Estimates of dual and full Medicaid benefit dual enrollees, 1999.
There is a clear need to develop better estimates of dual (Medicare and Medicaid) enrollees and the subpopulation of dual enrollees who receive full Medicaid benefits. Dual enrollees that may receive full Medicaid benefits include: qualified Medicare beneficiaries (QMBs), specified low-income Medicare beneficiaries (SLMBs), and other dual beneficiaries--a group that includes medically needy/spend-down enrollees. Better estimates are needed for a number of activities:
* A need to improve coordination of public funds from Medicare and Medicaid to meet the service needs of these vulnerable populations.
* Continuing increases in utilization and program spending for these vulnerable populations, especially dual disabled enrollees. These spending increases are straining Medicaid budgets in times that States are in fiscal crisis.
* A need for baseline estimates of State spending amounts for prescription drugs provided to dual enrollees by Medicaid to support cost estimates for these populations once drug coverage for these groups begins in 2006 under Medicare.
* A need to monitor changes in utilization and spending levels for dual enrollees under Medicaid.
The estimates shown in the tables are not official CMS estimates and should not be construed to represent data used for purposes of implementing the provisions of Section 103 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) relating to the Federal assumption of Medicaid prescription drug costs for dual enrollees.
NEED TO LINK MEDICARE AND MEDICAID DATA
Neither the Medicare nor the Medicaid systems, by themselves, permit complete and accurate reporting of dual enrollees.
The Medicare system maintains data on persons enrolled in Medicaid and for whom Medicaid has paid the Medicare Part A and B insurance premiums in the enrollment database (EDB). Historically, these third-party liability data were housed in a Medicare data set commonly known as the TPEarth file (or the third party buy-in). Data from these Medicare systems have traditionally represented an undercount of all dual enrollees because States do not necessarily pay Medicare premiums for all dual enrollees.
The Medicaid analytic extract (MAX) data include two possible data elements that may identify dual enrollees. The first is the "dual eligibility flag." In its current form, this data element was first required of State Medicaid agencies beginning with fiscal year (FY) 1999 reporting under the Medicaid statistical information system (MSIS), the source for MAX data. Data quality may vary substantially from State-to-State for this data element. The second is a pair of data elements that report Medicare deductible and coinsurance payment amounts paid by Medicaid for a dual enrollee on an individual claim. Again, data quality is uncertain because reporting of these amounts was also required of State Medicaid agencies for the first time, beginning with FY 1999.
MEDICARE AND MEDICAID LINK
The source data for the most recent link are the Medicaid MAX data for calendar year (CY) 1999 and the Medicare EDB for the 50 States and Washington, DC. In order to maximize the quality of the linking process, the Medicare health insurance claim (HIC) was not used as a primary linking variable. Instead, the linking criteria use the Medicaid enrollees' Social Security Number (SSN), date of birth (DOB), and sex. The link effort begins with Medicaid MAX data and consists of two steps:
* The first step has different criteria for aged versus disabled Medicaid enrollees. For aged Medicaid enrollees, SSN, and sex must match exactly. For disabled Medicaid beneficiaries, either the enrollees' SSN or the DOB must match exactly, or SSN and sex must match exactly, and two of the three elements in DOB must match exactly.
* In the second step, there is an attempt to link the Medicaid SSN to a claim account number (CAN) from the HIC in the EDB for records that were not linked in the first step. This is done because some enrollees incorrectly report the CAN from an account on which they receive auxiliary benefits (as a spouse, widow, child, etc.) as their own SSN. For example, a spouse will report her husband's SSN as though it were her SSN. A check on sex and DOB assures that a correct link is made.
Once it is determined that the enrollee appears in both the MSIS and EDB data sets, it is necessary to determine if the enrollee was eligible for both programs at the same time.
* For each MAX eligibility record, month-by-month Medicaid enrollment is compared to repeating segments of Medicare enrollment. A dual indicator is set whenever an overlap occurs. An annual (CY) dual indicator is set if the dual indicator for any month is set. The result is an enhanced MAX eligibility data set that includes information about the results of the EDB link.
* For persons identified as dual enrollees, selected data elements from the EDB are added to the Medicaid enrollment data. Because this is a Medicaid database, all MAX records are retained. However, information on dual enrollment status is not retained if the EDB contains an indication of dual enrollment status, but there is no record in the MAX file for the enrolled person.
