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Estimates of dual and full Medicaid benefit dual enrollees, 1999.

INTRODUCTION

There is a clear need to develop better estimates of dual (Medicare and Medicaid) enrollees and the subpopulation of dual enrollees who receive full Medicaid benefits. Dual enrollees that may receive full Medicaid benefits include: qualified Medicare beneficiaries (QMBs), specified low-income Medicare beneficiaries (SLMBs), and other dual beneficiaries--a group that includes medically needy/spend-down enrollees. Better estimates are needed for a number of activities:

* A need to improve coordination of public funds from Medicare and Medicaid to meet the service needs of these vulnerable populations.

* Continuing increases in utilization and program spending for these vulnerable populations, especially dual disabled enrollees. These spending increases are straining Medicaid budgets in times that States are in fiscal crisis.

* A need for baseline estimates of State spending amounts for prescription drugs provided to dual enrollees by Medicaid to support cost estimates for these populations once drug coverage for these groups begins in 2006 under Medicare.

* A need to monitor changes in utilization and spending levels for dual enrollees under Medicaid.

The estimates shown in the tables are not official CMS estimates and should not be construed to represent data used for purposes of implementing the provisions of Section 103 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) relating to the Federal assumption of Medicaid prescription drug costs for dual enrollees.

NEED TO LINK MEDICARE AND MEDICAID DATA

Neither the Medicare nor the Medicaid systems, by themselves, permit complete and accurate reporting of dual enrollees.

Medicare

The Medicare system maintains data on persons enrolled in Medicaid and for whom Medicaid has paid the Medicare Part A and B insurance premiums in the enrollment database (EDB). Historically, these third-party liability data were housed in a Medicare data set commonly known as the TPEarth file (or the third party buy-in). Data from these Medicare systems have traditionally represented an undercount of all dual enrollees because States do not necessarily pay Medicare premiums for all dual enrollees.

Medicaid

The Medicaid analytic extract (MAX) data include two possible data elements that may identify dual enrollees. The first is the "dual eligibility flag." In its current form, this data element was first required of State Medicaid agencies beginning with fiscal year (FY) 1999 reporting under the Medicaid statistical information system (MSIS), the source for MAX data. Data quality may vary substantially from State-to-State for this data element. The second is a pair of data elements that report Medicare deductible and coinsurance payment amounts paid by Medicaid for a dual enrollee on an individual claim. Again, data quality is uncertain because reporting of these amounts was also required of State Medicaid agencies for the first time, beginning with FY 1999.

MEDICARE AND MEDICAID LINK

The source data for the most recent link are the Medicaid MAX data for calendar year (CY) 1999 and the Medicare EDB for the 50 States and Washington, DC. In order to maximize the quality of the linking process, the Medicare health insurance claim (HIC) was not used as a primary linking variable. Instead, the linking criteria use the Medicaid enrollees' Social Security Number (SSN), date of birth (DOB), and sex. The link effort begins with Medicaid MAX data and consists of two steps:

* The first step has different criteria for aged versus disabled Medicaid enrollees. For aged Medicaid enrollees, SSN, and sex must match exactly. For disabled Medicaid beneficiaries, either the enrollees' SSN or the DOB must match exactly, or SSN and sex must match exactly, and two of the three elements in DOB must match exactly.

* In the second step, there is an attempt to link the Medicaid SSN to a claim account number (CAN) from the HIC in the EDB for records that were not linked in the first step. This is done because some enrollees incorrectly report the CAN from an account on which they receive auxiliary benefits (as a spouse, widow, child, etc.) as their own SSN. For example, a spouse will report her husband's SSN as though it were her SSN. A check on sex and DOB assures that a correct link is made.

Once it is determined that the enrollee appears in both the MSIS and EDB data sets, it is necessary to determine if the enrollee was eligible for both programs at the same time.

* For each MAX eligibility record, month-by-month Medicaid enrollment is compared to repeating segments of Medicare enrollment. A dual indicator is set whenever an overlap occurs. An annual (CY) dual indicator is set if the dual indicator for any month is set. The result is an enhanced MAX eligibility data set that includes information about the results of the EDB link.

* For persons identified as dual enrollees, selected data elements from the EDB are added to the Medicaid enrollment data. Because this is a Medicaid database, all MAX records are retained. However, information on dual enrollment status is not retained if the EDB contains an indication of dual enrollment status, but there is no record in the MAX file for the enrolled person.

