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Dual eligible enrollees are Medicare enrollees that are receiving some form of assistance from their states’ Medicaid program.  Dual beneficiaries may receive all or some of the following:

  • Medicare Part B premium assistance
  • Medicare cost sharing payment assistance
  • Eligibility for full Medicaid services

Detailed descriptions of the various, specific types of dual eligibility are found on the CMS web site. The MBSF variable “Medicare-Medicaid Dual Eligibility Status” occurs monthly. The values identify:

  • Qualified Medicare Beneficiaries (QMBs)
    • Medicare Part B Premium and cost-sharing assistance
    • With or without Medicaid benefits
  • Specified Low-Income Medicare Beneficiaries (SLMBs)
    • Medicare Part B Premium Assistance
    • With or without Medicaid benefits
  • Qualified Disabled and Working Individuals (QDWIs)
    • Medicaid only pays the Medicare Part A premium
    • Beneficiaries spend down assets to be eligible
  • Qualifying Individuals (Qis)
    • Medicaid paid Part B Premiums, effective 1/1/1998 to 12/31/2002
    • Beneficiaries spend down assets to be eligible
  • Medicaid Only Dual Eligibles, entitled to full Medicaid benefits but receive not cost-sharing or premium assistance

Prior to the development of the MBSF variable with the implementation of the Part D program, there was no reliable way to identify all dually eligible from Medicare enrollment files.

Statistics on the Dual Eligible Population are available from the Kaiser Family Foundation.