COUNTING DUAL ENROLLEES USING MAX DATA
Following the EDB link, the MAX data provides counts of confirmed dual enrollees, by State. There is the potential for bias both in terms of undercounting and overcounting. The potential for undercounting may be caused by one or more of several factors: (1) the record for a dual enrollee may have been missing from either the EDB or the MAX file, (2) SSN may have been missing in the MAX file, or (3) there may have been errors or number transpositions in the recorded SSN. The possibility of overcounting is not as likely, but could be caused if an enrollee moved to a different State during the year because the MAX data are State-specific data sets. Because of this, there has been no attempt to unduplicate persons across States.
Estimates include adjustments for under-counting persons reported as dual by Medicaid, but not linked with an SSN or with incorrect/non-matching SSNs. However, estimates do not include adjustments for undercounting of persons reported as dual enrollee by Medicare, but not linked to Medicaid (e.g. persons on Medicare TPEarth). The estimates do not adjust for over-counting that may occur if the Medicaid person was enrolled in more than one State or if more than one person was identified with the same SSN in Medicaid. In both cases where adjustments were not made, the extent of over-counting and/or undercounting should be extremely minor and offsetting.
DUAL ELIGIBLE COUNTS--ADJUSTING FOR BIAS
Two sets of State-specific estimates are produced in Table 1. The first set is known as the "best estimate." It consists of enrollees confirmed to be dual enrollees as a result of the EDB link and selected Medicaid enrollees not linked to EDB (those identified as dual enrollees by Medicaid and having at least one claim in the year where Medicare copayment and/or deductible was paid by Medicaid in 1999). The second set of estimates is known as the "upper bound estimate." It consists of enrollees confirmed to be dual enrollees as a result of the EDB link and selected Medicaid enrollees not linked to EDB (those identified as dual enrollees by Medicaid or having at least one claim in the year where Medicare copayment and/or deductible was paid by Medicaid. Because of data inconsistencies for several States, these estimates are adjusted to not exceed the total number of aged and disabled enrollees in each State.
Estimating Full Medicaid Benefit
Currently it is not possible to estimate full Medicaid benefit dual enrollees using Medicare data alone. However, there are two Medicaid data elements that are used to increase the accuracy of these estimates.
The first of these data elements is the dual eligible flag. This data element was first required in MSIS reporting for FY 1999. While MSIS has established a 2-percent error tolerance for this data element; reporting remains inconsistent. One State (Pennsylvania) did not report dual enrollment status. Five other States (Georgia, Ohio, Rhode Island, Tennessee, and West Virginia) reported no full Medicaid dual enrollees. Findings for these six States are inconsistent with national estimates that about 90 percent of all dual enrollees are full Medicaid dual enrollees. However, the most pervasive data reporting problem for this data element was that many States reported dual eligibility status of unknown for a high percentage of their dual enrollees. Based on MAX data for 1999, 21 States reported greater than 20 percent of dual enrollment status of unknown. Among those States, 11 reported greater than 50 percent unknown.
There are two estimates of full Medicaid benefit dual enrollees that are produced using this data element (Table 2). The first estimate, known as the "lower bound estimate", assumes that dual enrollees of unknown type are distributed according to the same percentages as those for whom type is known. This assumption becomes questionable as the percentage of dual enrollees of unknown type grows, but it does establish a lower bound for the number of full Medicaid benefit dual enrollees. The second estimate, known as the "best estimate", assumes that all dual enrollees of unknown type are full Medicaid benefit dual enrollees. This is a reasonable assumption because, as noted previously in the national estimates, about 90 percent of all dual enrollees are full Medicaid benefit dual enrollees. Also, it is likely that States would have correctly identified dual enrollees who do not receive full Medicaid benefits because of the need they have to coordinate coverage and reimbursement with Medicare.
The second data element is the "restricted benefits flag." As with the dual eligible flag, this data element was first reported by States, in MSIS for FY 1999. While this data element has a 5-percent error tolerance for States, it is reported that data quality is questionable (Ellwood, 2004). A code value of 3 for this data element indicates that the person is enrolled in Medicaid, but only entitled to restricted benefits based on Medicare dual-eligibility status (e.g. QMB only, SLMB only, qualified disabled and working individuals--QDWIs or qualifying individuals--QI1s or QI2s) (Centers for Medicare & Medicaid Services, 2004a). An estimate of full Medicaid benefit dual enrollees is made using this data element to subtract numbers of dual enrollees with restricted benefits from the total numbers of dual enrollees. These estimates are also shown in Table 2.