COUNTING DUAL ENROLLEES USING MAX DATA

Following the EDB link, the MAX data provides counts of confirmed dual enrollees, by State. There is the potential for bias both in terms of undercounting and overcounting. The potential for undercounting may be caused by one or more of several factors: (1) the record for a dual enrollee may have been missing from either the EDB or the MAX file, (2) SSN may have been missing in the MAX file, or (3) there may have been errors or number transpositions in the recorded SSN. The possibility of overcounting is not as likely, but could be caused if an enrollee moved to a different State during the year because the MAX data are State-specific data sets. Because of this, there has been no attempt to unduplicate persons across States.

Estimates include adjustments for under-counting persons reported as dual by Medicaid, but not linked with an SSN or with incorrect/non-matching SSNs. However, estimates do not include adjustments for undercounting of persons reported as dual enrollee by Medicare, but not linked to Medicaid (e.g. persons on Medicare TPEarth). The estimates do not adjust for over-counting that may occur if the Medicaid person was enrolled in more than one State or if more than one person was identified with the same SSN in Medicaid. In both cases where adjustments were not made, the extent of over-counting and/or undercounting should be extremely minor and offsetting.

DUAL ELIGIBLE COUNTS--ADJUSTING FOR BIAS

Two sets of State-specific estimates are produced in Table 1. The first set is known as the "best estimate." It consists of enrollees confirmed to be dual enrollees as a result of the EDB link and selected Medicaid enrollees not linked to EDB (those identified as dual enrollees by Medicaid and having at least one claim in the year where Medicare copayment and/or deductible was paid by Medicaid in 1999). The second set of estimates is known as the "upper bound estimate." It consists of enrollees confirmed to be dual enrollees as a result of the EDB link and selected Medicaid enrollees not linked to EDB (those identified as dual enrollees by Medicaid or having at least one claim in the year where Medicare copayment and/or deductible was paid by Medicaid. Because of data inconsistencies for several States, these estimates are adjusted to not exceed the total number of aged and disabled enrollees in each State.

Estimating Full Medicaid Benefit

Currently it is not possible to estimate full Medicaid benefit dual enrollees using Medicare data alone. However, there are two Medicaid data elements that are used to increase the accuracy of these estimates.

The first of these data elements is the dual eligible flag. This data element was first required in MSIS reporting for FY 1999. While MSIS has established a 2-percent error tolerance for this data element; reporting remains inconsistent. One State (Pennsylvania) did not report dual enrollment status. Five other States (Georgia, Ohio, Rhode Island, Tennessee, and West Virginia) reported no full Medicaid dual enrollees. Findings for these six States are inconsistent with national estimates that about 90 percent of all dual enrollees are full Medicaid dual enrollees. However, the most pervasive data reporting problem for this data element was that many States reported dual eligibility status of unknown for a high percentage of their dual enrollees. Based on MAX data for 1999, 21 States reported greater than 20 percent of dual enrollment status of unknown. Among those States, 11 reported greater than 50 percent unknown.

There are two estimates of full Medicaid benefit dual enrollees that are produced using this data element (Table 2). The first estimate, known as the "lower bound estimate", assumes that dual enrollees of unknown type are distributed according to the same percentages as those for whom type is known. This assumption becomes questionable as the percentage of dual enrollees of unknown type grows, but it does establish a lower bound for the number of full Medicaid benefit dual enrollees. The second estimate, known as the "best estimate", assumes that all dual enrollees of unknown type are full Medicaid benefit dual enrollees. This is a reasonable assumption because, as noted previously in the national estimates, about 90 percent of all dual enrollees are full Medicaid benefit dual enrollees. Also, it is likely that States would have correctly identified dual enrollees who do not receive full Medicaid benefits because of the need they have to coordinate coverage and reimbursement with Medicare.

The second data element is the "restricted benefits flag." As with the dual eligible flag, this data element was first reported by States, in MSIS for FY 1999. While this data element has a 5-percent error tolerance for States, it is reported that data quality is questionable (Ellwood, 2004). A code value of 3 for this data element indicates that the person is enrolled in Medicaid, but only entitled to restricted benefits based on Medicare dual-eligibility status (e.g. QMB only, SLMB only, qualified disabled and working individuals--QDWIs or qualifying individuals--QI1s or QI2s) (Centers for Medicare & Medicaid Services, 2004a). An estimate of full Medicaid benefit dual enrollees is made using this data element to subtract numbers of dual enrollees with restricted benefits from the total numbers of dual enrollees. These estimates are also shown in Table 2.

