Reminder: DUA and VRDC access needs to be extended or renewed annually. Read more.
This variable is contained in the following files:
Master Beneficiary Summary File (MBSF) Base A/B/C/D V2 Accountable Health Communities (AHC) Model Oncology Care Model (OCM) Current Clinical Status File Oncology Care Model (OCM) Clinical and Staging File Oncology Care Model (OCM) Medicare Bayesian Improved Surname Geocoding (MBISG) Acute Hospital Care at Home (AHCAH) - Patient Acute Hospital Care at Home (AHCAH) - Hospital Inpatient Rehab Facility-Patient Assessment Instrument TAF Demographic and Eligibility File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Alignment Files Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Provider List File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Practice List File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Visit File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Beneficiary Demographic File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Final Clinical File Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Raw Clinical File Million Hearts® Cardiovascular Disease Risk Reduction Model CMMI Model Data Sharing (CMDS) Beneficiary File CMMI Model Data Sharing (CMDS) Provider File CMMI Model Data Sharing (CMDS) Entity File CMMI Model Data Sharing (CMDS) Model Participation Data Initiative Healthcare Effectiveness Data and Information Set (HEDIS) File 2: Plan All-Cause Readmission (PCR) Measure Healthcare Effectiveness Data and Information Set (HEDIS) File 1: Measures File (does not include Plan All-Cause Readmission measure) MBSF 30 CCW Chronic Conditions Next Generation ACO Model Provider RIF Next Generation ACO Model Beneficiary RIF Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 3.0 TAF Annual Managed Care Plan (APL) TAF Annual Provider (APR) Comprehensive ESRD Care (CEC) Model - Provider Comprehensive ESRD Care (CEC) Model - Beneficiary Home Health Outcome and Assessment Information Set (OASIS) Long Term Care Minimum Data Set (MDS) 2.0 Plan Characteristics File Long Term Care Minimum Data Set (MDS) 3.0 Long Term Care Minimum Data Set (MDS) - Swing-Bed 3.0 MAX Personal Summary File Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) 2.0 TAF Pharmacy File TAF Other Services File TAF Long Term Care File TAF Inpatient File Skilled Nursing Facility (Encounter) Outpatient (Encounter) Inpatient (Encounter) Home Health Agency (Encounter) Durable Medical Equipment (Encounter) Carrier (Encounter) Risk Score Files Value Modifier Practice-Level File Value Modifier Beneficiary-Level File Medicare Shared Savings Program Accountable Care Organizations (ACO) Beneficiary-level RIF Medicare Shared Savings Program Accountable Care Organizations (ACO) Provider-level RIF Pioneer Accountable Care Organization (ACO) Medicare Data on Provider Practice and Specialty (MD-PPAS) Healthcare Effectiveness Data and Information Set (HEDIS) Long Term Care Minimum Data Set (MDS) - Swing-Bed 2.0 Consumer Assessment of Healthcare Providers & Systems RIF National Health and Aging Trends Study (NHATS) - Medicare Linked Data Health and Retirement Survey - Medicare Linked Data Health Outcomes Survey RIF Medicaid Enrollee Supplemental File (MESF): National Death Index (NDI) Segment Medicaid Enrollee Supplemental File (MESF): Conditions Segment MBSF Other Chronic or Potentially Disabling Conditions MBSF National Death Index (NDI) MBSF Cost and Use MBSF 27 CCW Chronic Conditions MBSF Base A/B/C/D MAX Long Term Care File MAX Inpatient File MAX Other Services File MAX Prescription Drug File Value Modifier NPI Practice-Level File Part D Medication Therapy Management Data File Part D Plan Election Type Beneficiary Summary File Part D Event (PDE) File Part D Formulary File Part D Pharmacy Characteristics File Part D Prescriber Characteristics File Part D Drug Characteristics File Carrier (Fee-for-Service) Durable Medical Equipment (Fee-for-Service) Home Health Agency (Fee-for-Service) Hospice (Fee-for-Service) Inpatient (Fee-for-Service) Outpatient (Fee-for-Service) Skilled Nursing Facility (Fee-for-Service) Medicare Provider Analysis and Review (MedPAR)
SAS Name
DUAL_STUS_CD_11
This variable indicates whether the beneficiary was eligible for both Medicare and Medicaid in a given month (November).
| Code | Code value |
|---|---|
| NA | Non-Medicaid |
| 00 | 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 |
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. Unlike most states, Puerto Rico and the Virgin Islands do not submit dual eligibility data to CMS through the MMA files. Consequently, the Master Beneficiary Summary File significantly undercounts dual-eligibles from these territories currently. Users should consider this variable to be incomplete when constructing an analysis population that includes dual-eligibles from these two territories. 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 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).
Source: CMS Common Medicare Environment (CME)