to view answer.
What recipients are included in the data set?
All recipients with full Medicaid or Medicaid-like benefits who are not otherwise excluded from the Care Cordination Innovations Project (CCIP) are included in the data mart from which the data set is extracted. This includes priority and non-priority populations. It includes recipients who did not have any claims during the experience period. If a recipient did not have any claims, they by definition, also do not have any Chronic Illness and Disability Payment System (CDPS) condition or drug flags. Partners can request sub-populations of the data mart.
What recipients are excluded from the data sets?
Full-benefits recipients who qualify via the Spend-down, Illinois Breast and Cervical Cancer Program (IBCCP), Integrated Care Program (ICP) and Health Benefits for Workers with Disabilities (HBWD) are excluded from the data sets. Please see the
for definitions of these programs. More information on populations excluded from Care Cordination Innovations Project (CCIP) can be found in
, Section 188.8.131.52.
Are recipients with partial benefits-related data included in the data sets?
No. Only data associated with recipients with full benefits, not otherwise excluded from Care Cordination Innovations Project (CCIP), is included. Anyone receiving partial benefits is excluded.
Are recipients who disenrolled from Medicaid during the experience period included in the data sets?
Yes. Recipients who had full benefits for any part of the experience period are included in the data sets. They are in the data set with the claims from their enrollment period. Their current eligibility indicator will be “0” and their Total Enrolled Days will be less than 365.
How many recipients’ records are in the data sets?
Over three million recipients are included in the data set. As some of these persons enrolled, disenrolled, or died during the experience period, the total number of recipients at any one point in time is approximately 2.8 million.
How are children included in the data sets?
People of all ages are included in the data sets. Age bands include information on three sets of children: age 0 (under age 1), people aged 1 to 18, and people aged 19-20. HFS generally classifies anyone under 19 (0-18 years of age) as a child, but certain specific programs extend the pediatric category up to 19 years old. Additionally, some waivers for developmentally disabled persons place children and young adults (aged 3 to 21 years) into one group. When analyzing data on pediatric populations, please be mindful of rules on age categories specific to the waiver or program of interest. Also, when describing how a Coordinated Care Entity (CCE) and Managed Care Community Network (MCCN) proposes to provide services to children, please describe the age range of child patients.
A specific solicitation related to children with complex medical needs will be released in the spring of 2012. We have not yet defined the term ‘children with complex medical needs.’ (It is reasonable to assume that children enrolled in the Medically Fragile and Technology Dependent waiver and many of the children who are classified as disabled will be classified as having complex medical needs.) That solicitation will describe children with complex medical needs and related data in more detail.
Who are priority populations and how they are included in the data sets?
Priority populations are groups of people who must be included in clinical planning for Coordinated Care Entities (CCEs) and Managed Care Community Networks (MCCNs). For the current solicitation, the priority population is Seniors and Persons with Disabilities (SPD), including Dual Eligibles. Seniors are defined as any individual over age 65, irrespective of their health condition.
Persons with Disabilities are defined as persons over 18 and under 65 years old, whose Medicaid eligibility is based on their status as a blind or disabled person, as defined in Section 1614(a) of the Social Security Act (42 U.S.C.1382). The category ‘Persons with Disabilities’ includes Long-Term Care populations, those with Serious Mental illness (SMI), Home and Community-Based waiver populations, and Dual Eligibles. For the current Solicitation, the state is particularly interested in proposals that include Clients with SMI and/or Substance Use Disorders (SUD).
The data sets include a flag for Seniors and Persons with Disabilities.
Who are non-priority populations and how are they included in the data sets?
The data set includes information on nearly 3 million Medicaid recipients. Many are non-priority recipients. All data fields for priority populations are also available for non-priority populations.
Non-priority recipients are adults (aged 19 to 64) who have Medicaid eligibility based on their income status, irrespective of any disabilities they may experience, and who do not qualify as a Senior or Person with Disability (SPD). Typically, these are parents or primary caregivers of Medicaid-eligible children. Children (under age 19) are also a non-priority population for the current solicitation, irrespective of disability status. In some contexts, this population may also be referred to as ‘other adults,’ ‘Temporary Assistance for Needy Families (TANF) adults,’ and ‘non-disabled adults (AA).’
The Solicitation refers to these adults as ‘Other IHC Adults’ as most non-priority adults are required to enroll in Illinois Health Connect (IHC), a Primary Care Case Management (PCCM) program. Please see Section 184.108.40.206 of the
for additional information.
Non-priority populations can be distinguished in the data set by a zero value with respect to the Seniors and Persons with Disabilities flag.
What recipients will be included in the data an organization receives?
Your particular data set will have only the recipient populations that you have requested. Each potential Coordinated Care Entity (CCE) and Managed Care Community Network (MCCN) organization can request two sets of data. We suggest that one data set specific to a target population and one that captures a broader geographic population may be useful. We will extract the data set(s) from our data mart based on the specifications of a prospective partner organization. An organization’s specifications, however, have to be based on data attributes that we have available.
Please refer to the FAQ section entitled “
Guidelines on Requesting and Using the Data
” and the Letter of Intent (Attachment D of the
) for more information.
What populations are excluded from the data sets?
(Pages 8-9): “Clients excluded from participation in the Care Coordination Innovations Project (CCIP) include: 1) Integrated Care Program (ICP) Clients in Suburban Cook (non-606 zip codes), DuPage, Kane, Kankakee, Lake, and Will counties; 2) Spend-down populations; 3) children under age 19 who are not in the family of an adult enrolled in a Coordinated Care Entity (CCE) or Managed Care Community Network (MCCN); 4) Illinois Breast and Cervical Cancer Program (IBCCP) Clients; 5) Health Benefits for Workers with Disabilities (HBWD) Clients; and 6) individuals enrolled in partial benefit plans.”
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