CONCLUSION

As a best estimate, there were about 6.881 million dual enrollees, nationally, ever enrolled in both Medicare and Medicaid during 1999. This represented about 16.2 percent of all Medicaid enrollees. An upper bound estimate was 7.288 million dual enrollees.

Because the quality of reporting was uncertain for data elements used to estimate full Medicaid benefit dual enrollees, the reliability of those estimates is less certain than the estimates of all dual enrollees. However, the estimates of full Medicaid dual enrollees ranged from a lower bound estimate of 5.916 million (86.0 percent of all dual enrollees) to a best estimate of 6.091 million (88.5 percent of all dual enrollees).

DISCUSSION

These estimates of dual enrollees compare favorably with estimates from other sources:

* An estimate for FY 1999 is 6.982 million duals, using an actuarial rules of thumb regarding the percentage of aged and disabled who are dual enrollees (95 percent of Medicaid aged and 40 percent of Medicaid disabled beneficiaries) on reported FY 1999 MSIS summary statistics (Klemm, 2004; Centers for Medicare & Medicaid Services, 2004b). The data reported in this article are quite close to this estimate because both estimates are counts of enrollees ever enrolled in a year. The primary difference is that one estimate is for CY 1999 and the other is for FY 1999.

* The Kaiser Commission on Medicaid and the Uninsured (2003) reported 5.84 million full Medicaid dual enrollees for FY 2000. Colleagues Bruen and Holahan (2004) reported 7.2 million dual enrollees and 6.13 million full Medicaid dual enrollees for 2002. These estimates are also counts of persons ever enrolled in a year.

* The Henry J. Kaiser Family Foundation (2004) reported 5.8 million dual enrollees as of the August 2002 billing cycle, reflecting enrollment as of June 2002. Estimates of dual enrollees for the first quarter of FY 1999 were 5.46 million (Ellwood, 2002). Using a similar methodology, Ku (2003) estimated 5.4 million full Medicaid dual enrollees in 1999. The Medicaid Chart Book reports an average number of 6.4 million dual enrollees during CY 2000 (Centers for Medicare & Medicaid Services, 2003). Data from the Medicare Current Beneficiary Survey in 1999 show 6.277 million persons with health insurance coverage through Medicaid (either as Medicare buy-in individuals or as reported by survey respondents). Clark and Hulbert (1998) reported between 6.4 and 6.7 million dual enrollees for 1997, using (form) HCFA-2082 reports that were actuarially adjusted to represent person years of enrollment and to approximate average monthly enrollment. It is reasonable that estimates reported here should be higher than these quarterly, monthly, or point-in-time estimates because of enrollment turnover through the year.

* Finally, Dale and Verdier (2003) estimated that there were 6 million dual enrollees in 2002.

Reprint Requests: David K. Baugh, M.A., Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mail Stop C3-20-17, Baltimore, Maryland 21244-1850. E-mail: dbaugh@ cms.hhs.gov

ACKNOWLEDGMENTS

The author would like to thank William Clark, Suzanne Dodds, Marilyn Ellwood, David Gibson, and John Klemm for their technical input and review. The author would also like to thank Matt Gillingham and Yifei Hu for providing background data for the estimates. Finally, the author would like to thank Chuck Brinker for his work on the linking methodology between Medicaid (MAX) and Medicare (EDB) data.

REFERENCES

Bruen, B. and Holahan, J.: Shifting the Cost of Dual Eligibles: Implications for Slates and the Federal Government. The Kaiser Commission on Medicaid and the Uninsured. November, 2003. Internet address: http://www.kff.org/medicaid/4152.dm (Accessed March 2004.)

Centers for Medicare & Medicaid Services: Medicaid Chart Book, unpublished data. July 2003.

Centers for Medicare & Medicaid Services: Internet address: http://www.cms.gov/medicaid/ msis/msisdd99.pdf (Accessed March 2004a.)

Centers for Medicare & Medicaid Services: Internet address: http://www.cms.gov/medicaid/msis/msis99sr.asp, (Accessed March 2004b.)

Clark, W. and Hulbert, M.: Research Issues: Dually Eligible Medicare and Medicaid Beneficiaries, Challenges and Opportunities. Health Care Financing Review, 20(2):1-10, Winter 1998.