As a best estimate, there were about 6.881 million dual enrollees, nationally, ever enrolled in both Medicare and Medicaid during 1999. This represented about 16.2 percent of all Medicaid enrollees. An upper bound estimate was 7.288 million dual enrollees.
Because the quality of reporting was uncertain for data elements used to estimate full Medicaid benefit dual enrollees, the reliability of those estimates is less certain than the estimates of all dual enrollees. However, the estimates of full Medicaid dual enrollees ranged from a lower bound estimate of 5.916 million (86.0 percent of all dual enrollees) to a best estimate of 6.091 million (88.5 percent of all dual enrollees).
These estimates of dual enrollees compare favorably with estimates from other sources:
* An estimate for FY 1999 is 6.982 million duals, using an actuarial rules of thumb regarding the percentage of aged and disabled who are dual enrollees (95 percent of Medicaid aged and 40 percent of Medicaid disabled beneficiaries) on reported FY 1999 MSIS summary statistics (Klemm, 2004; Centers for Medicare & Medicaid Services, 2004b). The data reported in this article are quite close to this estimate because both estimates are counts of enrollees ever enrolled in a year. The primary difference is that one estimate is for CY 1999 and the other is for FY 1999.
* The Kaiser Commission on Medicaid and the Uninsured (2003) reported 5.84 million full Medicaid dual enrollees for FY 2000. Colleagues Bruen and Holahan (2004) reported 7.2 million dual enrollees and 6.13 million full Medicaid dual enrollees for 2002. These estimates are also counts of persons ever enrolled in a year.
* The Henry J. Kaiser Family Foundation (2004) reported 5.8 million dual enrollees as of the August 2002 billing cycle, reflecting enrollment as of June 2002. Estimates of dual enrollees for the first quarter of FY 1999 were 5.46 million (Ellwood, 2002). Using a similar methodology, Ku (2003) estimated 5.4 million full Medicaid dual enrollees in 1999. The Medicaid Chart Book reports an average number of 6.4 million dual enrollees during CY 2000 (Centers for Medicare & Medicaid Services, 2003). Data from the Medicare Current Beneficiary Survey in 1999 show 6.277 million persons with health insurance coverage through Medicaid (either as Medicare buy-in individuals or as reported by survey respondents). Clark and Hulbert (1998) reported between 6.4 and 6.7 million dual enrollees for 1997, using (form) HCFA-2082 reports that were actuarially adjusted to represent person years of enrollment and to approximate average monthly enrollment. It is reasonable that estimates reported here should be higher than these quarterly, monthly, or point-in-time estimates because of enrollment turnover through the year.
* Finally, Dale and Verdier (2003) estimated that there were 6 million dual enrollees in 2002.
Reprint Requests: David K. Baugh, M.A., Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop C3-20-17, Baltimore, Maryland 21244-1850. E-mail: dbaugh@ cms.hhs.gov
The author would like to thank William Clark, Suzanne Dodds, Marilyn Ellwood, David Gibson, and John Klemm for their technical input and review. The author would also like to thank Matt Gillingham and Yifei Hu for providing background data for the estimates. Finally, the author would like to thank Chuck Brinker for his work on the linking methodology between Medicaid (MAX) and Medicare (EDB) data.
Bruen, B. and Holahan, J.: Shifting the Cost of Dual Eligibles: Implications for Slates and the Federal Government. The Kaiser Commission on Medicaid and the Uninsured. November, 2003. Internet address: http://www.kff.org/medicaid/4152.dm (Accessed March 2004.)
Centers for Medicare & Medicaid Services: Medicaid Chart Book, unpublished data. July 2003.
Centers for Medicare & Medicaid Services: Internet address: http://www.cms.gov/medicaid/ msis/msisdd99.pdf (Accessed March 2004a.)
Centers for Medicare & Medicaid Services: Internet address: http://www.cms.gov/medicaid/msis/msis99sr.asp, (Accessed March 2004b.)
