Texas Health and Human Services

Notes Highlighted monthly caseloads are incomplete and will change Source: CHIP PPS Data HHSC Forecasting

Notes Highlighted caseloads are incomplete and will change. Healthy Texas Women began July 2016; Texas Women's Health Program began Jan. 2013; Medicaid Women's Health Program began Jan. 2007. Source: PPS HHSC Forecasting

Medicaid enrollment includes Breast and Cervical Cancer Program recipients, February 2019 figures above are estimated based on incomplete data and will change, Source: PPS Data, HHSC Forecasting

NOTES: Medicaid Fee-For-Service (FFS) paid and partially paid inpatient hospital delivery claims were selected using the following DRG codes. Deliveries that occurred in other settings, such as birthing centers or homes, were excluded. MS-DRG codes 765-768 and 774-775 were used to identify FFS deliveries with discharge dates in FY2009 - FY2012. APR-DRG codes 5401-5404, 5411-5414, 5421-5424, and 5601-5604 were used to identify deliveries for FY2013-FY2015. Managed Care deliveries were selected from the Delivery Supplemental Payment (DSP) database. MCO cost was calculated by multiplying the DSP contract rate by the number of deliveries for each MCO plan. The DSP program does not include deliveries to MCO clients enrolled in STAR Health, STAR+PLUS, or MMP. The MCO Program excludes clients enrolled in Type Program 30. Deliveries are reported as the total number of unduplicated delivery dates per patient. Patients with multiple delivery claims on the same date are counted as having one delivery on that date. Some patients had more than one delivery date per fiscal year. Teenage mothers were defined as delivery patients who were under age 20 on the delivery date. Non-teenage mothers were defined as mothers who were age 20 or older on the delivery date.

NOTES: Medicaid Fee-For-Service (FFS) paid and partially paid inpatient hospital delivery claims were selected using the following DRG codes. FFS deliveries that occurred in other settings, such as birthing centers or homes, were excluded. CMS-DRG codes 370-375 were used to identify FFS deliveries with discharge dates in FY2008. MS-DRG codes 765-768 and 774-775 were used to identify FFS deliveries with discharge dates in FY2009 - FY2012. APR-DRG codes 5401-5404, 5411-5414, 5421-5424, and 5601-5604 were used to identify deliveries in FY2013-FY2015. Managed Care deliveries were selected from the Delivery Supplemental Payment (DSP) database. The DSP Program does not include deliveries to MCO clients enrolled in STAR Health, STAR+PLUS, or MMP. The MCO Program excludes clients enrolled in Type Program 30. Number of clients during the measurement year were reported as the total number of unduplicated mothers with deliveries during that year. For patients with more that one delivery during the measurement year, only the first delivery date during that year was used for the analysis. Age was reported as the mother's age on her first delivery date during the measurement year. Teenage mothers were defined as delivery patients who were under age 20 on the delivery date. Non-teenage mothers were defined as mothers who were age 20 or older on the delivery date. Total deliveries during the five-year prior period were defined as the total number of unduplicated deliveries that occurred during the 5-year period (1,826 days) prior to the first delivery date in the measurement year. Clients with prior deliveries were defined as the unduplicated number of clients who had one or more deliveries during the prior five-year period. Percent with prior deliveries was computed as the total number of clients with one or more prior deliveries during the prior five-year period, divided by the total number of clients in the measurement year.

Notes: The statewide numbers reflect the unduplicated number of children served in comprehensive and follow along services. Therefore, the sum of the counts for children served across counties does not equal the statewide counts. The projected population data are based on the number of children age 0 to 1, 1 to 2, and 2 to 3 in 2015 and the number of births in 2016, which is the children age 0 to 1 in 2016. A child who received comprehensive services and follow along services is counted only once in the total for the county. This provides a total count for each county that is an unduplicated count of children. A child who received services in a program in a county and then transferred to another program in the same county is counted only once; a child who transferred to another program in a different county is counted once in each county.

NOTES: Drug claims and acute care claims are based on the date of service. Behavioral Health expenditures for the acute care claims and encounters are based on a primary diagnosis code of 290-314.99. Psychotropic drug claims were identified as filled prescriptions with an AHFS codes beginning with 2812, 2816, 2820, 2824, 2828, or 2892. CHIP Perinate clients are included within all CHIP Behavioral Health Expenditures and are defined as follows: Risk Group 305: Risk Group 306: Long term supports and services claims (claims with Hdr_Care_Type='L') were excluded from the analysis. Prepared by Data Quality & Dissemination, Strategic Decision Support, HHSC. November 2016 (vp) Source: TX Medicaid Vendor Drug database, HHSC; 8 Month Eligibility database, HHSC; CHIP database, HHSC; CHIP DSP database, HHSC; AHQP Claims Universe, TMHP; Enc_Best Picture Universe, TMHP. Filename: TX Medicaid Behavioral Health Expenditures SFY15_primdiag_final.xlsx

Fee for Service and Managed Care client counts are not additive, as clients may appear in more than one category and/or in more than one year. Data sources: AHQP Claims Universe, TMHP; Encounters Best Picture Universe, TMHP. Prepared by: Data Quality and Dissemination, Center for Analytics and Decision Support, HHSC, February 2017 (lk).

