State MMA File of Dual Eligible Beneficiaries

SPOTLIGHT & RELEASES

 

Overview

Since 2005, states Medicaid agencies have been submitting files at least monthly to CMS to identify all people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible beneficiaries. This includes full benefit dually eligible individuals and partial benefit dually eligible individuals (i.e., who just get Medicaid help with Medicare premiums, and often for cost-sharing). The file is called the "MMA File" (after the Medicare Prescription Drug Improvement and Modernization Act of 2003), or State Phasedown File.

Frequency of File Submissions

Effective April 1, 2022, the Interoperability and Patient Access final rule requires states to submit and receive files on a daily basis.  See Section VII, Improving the Medicare-Medicaid Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges, and final changes to regulatory text in Parts 406, 407, and 423.

Learn more here (PDF) about the benefits of submitting multiple files.

MMA File Submission Procedures

Medicaid agencies for each of the fifty states and the District of Columbia ("states") must submit at least one monthly file to CMS identifying all known dually eligible beneficiaries. States have the option to submit multiple MMA files throughout the month (up to one per day). For those who do so, states will submit a large initial file including the bulk of enrollments for the reporting month, and smaller incremental files providing updates for changes in dual eligibility status (additions, deletions, or changes). States should not submit multiple full replacement files as CMS will not be able to effectively process the files.

How CMS Uses MMA Files

The monthly files support the following program needs for CMS:

  • Auto-enrolling full benefit dually eligible individuals into Medicare drug plans;
  • Deeming full and partial benefit dually eligible individuals automatically eligible for the Medicare Part D Low Income Subsidy (LIS, sometimes called extra help);
  • Determining monthly phase down payment amounts due from states;
  • Risk-adjusting capitation payments to Medicare Advantage plans; and
  • In Original Medicare, identifying Qualified Medicare Beneficiary status to alert those individuals, and the providers who serve them, that they are not liable for Medicare cost-sharing for Medicare Parts A and B services.

The MAPD State User Guide includes the following information:

  • Section 4, Technical instructions for submitting state data for MMA to view MMA file layouts
  • Section 5, State MMA Request File Timing & Content
  • Section 6, MMA Request File
  • Section 7, MMA Response File

For More Information

Click here to find answers to the questions we get asked most about the MMA file.

Contact the CMS Medicare-Medicaid Coordination Office via email to learn about more frequent MMA file submissions.

The MAPD Help Desk provides technical system support to states for file exchanges. Visit the MAPD Help Desk Web site for more information.


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Page Last Modified:
12/01/2021 08:00 PM