Medicare-Medicaid dual eligibility code - January

Short SAS Name: 

This variable indicates whether the beneficiary was eligible for both Medicare and Medicaid in a given month (January).

The original source for this variable is the State Medicare Modernization Act (MMA) files that states submit to CMS. Those files are considered the “gold standard” for identifying dual eligibles because the information in them is used to determine the level of Medicare Part D low-income subsidies. Dual eligibles are often divided into “full duals” and “partial duals” based on the level of Medicaid benefits they receive. CMS generally considers beneficiaries to be full duals if they have values of 02, 04, or 08, and to be partial duals if they have values of 01, 03, 05, or 06. Partial duals sometimes divided into the QMB-only population (01) and all other partial duals (03, 05, or 06). There are CMS Chronic Conditions Data Warehouse (CCW) – Codebook Master Beneficiary Summary File (MBSF) with Medicare Part A, B, C & D May 2017 – Version 1.0 Page 56 of 225 different ways to classify dually eligible beneficiaries. Additional information regarding various ways to identify dually enrolled populations, refer to a CCW Technical Guidance document entitled: "Options in Determining Dual Eligibles". There are 12 monthly variables - where the 01 through 12 at the end of the variable name correspond with the month (e.g., 01 is January and 12 is December).
CodeCode value
Enrolled in Medicare A and/or B, but no Part D enrollment data for the beneficiary. (This status was indicated as 'XX' for 2006-2009)
Not Medicare enrolled for the month
Qualified Medicare Beneficiary (QMB)-only
QMB and full Medicaid coverage, including prescription drugs
Specified Low-Income Medicare Beneficiary (SLMB)-only
SLMB and full Medicaid coverage, including prescription drugs
Qualified Disabled Working Individual (QDWI)
Qualifying individuals (QI)
Other dual eligible (not QMB, SLMB, QWDI, or QI) with full Medicaid coverage, including prescription drugs
Other dual eligible, but without Medicaid coverage

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This variable is contained in the following files: