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T-MSIS: It’s More Than Just a Federal Requirement

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The Transformed Medicaid Statistical Information System or T-MSIS is the only federal Medicaid data source with person-level information on eligibility, demographics, service use and spending. As the largest national resource of beneficiary information, it is a valuable tool for improving care, as well as bolstering CMS oversight and program integrity.

T-MSIS collects Medicaid and Children’s Health Insurance Program (CHIP) data. Gathering clean T-MSIS data is more than just a federal requirement imposed on the states; it’s a critically important activity that supports those who face barriers to better health.

The Case for Clean T-MSIS Data

Although states have a regulatory mandate to submit high-quality T-MSIS information, they also have an ethical duty to do so. Without clean data, it’s difficult to conduct sound research or make decisions that are in the best interest of beneficiaries and taxpayers.

In its June 2022 report to Congress on Medicaid and CHIP, the Medicaid and CHIP Payment and Access Commission (MACPAC) identified several opportunities to improve T-MSIS data quality and use, including:

  • Provider availability. Standardizing T-MSIS provider type definitions could improve provider availability data and enable key stakeholders to identify active Medicaid and CHIP providers across states. For example, enabling researchers to identify a specific provider associated with a claim could aid in assessing active providers in a given state or region.
  • Service usage. T-MSIS is the most complete and consistent data source on beneficiary utilization across states. Greater standardization would make T-MSIS even more helpful for access monitoring.
  • Comparability across states and populations. This requires standardization of T-MSIS coding, where definitions are unclear. It also requires more work to address data elements where there are high rates of missing information.
  • Diversity, equity and inclusion. Assessments of T-MSIS data by CMS, the U.S. Department of Health and Human Services Office of the Inspector General and researchers have identified the need for more complete and reliable beneficiary demographic data, particularly on race, ethnicity and disability status. More complete eligibility and demographic information would support comparisons across groups of interest.

It's Time for States to Invest in T-MSIS

CMS provides states with technical assistance to address T-MSIS data quality issues, but it’s clear more work needs to be done. The federal government monitors T-MSIS data quality for outcomes-based assessment (OBA), which has three criteria — critical priority, high priority and expenditures. States must hit all three OBA targets to meet data quality expectations. Recent findings revealed:

  • Thirty-five states and two territories had met targets for critical-priority, high-priority and expenditures data content categories.
  • Nine states passed the critical priority criterion, but didn’t meet at least one target for high-priority and/or expenditures data content.
  • Seven states haven’t met the criteria for critical priority.
  • Three territories haven’t submitted T-MSIS data.

Gainwell Technologies is ready to help. Investing in more robust T-MSIS data reporting is a win for all. It helps states support research, analysis and policymaking to support the populations they serve, while maximizing the impact of public funds spent on healthcare services.