Clark, W. and Hulbert, M.: Research Issues: Dually Eligible Medicare and Medicaid Beneficiaries, Challenges and Opportunities. Health Care Financing Review, 20(2):1-10, Winter 1998.
Dale, S. and Verdier, J.: State Medicaid Prescription Drug Expenditures for Medicare-Medicaid Dual Eligibles, Issue Brief Number 627. The Commonwealth Fund. New York. Internet address: www.cmwf.org. (Accessed April 2003.)
Ellwood, M.: Background Information on Dual Eligibles in MSIS (FY 1999). Unpublished manuscript, originally prepared for Assistant Secretary for Planning and Evaluation, February 2001. Updated February 28, 2002.
Ellwood, M.: Personal communication: February 27, 2004.
Henry J. Kaiser Family Foundation: Internet address: http://www.statehealthfacts.org/cgi-bin/ healthfacts.cgi?action=compare&category=Medica re&subcategory=Dual+Eligibles&topic=Total+Dual +Eligibles (Accessed March 2004.)
Kaiser Commission on Medicaid and the Uninsured: A Prescription Drug Benefit in Medicare: Implications for Medicaid and Low-Income Medicare Beneficiaries. Internet address: http://www.kff.org/medicaid/kcmu4136brief.cfm. (Accessed September 2003.)
Klemm, J.: Personal communication. March 1, 2004.
Ku, L.: How Many Low-Income Medicare Beneficiaries in Each State Would Be Denied the Medicare Prescription Drug Benefit Under the Senate Bill? Center for Budget and Policy Priorities. Internet address: http://www.centeronbudget. org/7-31-03health.htm. (Accessed July 2003.)
David K. Baugh, M.A.
The author is with the Centers for Medicare & Medicaid Services (CMS). The statements expressed in this article are those of the author and do not necessarily reflect the views or policies of CMS.
Table 1 Estimates of Medicaid Dual Enrollees Ever Enrolled, by State: Calendar Year 1999 Best Confirmed Estimate Total Dual of Dual Medicaid Enrollees Enrollees State Enrollees (1) (2,4) Alabama 657,495 152,607 153,670 Alaska 103,789 9,756 9,807 Arizona 648,016 60,683 61,032 Arkansas 491,245 92,080 95,611 California 7,288,627 897,559 901,639 Colorado 357,814 65,503 65,889 Connecticut 417,767 80,036 80,620 Delaware 116,454 14,038 14,147 District of Columbia 146,668 17,334 17,507 Florida 2,104,306 375,666 377,811 Georgia 1,249,063 195,687 197,542 Hawaii 199,173 24,862 25,048 Idaho 134,065 18,889 18,924 Illinois 1,712,826 217,700 219,437 Indiana 694,508 116,613 117,168 Iowa 313,720 64,155 64,555 Kansas 256,690 51,714 51,979 Kentucky 687,437 140,341 141,612 Louisana 786,601 132,446 133,604 Maine 204,329 48,226 48,364 Maryland 686,834 85,887 86,628 Massachusetts 1,060,289 204,531 205,797 Michigan 1,339,452 204,389 205,323 Minnesota 591,427 96,760 97,234 Mississippi 552,951 125,374 126,330 Missouri 898,028 151,206 152,305 Montana 96,453 17,009 17,153 Nebraska 227,395 35,359 35,541 Nevada 139,700 23,941 24,085 New Hampshire 106,887 19,411 19,561 New Jersey 869,612 178,150 179,285 New Mexico 378,433 39,530 39,794 New York 3,403,171 562,166 578,402 North Carolina 1,209,799 261,684 263,206 North Dakota 61,806 14,182 14,250 Ohio 1,386,016 219,622 221,151 Oklahoma 533,438 89,656 90,213 Oregon 543,964 67,508 67,759 Pennsylvania 1,694,804 290,403 290,403 Rhode Island 169,491 31,518 31,670 South Carolina 757,964 119,023 120,444 South Dakota 95,437 17,161 17,236 Tennessee 1,541,222 253,772 255,027 Texas 2,710,200 464,601 467,926 Utah 202,235 20,307 20,366 Vermont 142,051 26,807 26,897 Virginia 696,419 139,649 141,355 Washington 899,702 104,903 105,560 West Virginia 