Dale, S. and Verdier, J.: State Medicaid Prescription Drug Expenditures for Medicare-Medicaid Dual Eligibles, Issue Brief Number 627. The Commonwealth Fund. New York. Internet address: www.cmwf.org. (Accessed April 2003.)

Ellwood, M.: Background Information on Dual Eligibles in MSIS (FY 1999). Unpublished manuscript, originally prepared for Assistant Secretary for Planning and Evaluation, February 2001. Updated February 28, 2002.

Ellwood, M.: Personal communication: February 27, 2004.

Henry J. Kaiser Family Foundation: Internet address: http://www.statehealthfacts.org/cgi-bin/ healthfacts.cgi?action=compare&category=Medica re&subcategory=Dual+Eligibles&topic=Total+Dual +Eligibles (Accessed March 2004.)

Kaiser Commission on Medicaid and the Uninsured: A Prescription Drug Benefit in Medicare: Implications for Medicaid and Low-Income Medicare Beneficiaries. Internet address: http://www.kff.org/medicaid/kcmu4136brief.cfm. (Accessed September 2003.)

Klemm, J.: Personal communication. March 1, 2004.

Ku, L.: How Many Low-Income Medicare Beneficiaries in Each State Would Be Denied the Medicare Prescription Drug Benefit Under the Senate Bill? Center for Budget and Policy Priorities. Internet address: http://www.centeronbudget. org/7-31-03health.htm. (Accessed July 2003.)

David K. Baugh, M.A.

The author is with the Centers for Medicare & Medicaid Services (CMS). The statements expressed in this article are those of the author and do not necessarily reflect the views or policies of CMS.
Table 1
Estimates of Medicaid Dual Enrollees Ever Enrolled, by
State: Calendar Year 1999

 Best
 Confirmed Estimate
 Total Dual of Dual
 Medicaid Enrollees Enrollees
State Enrollees (1) (2,4)

Alabama 657,495 152,607 153,670
Alaska 103,789 9,756 9,807
Arizona 648,016 60,683 61,032
Arkansas 491,245 92,080 95,611
California 7,288,627 897,559 901,639
Colorado 357,814 65,503 65,889
Connecticut 417,767 80,036 80,620
Delaware 116,454 14,038 14,147
District of
 Columbia 146,668 17,334 17,507
Florida 2,104,306 375,666 377,811
Georgia 1,249,063 195,687 197,542
Hawaii 199,173 24,862 25,048
Idaho 134,065 18,889 18,924
Illinois 1,712,826 217,700 219,437
Indiana 694,508 116,613 117,168
Iowa 313,720 64,155 64,555
Kansas 256,690 51,714 51,979
Kentucky 687,437 140,341 141,612
Louisana 786,601 132,446 133,604
Maine 204,329 48,226 48,364
Maryland 686,834 85,887 86,628
Massachusetts 1,060,289 204,531 205,797
Michigan 1,339,452 204,389 205,323
Minnesota 591,427 96,760 97,234
Mississippi 552,951 125,374 126,330
Missouri 898,028 151,206 152,305
Montana 96,453 17,009 17,153
Nebraska 227,395 35,359 35,541
Nevada 139,700 23,941 24,085
New Hampshire 106,887 19,411 19,561
New Jersey 869,612 178,150 179,285
New Mexico 378,433 39,530 39,794
New York 3,403,171 562,166 578,402
North Carolina 1,209,799 261,684 263,206
North Dakota 61,806 14,182 14,250
Ohio 1,386,016 219,622 221,151
Oklahoma 533,438 89,656 90,213
Oregon 543,964 67,508 67,759
Pennsylvania 1,694,804 290,403 290,403
Rhode Island 169,491 31,518 31,670
South Carolina 757,964 119,023 120,444
South Dakota 95,437 17,161 17,236
Tennessee 1,541,222 253,772 255,027
Texas 2,710,200 464,601 467,926
Utah 202,235 20,307 20,366
Vermont 142,051 26,807 26,897
Virginia 696,419 139,649 141,355
Washington 899,702 104,903 105,560
West Virginia 358,317 55,708 56,291
Wisconsin 575,138 119,366 120,078
Wyoming 52,177 7,961 7,987
50 States and
 Washington, DC 42,551,405 6,823,439 6,881,223

