Medicaid Intelligence MCP server

@pipeworx/medicaid-intelligence

Medicaid drug utilization, managed-care enrollment and state enrollment operations from the CMS Medicaid Open Data API. Keyless.

Part of Pipeworx — an MCP gateway connecting AI agents to 1476+ live data sources.

Tools

Auth

None. Every endpoint is public CMS infrastructure at data.medicaid.gov.

Reading these numbers correctly

This source is easy to misread, and most of the pack's design is about preventing that. Each response carries an interpretation field stating the caveat that applies to it.

programs paid pharmacies. It is neither manufacturer revenue nor net price — Medicaid rebates are substantial and are not in this data. Treating these figures as a manufacturer's Medicaid revenue overstates it, often by a lot.

• Reimbursement is gross, before rebates. totalamountreimbursed is what state Medicaid

suppression_used flag). Those become null, never 0, and a channel that is entirely suppressed is reported as unavailable rather than as an absence of utilization. Tests guard this specifically.

• Suppressed is not zero. CMS suppresses small cells (DS, *, --, or a

not meaningful for most questions, because a state's mix shifts over time.

• Fee-for-service and managed care are separate measures and stay separate. Adding them is

under comprehensive MCO and MLTSS and behavioral health. medicaidmanagedcareprogrammix says so in its interpretation.

• Managed-care program categories overlap and must not be summed. A beneficiary can appear

a particular insurer. They do not map cleanly onto a payer's book of business.

• Enrollment counts are state-reported program enrollment, not covered lives attributable to

medicaidplanmarket returns a bounded sample plus the authoritative total row count, so a short list never implies a small market.

• A zero in the plan file can be confidentiality suppression, not an empty plan.

Argument conventions

The underlying datasets disagree about how a state is written — the drug files use two-letter codes, the enrollment and managed-care files use full names. Both forms are accepted on every tool and converted internally. This matters: before that, asking the managed-care summary for "CA" matched nothing and returned a confident total: 0, which reads as "California has no managed care" rather than as a wrong argument.

ndc takes an exact 11-digit National Drug Code, hyphenated or not. A brand or ingredient name returns {found:false, reason:'ndcexpectedgotname'} with a hint pointing at openfdadrug_label or rxnorm to resolve it first.

Failure shapes

A recoverable caller mistake resolves to {found:false, reason, hint} naming what to do instead. An upstream failure or a genuine defect resolves to {error, hint}. The two are deliberately distinguishable, so a monitoring sweep can tell "CMS refused us" apart from "we returned garbage".

Data sources

Shortened. The full README is on GitHub.