358,317 55,708 56,291 Wisconsin 575,138 119,366 120,078 Wyoming 52,177 7,961 7,987 50 States and Washington, DC 42,551,405 6,823,439 6,881,223 Dual Enrollees (Best Upper Bound Estimate) as Estimate a Percent of of Dual Total Enrollees State Enrollees (3,4) Alabama 23.4 159,183 Alaska 9.4 9,931 Arizona 9.4 66,118 Arkansas 19.5 121,518 California 12.4 911,450 Colorado 18.4 67,422 Connecticut 19.3 81,147 Delaware 12.1 14,341 District of Columbia 11.9 19,063 Florida 18.0 380,456 Georgia 15.8 199,573 Hawaii 12.6 40,364 Idaho 14.1 19,057 Illinois 12.8 221,400 Indiana 16.9 118,548 Iowa 20.6 65,542 Kansas 20.2 53,222 Kentucky 20.6 208,686 Louisana 17.0 135,371 Maine 23.7 49,977 Maryland 12.6 89,249 Massachusetts 19.4 207,579 Michigan 15.3 222,843 Minnesota 16.4 98,038 Mississippi 22.8 217,657 Missouri 17.0 155,259 Montana 17.8 17,350 Nebraska 15.6 35,800 Nevada 17.2 26,132 New Hampshire 18.3 20,339 New Jersey 20.6 185,313 New Mexico 10.5 40,137 New York 17.0 600,751 North Carolina 21.8 269,374 North Dakota 23.1 14,313 Ohio 16.0 223,170 Oklahoma 16.9 114,432 Oregon 12.5 71,278 Pennsylvania 17.1 290,403 Rhode Island 18.7 31,936 South Carolina 15.9 122,667 South Dakota 18.1 17,488 Tennessee 16.5 304,033 Texas 17.3 484,020 Utah 10.1 20,649 Vermont 18.9 27,171 Virginia 20.3 142,509 Washington 11.7 109,131 West Virginia 15.7 57,507 Wisconsin 20.9 120,710 Wyoming 15.3 8,051 50 States and Washington, DC 16.2 7,287,658 (1) Dual enrollment status was confirmed by a link between Medicaid analytic extract (MAX) and Medicare enrollment data base (EDB) data for 1999. (2) Confirmed dual enrollees and non-confirmed Medicaid enrollees who were identified as dual enrollees by Medicaid and had at least one claim with Medicare copayment and deductible amounts paid by Medicaid. (3) Confirmed dual enrollees and non-confirmed Medicaid enrollees who were identified as dual enrollees by Medicaid or had at least one claim with Medicare copayment and/or deductible amounts paid by Medicaid. (4) Because of data inconsistencies for several States, this estimate is adjusted to not exceed the total number of aged and disabled enrollees in each State. SOURCE: Centers for Medicare 8 Medicaid Services: Medicaid Analytic Extract (MAX) data, 2004. Table 2 Estimates of Full Medicaid Benefit Dual Enrollees Ever Enrolled, by State: Calendar Year 1999 Lower Bound Best Estimate of Estimate of Best Full Medicaid Full Medicaid Estimate Dual Dual of Dual Enrollees Enrollees State Enrollees (1,2) (1,3) Alabama 153,670 103,069 110,921 Alaska 9,807 9,715 9,732 Arizona 61,032 39,908 47,191 Arkansas 95,611 74,745 74,745 California 901,639 883,585 883,604 Colorado 65,889 51,637 54,834 Connecticut 80,620 72,398 74,932 Delaware 14,147 8,038 9,895 District of Columbia 17,507 17,507 17,507 Florida 377,811 355,983 355,983 Georgia 197,542 169,846 174,858 Hawaii 25,048 24,966 24,972 Idaho 18,924 15,205 15,205 Illinois 219,437 154,097 158,821 Indiana 117,168 100,996 100,996 Iowa 64,555 50,637 53,523 Kansas 51,979 45,106 45,106 Kentucky 141,612 97,177 101,423 Louisana 133,604 111,718 111,718 Maine 48,364 42,434 42,434 Maryland 86,628 68,575 68,646 Massachusetts 205,797 166,827 191,568 Michigan 205,323 150,356 182,483 Minnesota 97,234 81,393 84,768 Mississippi 126,330 118,924 118,924 Missouri 152,305 137,478 137,478 Montana 17,153 16,525 16,532 Nebraska 35,541 33,844 33,878 Nevada 24,085 14,746 14,746 New Hampshire 19,561 18,517 18,517 New Jersey 179,285 147,286 