Indicates coverage for beneficiaries entitled to Medicare (Part A and/or B benefits) and eligible for some category of Medicaid benefits; most recent in the calendar year.
Dual eligibles are often divided into “full duals” and “partial duals” based on the level of Medicaid benefits received. CMS generally considers beneficiaries as full duals if they have values of 02, 04, or 08, and partial duals if they have values of 01, 03, 05, or 06. Partial duals are sometimes divided into QMB-only population (01) and all other partial duals (03, 05, or 06). There are different ways to classify dually eligible beneficiaries.
SOURCE: T-MSIS Annual Demographic and Eligibility TAF
|00||Eligible is not a Medicare beneficiary|
|01||Eligible is entitled to Medicare-Qualified Medicare Beneficiary (QMB) only|
|02||Eligible is entitled to Medicare-QMB and Medicaid coverage including prescription
|03||Eligible is entitled to Medicare-Specified Low-Income Medicare Beneficiary (SLMB)
|04||Eligible is entitled to Medicare-SLMB and Medicaid coverage including prescription
|05||Eligible is entitled to Medicare-Qualified Disabled Working Individual (QDWI)|
|06||Eligible is entitled to Medicare-Qualifying Individuals (QI)|
|08||Eligible is entitled to Medicare-Other Dual Eligibles (Non QMB, SLMB, QDWI or QI)
including prescription drugs
|09||Eligible is entitled to Medicare – but without Medicaid coverage (This code is to be
used only with specific CMS approval).
|10||Separate CHIP Eligible is entitled to Medicare|
|Null/missing||source value is missing or unknown|