Notes
Estimates include full-benefit dual-eligible individuals in 47 states and the District of Columbia if (1) they were in both the research-identifiable Master Beneficiary Summary File (MBSF) Base and the 2020 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) file using a Chronic Conditions Warehouse (CCW) beneficiary identifier crosswalk (2) and if individuals were a full-benefit dual-eligible individual in March (03) 2020 using the Medicare monthly DUALSTUS CD03 with values of 02,04,08 or the Medicaid monthly code (March=03) DUAL ELGBLCD 03 with values of 02,04,08 or the monthly code (March=03) RSTRCTDBNFTS CD_03 with values of 1,A,D,4,5,7. Dual-eligible individuals also had to have both Medicare Part A and B in March 2020 to be included in this analysis. The estimated total of dual-eligible individuals (7.5 million) differs from other KFF estimates due to differences in methods. Due to data suppression and rounding, subgroup estimates may not always sum to the total.
Estimates include full-benefit dual-eligible individuals in 47 states and the District of Columbia if (1) they were in both the research-identifiable Master Beneficiary Summary File (MBSF) Base and the 2021 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) file using a Chronic Conditions Warehouse (CCW) beneficiary identifier crosswalk (2) and if individuals were a full-benefit dual-eligible individual in March (03) 2021 using the Medicare monthly DUALSTUS CD03 with values of 02,04,08 or the Medicaid monthly code (March=03) DUAL ELGBLCD 03 with values of 02,04,08 or the monthly code (March=03) RSTRCTDBNFTS CD_03 with values of 1,A,D,4,5,7. Dual-eligible individuals also had to have both Medicare Part A and B in March 2021 to be included in this analysis. The estimated total of dual-eligible individuals (7.9 million) differs from other KFF estimates due to differences in methods. Due to data suppression and rounding, subgroup estimates may not always sum to the total. Data were updated on October 18, 2024 to incorporate updates to Medicare and Medicaid administrative data.
Coverage arrangement categories are mutually exclusive. See The Landscape of Medicare and Medicaid Coverage Arrangements for Dual-Eligible Individuals Across States for details on how various Medicaid/Medicare coverage arrangements are defined.
Sources
Data are from a KFF analytic file that merged the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse 2020 research-identifiable Master Beneficiary Summary File (MBSF) Base and the 2020 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) file using a Chronic Conditions Warehouse (CCW) beneficiary identifier crosswalk.
Data are from a KFF analytic file that merged the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse 2021 research-identifiable Master Beneficiary Summary File (MBSF) Base and the 2021 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) file using a Chronic Conditions Warehouse (CCW) beneficiary identifier crosswalk.
Definitions
Full-benefit Dual-Eligible Individuals receive full Medicaid benefits and Medicaid payment of Medicare premiums and, in many cases, cost-sharing.
MMP : Medicare-Medicaid Plans were established as a demonstration under the Financial Alignment Initiative where a single health plan provides all Medicare- and Medicaid-covered benefits.
PACE : The Program of All-Inclusive Care for the Elderly provides comprehensive medical and social services to individuals who: (1) are 55 years of age or older, (2) need a nursing home level of care but can live safely in the community, and (3) live in a PACE organization service area.
Managed Care : Organizations that receive a payment per enrollee from the state government to deliver either general Medicaid benefits or long-term care.
Fee-for-Service : States reimburse health care providers a fee for each service.
N/A : not applicable. These coverage arrangements or programs do not operate in the state as of March of the reporting year.
NSD : not significant data (cells representing fewer than 50 enrollees).
DQ : represent data categorized as "Unusable/Unclassified" in the DQ Atlas assessment and with substantial differences in Medicaid managed care enrollment from other sources. These values are not included in the national totals.