 Dual
 Enrollees
 (Best Upper Bound
 Estimate) as Estimate
 a Percent of of Dual
 Total Enrollees
State Enrollees (3,4)

Alabama 23.4 159,183
Alaska 9.4 9,931
Arizona 9.4 66,118
Arkansas 19.5 121,518
California 12.4 911,450
Colorado 18.4 67,422
Connecticut 19.3 81,147
Delaware 12.1 14,341
District of
 Columbia 11.9 19,063
Florida 18.0 380,456
Georgia 15.8 199,573
Hawaii 12.6 40,364
Idaho 14.1 19,057
Illinois 12.8 221,400
Indiana 16.9 118,548
Iowa 20.6 65,542
Kansas 20.2 53,222
Kentucky 20.6 208,686
Louisana 17.0 135,371
Maine 23.7 49,977
Maryland 12.6 89,249
Massachusetts 19.4 207,579
Michigan 15.3 222,843
Minnesota 16.4 98,038
Mississippi 22.8 217,657
Missouri 17.0 155,259
Montana 17.8 17,350
Nebraska 15.6 35,800
Nevada 17.2 26,132
New Hampshire 18.3 20,339
New Jersey 20.6 185,313
New Mexico 10.5 40,137
New York 17.0 600,751
North Carolina 21.8 269,374
North Dakota 23.1 14,313
Ohio 16.0 223,170
Oklahoma 16.9 114,432
Oregon 12.5 71,278
Pennsylvania 17.1 290,403
Rhode Island 18.7 31,936
South Carolina 15.9 122,667
South Dakota 18.1 17,488
Tennessee 16.5 304,033
Texas 17.3 484,020
Utah 10.1 20,649
Vermont 18.9 27,171
Virginia 20.3 142,509
Washington 11.7 109,131
West Virginia 15.7 57,507
Wisconsin 20.9 120,710
Wyoming 15.3 8,051
50 States and
 Washington, DC 16.2 7,287,658

(1) Dual enrollment status was confirmed by a link between
Medicaid analytic extract (MAX) and Medicare enrollment data
base (EDB) data for 1999.

(2) Confirmed dual enrollees and non-confirmed Medicaid
enrollees who were identified as dual enrollees by Medicaid and
had at least one claim with Medicare copayment and deductible
amounts paid by Medicaid.

(3) Confirmed dual enrollees and non-confirmed Medicaid
enrollees who were identified as dual enrollees by Medicaid or
had at least one claim with Medicare copayment and/or deductible
amounts paid by Medicaid.

(4) Because of data inconsistencies for several States, this
estimate is adjusted to not exceed the total number of aged and
disabled enrollees in each State.

SOURCE: Centers for Medicare 8 Medicaid Services: Medicaid
Analytic Extract (MAX) data, 2004.

Table 2
Estimates of Full Medicaid Benefit Dual Enrollees Ever
Enrolled, by State: Calendar Year 1999

 Lower Bound Best
 Estimate of Estimate of
 Best Full Medicaid Full Medicaid
 Estimate Dual Dual
 of Dual Enrollees Enrollees
State Enrollees (1,2) (1,3)

Alabama 153,670 103,069 110,921
Alaska 9,807 9,715 9,732
Arizona 61,032 39,908 47,191
Arkansas 95,611 74,745 74,745
California 901,639 883,585 883,604
Colorado 65,889 51,637 54,834
Connecticut 80,620 72,398 74,932
Delaware 14,147 8,038 9,895
District of
 Columbia 17,507 17,507 17,507
Florida 377,811 355,983 355,983
Georgia 197,542 169,846 174,858
Hawaii 25,048 24,966 24,972
Idaho 18,924 15,205 15,205
Illinois 219,437 154,097 158,821
Indiana 117,168 100,996 100,996
Iowa 64,555 50,637 53,523
Kansas 51,979 45,106 45,106
Kentucky 141,612 97,177 101,423
Louisana 133,604 111,718 111,718
Maine 48,364 42,434 42,434
Maryland 86,628 68,575 68,646
Massachusetts 205,797 166,827 191,568
Michigan 205,323 150,356 182,483
Minnesota 97,234 81,393 84,768
Mississippi 126,330 118,924 118,924
Missouri 152,305 137,478 137,478
Montana 17,153 16,525 16,532
Nebraska 35,541 33,844 33,878
Nevada 24,085 14,746 14,746
New Hampshire 19,561 18,517 18,517
New Jersey 179,285 147,286 151,920
New Mexico 39,794 12,912 29,041
New York 578,402 575,309 577,173
North Carolina 263,206 226,469 228,868
North Dakota 14,250 7,758 13,087
Ohio 221,151 190,145 195,756
Oklahoma 90,213 74,087 74,087
Oregon 67,759 47,654 52,466
Pennsylvania 290,403 249,688 257,056
Rhode Island 31,670 27,230 28,033
South Carolina 120,444 120,444 120,444
South Dakota 17,236 9,576 13,732
Tennessee 255,027 219,272 225,742
Texas 467,926 376,012 380,162
Utah 20,366 17,729 17,729
Vermont 26,897 25,802 26,159
Virginia 141,355 97,551 99,450
Washington 105,560 88,168 93,985
West Virginia 56,291 48,399 49,827
Wisconsin 120,078 114,405 114,405
Wyoming 7,987 4,614 5,984
50 States and
Washington, DC 6,881,223 5,916,462 6,091,049

