The Medicaid MCP Server provides programmatic access to public Medicaid data including state formularies, drug pricing, enrollment trends, and utilization statistics for analysis and decision-making.
Core Capabilities:
State Formulary Access: Search drug formularies for California, New York, Ohio, Texas, and Illinois (163K+ drugs, covering 43% of US Medicaid beneficiaries) with filters for NDC codes, prior authorization requirements, cost tiers, preferred drug status, step therapy, and program eligibility. Includes automatic NADAC pricing integration and cross-state NDC enrichment for Illinois (61.7% coverage).
Drug Pricing Intelligence: Access National Average Drug Acquisition Costs (NADAC) for 1.5M NDC codes with weekly updates, Federal Upper Limits for generic drug maximum reimbursements (2.1M records), and multi-drug price comparisons with date range and price threshold filtering.
Enrollment & Demographics: Track monthly Medicaid/CHIP enrollment trends across all 50 states and territories with multi-state comparisons and filtering by enrollment type (total, Medicaid, CHIP, adult, child segments).
Drug Rebate & Utilization: Access manufacturer product information and rebate agreements (~3M records) with filtering by labeler or drug name and year. Query state prescription volume by drug and quarter (5.3M records) to analyze prescribing patterns.
Dataset Discovery: Browse available datasets and execute custom queries using Socrata Query Language (SoQL) WHERE clauses with flexible pagination (up to 5,000 records).
Performance Features: Hybrid architecture with in-memory caching for frequently accessed data (<100ms response), streaming API for large datasets (1-2s), low memory footprint (~215 MB), and automatic data refresh (weekly/monthly/quarterly).
Use Cases: Market access strategy, pricing intelligence, policy analysis, economic forecasting, and state-level aggregate analysis (not provider-level data).
Click on "Install Server".
Wait a few minutes for the server to deploy. Once ready, it will show a "Started" state.
In the chat, type
@followed by the MCP server name and your instructions, e.g., "@Medicaid MCP Serversearch for Ozempic in California formulary"
That's it! The server will respond to your query, and you can continue using it as needed.
Here is a step-by-step guide with screenshots.
Unofficial Medicaid MCP Server
Model Context Protocol (MCP) server for Medicaid public data access via data.medicaid.gov and state formularies
Features
State Formulary Coverage
Access Medicaid formularies for 5 states covering 43% of US Medicaid beneficiaries (32M of 74M):
California - 40K drugs with NDC codes, prior authorization requirements, tier-based pricing
New York - 37K drugs with MRA pricing, daily updates, preferred drug lists
Ohio - 76K drugs with comprehensive step therapy and quantity limit data
Texas - 4.7K drugs with multi-program pricing (Medicaid, CHIP, specialty programs)
Illinois - 5.7K drugs with intelligent cross-state NDC enrichment (61.7% coverage)
Pricing & Utilization Data
NADAC Drug Pricing - National average drug acquisition costs (1.5M NDCs, weekly updates)
Federal Upper Limits - Generic drug maximum reimbursement (2.1M records, monthly updates)
Drug Rebate Program - Manufacturer product information and rebate agreements (~3M records)
State Drug Utilization - Prescription volume by state, drug, and quarter (5.3M records)
Enrollment Trends - Monthly Medicaid/CHIP enrollment by state (all 50 states + territories)
Technical Features
Hybrid Architecture - Optimized data access: in-memory caching for small datasets, streaming API for large datasets
Automatic Pricing Integration - Formulary queries auto-enrich with NADAC pricing data
Intelligent Enrichment - Illinois formulary enhanced via cross-state NDC matching (CA/NY/OH sources)
Usage
API Reference
Unified Tool: medicaid_info
The server provides a single tool with multiple methods:
State Formulary Search
Parameters:
state(required): State code (CA, NY, OH, TX, IL)label_name: Brand/trade namegeneric_name: Generic drug namendc: 11-digit NDC coderequires_pa: Prior authorization filter (true/false)has_ndc: Filter for drugs with NDC codes (Illinois only)limit: Max results (default: 10)
State-Specific Parameters:
California:
tier: Cost ceiling tier ("Brand" or "Generic")extended_duration: Extended duration eligibility (true/false)
Texas:
pdl_pa: PDL prior authorization (true/false)clinical_pa: Clinical prior authorization (true/false)program: Program filter (medicaid, chip, cshcn, etc.)max_price/min_price: Price range filters
New York:
preferred: Preferred drug status (true/false)is_brand: Brand vs generic filter (true/false)max_price/min_price: MRA cost range
Drug Pricing
Parameters:
drug_name: Drug name (fuzzy match)ndc: Specific 11-digit NDC codelimit: Max results (default: 10)
Enrollment Trends
Federal Upper Limits
Drug Rebate Information
State Drug Utilization
Architecture
The server uses a hybrid data access strategy optimized for performance and memory efficiency:
Cached Datasets - Small, frequently accessed data loaded into memory:
State formularies (CA, NY, OH, TX, IL) - Excel/CSV/JSON/Text parsing with TTL-based refresh
NADAC pricing (123 MB) - Weekly CSV download, cached for fast lookups
State enrollment (3.6 MB) - Monthly snapshots, cached for trend analysis
Streaming API - Large datasets queried on-demand via CMS DKAN API:
Federal Upper Limits (196 MB, 2.1M records)
Drug Rebate Program (291 MB, ~3M records)
State Drug Utilization (192 MB, 5.3M records)
Memory Footprint: ~215 MB total for cached datasets, minimal for API queries
Performance Characteristics
Dataset | Access Method | Typical Response Time |
State Formularies | In-memory cache | <100ms |
NADAC Pricing | In-memory cache | <100ms (20-30s initial load) |
State Enrollment | In-memory cache | <50ms |
Federal Upper Limits | DKAN API streaming | 1-2s |
Drug Rebate Program | DKAN API streaming | 1-2s |
State Drug Utilization | DKAN API streaming | 1-2s |
Data Sources
Dataset | Update Frequency | Coverage | Authority |
NADAC | Weekly | 1.5M NDC codes | CMS |
State Formularies | Daily-Monthly | 43% of US Medicaid | State agencies |
Federal Upper Limits | Monthly | 2.1M records | CMS |
Drug Rebate | Quarterly | ~3M records | CMS |
Drug Utilization | Quarterly | 5.3M records | CMS |
Enrollment | Monthly | All states | CMS |
Query Examples
State Formulary Search with Automatic Pricing
Multi-State Enrollment Comparison
Cross-State NDC Enrichment
Use Cases
Market Access & Strategy
State formulary coverage analysis and prioritization
Prior authorization landscape mapping
Competitive tier placement assessment
Pricing Intelligence
NADAC price trend analysis and forecasting
Multi-state pricing comparisons
Rebate program eligibility verification
Policy & Economics
Medicaid expansion impact analysis
State enrollment forecasting and growth trends
Utilization pattern analysis by geography
Limitations
Provider-level utilization data not available (use Medicare MCP for provider analytics)
Individual beneficiary claims require CMS Data Use Agreement (T-MSIS/TAF)
No HCPCS procedure-level analysis (state-level aggregate data only)