Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office
Since 2005, states have exchanged files with the Centers for Medicare & Medicaid Services (CMS) that identify current and prospective dually eligible individuals. These files are known as Medicare Modernization Act (MMA) files. Through MMA file exchange, states can identify Medicaid enrollees who are currently dually eligible, as well as Medicaid enrollees who will become dually eligible in the next three months (known as “prospective” dually eligible individuals). This TA tool explains how states can use these files to identify dually eligible individuals for a number of reasons. For example, states may wish to ensure that dually eligible individuals are enrolled into Medicare Parts A and B and the Medicare Part D Low-Income Subsidy as soon as they become eligible for Medicare. Accurate identification of dually eligible individuals also helps to ensure timely and accurate payments to providers for services rendered and timely beneficiary receipt of state coverage of Medicare premiums and cost-sharing. States with integrated care initiatives for dually eligible individuals also need to identify these individuals in a timely manner to use passive and default enrollment processes.
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