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State MMA File of Dual Eligible Beneficiaries

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 dual eligible beneficiaries. This includes full benefit dual eligible individuals and partial benefit dual 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.

MMA File Submission Procedures

Medicaid agencies for each of the fifty states and the District of Columbia (hereafter referred to as "states") must submit at least one monthly file identifying all known dual eligible beneficiaries. States have the option to submit multiple MMA files throughout the month (up to one per day). CMS encourages multiple file submissions. There are several benefits of submitting multiple files. 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 dual eligible individuals into Medicare drug plans;
  • Deeming full and partial benefit dual 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 Medicare Advantage Prescription Drug (MAPD) State Users Guide (SUG) (Version 7.0 (02/28/2018)) 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

Learn more about the MMA file here. For questions, please contact the MAPD Help Desk directly.

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