 Full Dual
 Enrollees Full Dual
 (Best Enrollees
 Estimate) as Estimate (Using
 a Percent of Restricted
 Dual Benefits)
State Enrollees (4)

Alabama 72.2 107,468
Alaska 99.2 9,744
Arizona 77.3 52,089
Arkansas 78.2 71,745
California 98.0 884,405
Colorado 83.2 54,579
Connecticut 92.9 74,565
Delaware 69.9 9,887
District of
 Columbia 100.0 17,507
Florida 94.2 356,550
Georgia 88.5 148,542
Hawaii 99.7 24,974
Idaho 80.3 15,958
Illinois 72.4 154,956
Indiana 86.2 100,883
Iowa 82.9 52,459
Kansas 86.8 44,736
Kentucky 71.6 103,784
Louisana 83.6 111,238
Maine 87.7 41,979
Maryland 79.2 68,235
Massachusetts 93.1 194,351
Michigan 88.9 188,533
Minnesota 87.2 87,885
Mississippi 94.1 116,616
Missouri 90.3 134,407
Montana 96.4 16,515
Nebraska 95.3 33,896
Nevada 61.2 13,837
New Hampshire 94.7 18,695
New Jersey 84.7 151,223
New Mexico 73.0 30,790
New York 99.8 576,119
North Carolina 87.0 226,765
North Dakota 91.8 13,147
Ohio 88.5 190,463
Oklahoma 82.1 71,529
Oregon 77.4 60,197
Pennsylvania 88.5 261,546
Rhode Island 88.5 29,808
South Carolina 100.0 120,444
South Dakota 79.7 13,065
Tennessee 88.5 195,492
Texas 81.2 367,049
Utah 87.1 18,326
Vermont 97.3 26,897
Virginia 70.4 95,855
Washington 89.0 92,775
West Virginia 88.5 42,895
Wisconsin 95.3 113,842
Wyoming 74.9 5,686
50 States and
Washington, DC 88.5 6,014,927

(1) Dual enrollment status was confirmed by a link between
Medicaid analytic extract (MAX) and Medicare enrollment data
base (EDB) data for 1999. Estimates of full Medicaid dual
enrollees were based on distributions of person-years of
enrollment by code values of the Medicaid statistical
information system (MSIS) data element "dual eligibility flag,
as reported in MAX validation reports.

(2) Estimates consist of confirmed full dual enrollees plus a
percentage of unconfirmed dual enrollees with MAX dual
eligibility flag values of 50 (dual status was indicated by the
EDB, but not MAX) and 59 (dual status was indicated by the EDB
and unknown in MAX).

(3) Estimates consist of confirmed full dual enrollees, all
unconfirmed dual enrollees with a MAX dual eligibility flag
value of 59 (dual status was indicated by the EDB and unknown
in MAX) plus a percentage of unconfirmed dual enrollees with
MAX dual eligibility flag value of 50 (dual status was indicated
by the EDB, but not MAX).

(4) Estimates consist of dual enrollees with restricted benefits
as reported in the MAX data element restricted benefits flag.

SOURCE: Centers for Medicare & Medicaid Services: Medicaid
Analytic Extract (MAX) data, 2004.
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Title Annotation:Data View
Author:Baugh, David K.
Publication:Health Care Financing Review
Geographic Code:1USA
Date:Dec 22, 2004
Words:4357
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