Thank you for your interest in advancing best practices and policies through analysis of Maryland Medicaid data.  The MDH Planning Administration team looks forward to working with you.  The data request process is outlined below.  Please submit all required information and any collateral questions, comments or concerns to
***Please Note: Online forms and documents are best accessed when using Google Chrome as the web browser.  The links and forms on this page may not be immediately compatible with other web browser types.***
To view Frequently Asked Questions (FAQs) about authorized Medicaid Data Requests, click here.  The forms referenced in the FAQs are listed immediately below:
Step 1:   Data Request Submission
Complete the Maryland Medicaid Data Request Form.  This form may be downloaded and submitted by e-mail to or complete the online Maryland Medicaid Data Request Google form.
·         To download the form, click here.
·         To complete the form online, click here.   
Via this form, address each of the following points if relevant to your study:
·         Proposed Project’s Central Aim, Goals and Objectives
·         Data Needed
o   HealthChoice Managed Care Organization Claims Data
                                           Fee-for-Service Claims Data
o   Pharmacy Claims Data
o   All of the Above
o   Other Data Needed (Specify)
·         Planned Data Analyses & Software Tools to Be Applied (e.g., SAS, SPSS, Stata)
·         Data Specifications:
o   Time Period of Needed Data (Date of Onset … Date of Offset)
o   Targeted Medicaid Beneficiary Population(s) To Be Studied
o   Targeted Beneficiary Characteristics (e.g., Race, Age, Gender, ZIP Code, Other Demographics of Interest)
o   Targeted Diagnoses, including a listing of relevant ICD Diagnostic Codes (Note:  When indicated, take into account timing of  migration from ICD-9 to ICD-10 codes on October 1, 2015.)
o   Targeted Health & Related Services To Be Evaluated, including a listing of relevant CPT, HCPCS or other revenue/reimbursement codes
o   Targeted Service Locations or Provider Types
o   Other Key Parameters of Needed Data Sample
You may be contacted by e-mail or telephone if there are questions regarding your data request. 
Step 2: Generation / Execution of Inter-Agency Agreement & Data Use Agreement
[Note:  Under certain circumstances the MDH team will allow the research team to simultaneously pursue Steps 2 and 3, or to complete Step 3 prior to completing Step 2.]
Depending on the nature and scope of the data request, the Principal Investigator (PI) and her/his organization may be required to enter into an Inter-Agency Agreement (IAA) and a Data Use Agreement (DUA) with MDH and other participating legal entities prior to the release of any data.  This determination will typically be made during the review of the submitted Data Request Form.
The IAA will include:
·         A brief description of the research project and data to be shared; and
·         Specific duties of each party to the agreement, such as requirements to submit periodic reports and updates to reflect changes in study design or procedures that affect the rights and interests of Medicaid recipients and the period of the agreement.
The DUA will include specifications regarding:
·         Data to be released and data ownership rights;
·         Scope of work and permitted uses of the covered data;
·         Permitted users of the covered data;
·         Data security, including provisions regarding confidentiality, breach of agreement, data management plan, data storage location, and data destruction.
Each party to these agreements will be required to submit source information to for use by the MDH legal team during its generation of draft agreements.
·         To download the source information collection tool, click here.
·         To complete the source information collection tool online, click here .   
·         To download outlines with instructions of each attachment to the Data Use Agreement, click here. 
To complete a required Data Use Agreement Quarterly Report online, click here.
Step 3:  MDH IRB Review & Approval
Certain data requests require approval by the MDH Institutional Review Board (IRB).  Additional information regarding this process is available through the IRB website:  The basic process is outlined below.
Questions regarding the IRB process may be submitted to Ms. Gay Hutchen, IRB Administrator,
Step 3a:  Download and complete required IRB Form 1 (MDH 2124) from the MDH IRB home page. 
Click here for Form 1 (MDH 2124). 
You will need to attach to this form:
·         a narrative description of the proposed research,
·         fully drafted informed consent form (if applicable),
·         copy of each data collection instrument to be used (if any),
·         the results of prior IRB reviews (if any); and
·         any other supportive material that serves to clarify prospective participant risks and benefits specific to the proposed protocol.
Step 3b:  Submit one copy of the completed IRB Form 1 (MDH 2124), all attachments, and a cover letter on the PI’s letterhead to   
·         The PI must sign and date the first page of Form 2124.
·         An incomplete form, or a form not accompanied by the required attachments, will be returned to the Principal Investigator for additional work.
Step 4:  Final Approval of Data Request before IRB Submission
The submitted IRB Form 1 (MDH 2124) will be reviewed by the Director of Maryland Medicaid Planning or her designee.  If the request is approved, the Medicaid Planning team will provide the PI with an approved (i.e., signed and dated) copy of the previously submitted IRB Form 1 (MDH 2124) by email. 
Step 5.  Formal Submission to IRB
Step 5a.  Upon receipt of this signed and approved IRB Form I (MDH 2124), either the PI or the Medicaid Planning team will agree to assume responsibility for submitting the requisite number of copies of it (10 copies for full board review; 4 copies for expedited review), along with the required attachments, to the MDH IRB located at:
                                    MDH Institutional Review Board
                                    201 West Preston Street, 5th Floor
                                    Baltimore, Maryland 21201
Step  5b.  If the IRB packet is to be submitted by the PI to the IRB, upon completion of this step the PI is to notify the MDH Planning Administration team via email sent to:  Similarly, if the IRB packet is submitted by the Medicaid Planning team the PI will be notified.
Step 6.  Initiation of Data Release  
Once all relevant prior steps (1-5b) have been completed satisfactorily, the requested data will be released to the authorized data recipient.