Medicare — Medicaid Dual Eligibility Code — September

SAS Name
MDCR_DUAL_STUS_CD_09

This variable is the monthly Medicare and Medicaid dual enrollment status variable. There are separate variables for each of the 12 months during the year.

Comments

CCW obtains this directly from the MBSF DUAL_STUS_CD_01–12 variables.

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.

Source: Medicare MBSF

Code Code value
00 Medicare beneficiary not enrolled in Medicare for the month
01 Qualified Medicare Beneficiary (QMB)-only
02 QMB and full Medicaid coverage, including prescription drugs
03 Specified Low-Income Medicare Beneficiary (SLMB)-only
04 SLMB and full Medicaid coverage, including prescription drugs
05 Qualified Disabled Working Individual (QDWI)
06 Qualifying individuals (QI)
08 Other dual eligible (not QMB, SLMB, QWDI, or QI) with full Medicaid coverage, including prescription drugs
09 Other dual eligible, but without Medicaid coverage
99 Unknown
NA Medicare enrolled — non-Medicaid (i.e., no dual status)
Null/missing Not Medicare enrolled