151,920 New Mexico 39,794 12,912 29,041 New York 578,402 575,309 577,173 North Carolina 263,206 226,469 228,868 North Dakota 14,250 7,758 13,087 Ohio 221,151 190,145 195,756 Oklahoma 90,213 74,087 74,087 Oregon 67,759 47,654 52,466 Pennsylvania 290,403 249,688 257,056 Rhode Island 31,670 27,230 28,033 South Carolina 120,444 120,444 120,444 South Dakota 17,236 9,576 13,732 Tennessee 255,027 219,272 225,742 Texas 467,926 376,012 380,162 Utah 20,366 17,729 17,729 Vermont 26,897 25,802 26,159 Virginia 141,355 97,551 99,450 Washington 105,560 88,168 93,985 West Virginia 56,291 48,399 49,827 Wisconsin 120,078 114,405 114,405 Wyoming 7,987 4,614 5,984 50 States and Washington, DC 6,881,223 5,916,462 6,091,049 Full Dual Enrollees Full Dual (Best Enrollees Estimate) as Estimate (Using a Percent of Restricted Dual Benefits) State Enrollees (4) Alabama 72.2 107,468 Alaska 99.2 9,744 Arizona 77.3 52,089 Arkansas 78.2 71,745 California 98.0 884,405 Colorado 83.2 54,579 Connecticut 92.9 74,565 Delaware 69.9 9,887 District of Columbia 100.0 17,507 Florida 94.2 356,550 Georgia 88.5 148,542 Hawaii 99.7 24,974 Idaho 80.3 15,958 Illinois 72.4 154,956 Indiana 86.2 100,883 Iowa 82.9 52,459 Kansas 86.8 44,736 Kentucky 71.6 103,784 Louisana 83.6 111,238 Maine 87.7 41,979 Maryland 79.2 68,235 Massachusetts 93.1 194,351 Michigan 88.9 188,533 Minnesota 87.2 87,885 Mississippi 94.1 116,616 Missouri 90.3 134,407 Montana 96.4 16,515 Nebraska 95.3 33,896 Nevada 61.2 13,837 New Hampshire 94.7 18,695 New Jersey 84.7 151,223 New Mexico 73.0 30,790 New York 99.8 576,119 North Carolina 87.0 226,765 North Dakota 91.8 13,147 Ohio 88.5 190,463 Oklahoma 82.1 71,529 Oregon 77.4 60,197 Pennsylvania 88.5 261,546 Rhode Island 88.5 29,808 South Carolina 100.0 120,444 South Dakota 79.7 13,065 Tennessee 88.5 195,492 Texas 81.2 367,049 Utah 87.1 18,326 Vermont 97.3 26,897 Virginia 70.4 95,855 Washington 89.0 92,775 West Virginia 88.5 42,895 Wisconsin 95.3 113,842 Wyoming 74.9 5,686 50 States and Washington, DC 88.5 6,014,927 (1) Dual enrollment status was confirmed by a link between Medicaid analytic extract (MAX) and Medicare enrollment data base (EDB) data for 1999. Estimates of full Medicaid dual enrollees were based on distributions of person-years of enrollment by code values of the Medicaid statistical information system (MSIS) data element "dual eligibility flag, as reported in MAX validation reports. (2) Estimates consist of confirmed full dual enrollees plus a percentage of unconfirmed dual enrollees with MAX dual eligibility flag values of 50 (dual status was indicated by the EDB, but not MAX) and 59 (dual status was indicated by the EDB and unknown in MAX). (3) Estimates consist of confirmed full dual enrollees, all unconfirmed dual enrollees with a MAX dual eligibility flag value of 59 (dual status was indicated by the EDB and unknown in MAX) plus a percentage of unconfirmed dual enrollees with MAX dual eligibility flag value of 50 (dual status was indicated by the EDB, but not MAX). (4) Estimates consist of dual enrollees with restricted benefits as reported in the MAX data element restricted benefits flag. SOURCE: Centers for Medicare & Medicaid Services: Medicaid Analytic Extract (MAX) data, 2004.
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|Title Annotation:||Data View|
|Author:||Baugh, David K.|
|Publication:||Health Care Financing Review|
|Date:||Dec 22, 2004|
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