Notes
Includes dual-eligible individuals with at least one month of enrollment in Medicaid. Estimates include enrollees living in the 50 states and DC, excluding residents in the territories. Dual-eligible individuals are assigned to Full-benefit status and Partial-benefit status based on a "last-best" approach. Dual-eligible individuals are shown as a share of total Medicaid enrollees. Dual-eligible individuals under 65 are shown as a share of all Medicaid enrollees under 65. Dual-eligible individuals 65 and older are shown as a share of all Medicaid enrollees 65 and older. For more information on data quality issues that may lead to unusual spending or enrollment among dual-eligible individuals, see CMS DQ Atlas or the MACPAC Duals Data Book.
Estimates include dual-eligible individuals in 50 states and the District of Columbia if (1) they were in both the MBSF and T-MSIS files using the CCW crosswalk, and (2) Dual-eligible individuals are assigned Full-benefit status and partial benefit status using an “ever” approach and a hierarchy by giving priority to the Full-benefit status. Individuals were a Full-benefit dual-eligible individual in each year using the Medicare monthly DUALSTUS CD with values of 02,04,08 or the Medicaid monthly code DUALELGBL CD with values of 02,04,08 or the monthly code RSTRCTDBNFTS CD03 values of 1,A,D,4,5,7. If not a Full-benefit dual-eligible and the individual had DUAL STUSCD with values of 01,03,05,06 or the Medicaid monthly code DUAL ELGBLCD with values of 01,03,05,06 or the monthly code RSTRCTD BNFTSCD 03 values of 2,3,C,6,E,F they were assigned Partial-benefit status. Due to data suppression and rounding, subgroup estimates may not always sum to the total.
Caution is recommended when comparing data between 2016-2019 data and 2020-2021, since 2016-2019 versus 2020-2021 data come from different sources/approaches.
Sources
KFF estimates based on analysis of data from the CY 2016 R2 Transformed Medicaid Statistical Information System (T-MSIS).
KFF estimates based on analysis of data from the CY 2017 R1 Transformed Medicaid Statistical Information System (T-MSIS).
KFF estimates based on analysis of data from the CY 2018 R1 Transformed Medicaid Statistical Information System (T-MSIS).
KFF estimates based on analysis of data from the CY 2019 R1 Transformed Medicaid Statistical Information System (T-MSIS).
KFF estimates based on analysis of data from the CY 2020 R1 Transformed Medicaid Statistical Information System (T-MSIS).
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
Dual-Eligible Individuals : Individuals who are dually enrolled in Medicaid and Medicare at any time during the calendar year.
Full-benefit Dual-Eligible Individuals receive full Medicaid benefits and Medicaid payment of Medicare premiums and, in many cases, cost-sharing.
Partial-benefit Dual-Eligible Individuals receive assistance from Medicaid in the form of payment of Medicare premiums and, in many cases, cost-sharing, but do not receive full Medicaid benefits.
N/A : Data are not available due to a data quality issue. Arkansas reports zero enrollees with a valid DUALELGBL CD_LTST value. Idaho categorizes all dual-eligible individuals as partial benefit, so there are not data available for Full-benefit dual-eligible individuals.
N/A : Data are not available due to a data quality issue. New Jersey reports zero partial benefit dual-eligible individuals with a valid DUALELGBL CD_LTST value.