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This tool does not predict payer actions. It highlights statistical variance patterns that may warrant clearer documentation.
Module intelligence
Payer Mix Context v1
Medicaid dependency proxy bands by state from Medicaid-only billing intensity. Use this page to confirm readiness, cross-state checks, and implementation fit. Readiness: Ready.
These metrics measure statistical consistency, not clinical appropriateness.
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Module: payer-mixCross-state readiness check: PassedReadiness: ReadyProduction-ready: Yes
Maturity
Shipped
Readiness
Ready
Cross-state readiness
Passed
Coverage rows
N/A
Module details
This module ID is payer-mix, and the data package type is N/A.
The transform version is payer-mix-context-v1, generated 2/18/2026, 6:41:12 PM.
The production-ready flag is Yes.
The primary buyers are Provider compliance teams, Policy researchers.
The roadmap document is docs/prd/medicaid-intelligence-platform.backlog.md.
Release file path public/data/medicaid/derived/v1/latest/payer_mix_context_v1_manifest.json
Published data path public/data/medicaid/derived/v1/latest/payer_mix_context_v1.csv
Module API route /api/medicaid/intelligence/module/payer-mix.json
Data sample
| state | medicaid_dependency_band | provider_count | total_medicaid_paid | total_medicaid_claims | avg_paid_per_provider | avg_claims_per_provider | avg_observed_span_months | avg_rows_per_provider | payer_mix_inference_type | limitation | snapshot_id | dq_gate_version |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AK | high | 68 | 2152092068.54 | 8422697.0 | 31648412.772647 | 123863.191176 | 71.0588 | 119.9853 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AK | low | 68 | 38731706.08 | 132430.0 | 569583.912941 | 1947.5 | 15.9706 | 4.7059 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AK | medium | 69 | 328839818.46 | 1957662.0 | 4765794.470435 | 28371.913043 | 41.5652 | 30.5362 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AL | high | 40 | 4424313112.93 | 28209750.0 | 110607827.82325 | 705243.75 | 63.475 | 295.425 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AL | low | 40 | 19456055.54 | 157198.0 | 486401.3885 | 3929.95 | 10.85 | 4.275 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AL | medium | 39 | 108405848.57 | 417698.0 | 2779637.142821 | 10710.205128 | 31.7179 | 21.6923 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AR | high | 89 | 2158367174.32 | 20784200.0 | 24251316.565393 | 233530.337079 | 65.7528 | 74.6517 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AR | low | 89 | 27042166.86 | 259062.0 | 303844.571461 | 2910.808989 | 6.9438 | 2.5506 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AR | medium | 88 | 248798899.51 | 2363323.0 | 2827260.221705 | 26855.943182 | 33.4432 | 20.5568 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AZ | high | 433 | 15933404294.3 | 95143647.0 | 36797700.44873 | 219731.286374 | 58.6697 | 103.0947 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AZ | low | 433 | 205082482.97 | 1243309.0 | 473631.600393 | 2871.383372 | 8.3141 | 3.612 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| AZ | medium | 435 | 1500968995.41 | 9341617.0 | 3450503.437724 | 21474.981609 | 27.6506 | 20.7333 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CA | high | 1253 | 41455969884.6099 | 309528635.0 | 33085371.017247 | 247030.035914 | 68.3121 | 136.2777 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CA | low | 1253 | 521228229.73 | 2961197.0 | 415984.221652 | 2363.285714 | 9.9721 | 3.4389 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CA | medium | 1255 | 3726297306.24 | 20555211.0 | 2969161.200191 | 16378.654183 | 35.5386 | 20.659 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CO | high | 242 | 8813158543.34 | 122059128.0 | 36418010.509669 | 504376.561983 | 63.2438 | 96.8471 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CO | low | 242 | 82924543.85 | 422628.0 | 342663.404339 | 1746.396694 | 6.6198 | 2.8554 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CO | medium | 243 | 653139858.59 | 3783015.0 | 2687818.348107 | 15567.962963 | 27.2428 | 18.8971 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CT | high | 72 | 4399685516.92 | 64147247.0 | 61106743.290556 | 890933.986111 | 77.4444 | 200.6806 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CT | low | 72 | 35480358.71 | 263857.0 | 492782.759861 | 3664.680556 | 9.125 | 3.9028 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| CT | medium | 72 | 372466638.65 | 5963628.0 | 5173147.759028 | 82828.166667 | 44.75 | 35.5 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| DC | high | 55 | 3169169569.02 | 18043026.0 | 57621264.891273 | 328055.018182 | 74.1455 | 121.0727 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| DC | low | 55 | 81092541.13 | 748299.0 | 1474409.838727 | 13605.436364 | 18.6545 | 11.3455 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| DC | medium | 55 | 497620422.53 | 4037686.0 | 9047644.046 | 73412.472727 | 42.6182 | 40.2 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
| DE | high | 39 | 1290261974.87 | 6978970.0 | 33083640.381282 | 178947.948718 | 49.5641 | 70.6667 | medicaid_dependency_proxy | Proxy from Medicaid-only billing intensity; non-Medicaid payer denominators are not observed. | 2026-02-18__210410Z | 1.0.0 |
Method and limitations
- This tool does not predict payer actions. It highlights statistical variance patterns that may warrant clearer documentation.
- Statistical consistency context; not payer prediction, not clinical appropriateness.
- Availability and cross-state checks are data-readiness indicators, not clinical or payer outcomes.
- All data samples are aggregate-only and must not be interpreted as provider-level adjudication evidence.
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Page updated: 2026-02-16