NOTES: Undocumented aliens were identified as clients enrolled in Medicaid Type Program code 30 and Program code 100 (FFS Program). Fee-For-Service (FFS) paid and partially paid inpatient hospital delivery claims for Undocumented Aliens were selected using the following DRG codes. Total claims may include multiple claims per delivery date and multiple delivery dates per patient. Deliveries that occurred in other settings, such as birthing centers or homes, were excluded.   CMS-DRG codes 370-375 were used to identify deliveries with discharge dates before 10/1/2007.   MS-DRG codes 765-768 and 774-775 were used to identify deliveries with discharge dates on or after       10/1/2007.  APR-DRG codes 5401-5404, 5411-5414, 5421-5424, and 5601-5604 were used to identify deliveries with   admission dates on or after 9/1/2012. Deliveries are reported as the total number of unique delivery dates per patient. Patients with multiple delivery claims on the same date are counted as having one delivery on that date. Patients with multiple delivery dates are counted as having more than one delivery.

Note: Data include Fee-For-Service (FFS) and managed care (MCO) porgrams. Managed care health plans are paid on a capitation basis. Texas Medicaid does not reimburse individual providers under contract with the health plans.   Submitted procedure codes in FFS claims are not used for identifying relevant claims, effectively excluding most of SHARS providers from the analysis. About 0.26% of all claims/encounters in the analytic dataset are for SHARS providers, accounting for 0.04% of the amount paid reported.   Expenditures reflect client services only and do not include administrative, capitations, supplemental payments, DSH or UPL dollars.

Notes:  1) MCO medical cost was reported as the total monthly capitated cost for clients enrolled in Type Programs 40 and 42. Cost data were not available for delivery clients enrolled in other Type Programs. The MCO Program excludes clients enrolled in Type Program 30.   2) MCO delivery cost was calculated using the Delivery Supplemental Payment (DSP) program contract rates. The DSP program does not include deliveries to MCO clients enrolled in STAR Health, STAR+PLUS, or MMP. The MCO Program excludes clients enrolled in Type Program 30.   3) MCO prescription drug cost was reported as the total monthly capitated prescription drug cost for clients enrolled in Type Programs 40 and 42. Prescription drug cost data were not available for clients enrolled in other Type Programs. The MCO Program excludes clients enrolled in Type Program 30. The MCO prescription drug program began in FY2012, so MCO cost data were $0 for FY2008 - FY2011.   4) Total MCO deliveries were calculated as the total number of unduplicated delivery dates for clients with deliveries during the fiscal year. The MCO Program excludes clients enrolled in Type Program 30.     5) Estimated infant care cost for 1 year was calculated by multiplying the average monthly newborn cost by the number of deliveries times 12 months. The estimate wasn't adjusted for multiple births, fetal deaths, or attrition. The following monthly cost averages were used to calculate infant care cost for each fiscal year:   6) FFS and MCO cost data for SFY2012 and subsequent years may be different from program cost data in prior years. The MCO program expanded on March 1, 2012 to incorporate all PCCM clients. The expansion caused a reduction in FFS/PCCM deliveries and related services and an increase in MCO deliveries and related services in SFY2012 compared to prior years.  

Long-acting reversible contraceptive (LARC) claims were defined as contraceptive implants and intrauterine devices using procedure codes 11981, 58300, J7300, J7301, J7302, and J7307. All other procedure codes were categorized as "Other Contraceptive Services". Medicaid prescription drugs used for contraception were defined using HIC3, AHFS, General Therapeutic Class, and Standard Therapeutic Class codes (see detailed list in the "Notes" tab). All payment status codes were included in the analysis. Paid claims (e.g., status code = 'PD') were used to compute unduplicated client counts and claim counts. All claims (e.g., status code = 'PD', 'RV', 'PR') were used to compute total cost. Long-acting reversible contraceptive (LARC) prescriptions were defined as contraceptive implants and intrauterine devices, using HIC3 code X1C. Women's Health Program (WHP) clients were identified as women enrolled in Medicaid Type Program code 68 between 9/1/2011 and 8/31/2012. Texas Women's Health Program (TWHP) clients were identified as women enrolled in Medicaid Type Program code 68 between 9/1/2012 and 8/31/2014. Clients were enrolled in only one Medicaid program per calendar month, but they could be enrolled in both WHP/TWHP and other Medicaid programs during the same fiscal year. Contraceptive claims and prescriptions for WHP/TWHP clients were identified by matching WHP/TWHP enrollment files with all contraceptive claims and prescription drug claims by client id and calendar month. All contraceptive claims that were not provided to WHP/TWHP clients were identified as Medicaid claims. LIMITATIONS: Diagnosis code was not used in the analysis to differentiate contraceptive-related services from general medical services. In addition, the analysis was not restricted to females, so the results for some contraceptive-related procedure codes that can also be used for non-contraceptive purposes may have inadvertently included males. The following procedure codes may include general medical services in addition to contraceptive-related services, which may overstate the results for contraceptive services: 96372 - Injection, Therapeutic, Prophalactic, or Diagnostic J3490 - Injection, Drugs Unclassified 00840 - Anesthetic, Surgery to Lower Abdomen