DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
 
CMCS Informational Bulletin 
DATE:  July 15, 2016 
 
FROM:  Vikki Wachino, Director 
Center for Medicaid and CHIP Services 
 
SUBJECT:  Annual Re-determination of Medicare Part D Low-Income Subsidy Deemed 
Status (Re-deeming) 
 
CMS CONTACT:  Stephen Ludwig, 410-786-0554, stephen.ludwig@cms.hhs.gov  
 
The Centers for Medicare & Medicaid Services (CMS) is preparing for the annual redetermination 
of Medicare Part D low-income subsidy (LIS) deemed status, also known as re-deeming. The 
information below is being provided to help states understand the process and their role in ensuring 
that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under the 
Medicare Part D prescription drug benefit. 
 
General Background 
 
The Medicare Part D LIS provides extra help for beneficiaries who have limited income and 
resources to help them pay for their Medicare prescription drug plans premiums, co-payments, 
and the annual deductible. Medicare beneficiaries who automatically qualify and are then deemed 
eligible for LIS include: full-benefit dual eligible individuals, partial dual eligible individuals 
(Qualified Medicare Beneficiaries (QMB-only), Specified Low-Income Medicare Beneficiaries 
(SLMB-only), Qualifying Individuals (QI), and people who receive Supplemental Security 
Income (SSI) benefits but not Medicaid. 
 
Additionally, individuals with limited incomes and resources who do not automatically qualify can 
apply for LIS and have their eligibility determined by either the Social Security Administration 
(SSA) or their state Medicaid agency. Details on the LIS benefit may be found in Chapter 13 of 
the Medicare Prescription Drug Benefit Manual at http://www.cms.gov/Medicare/Prescription-
Drug-Coverage/PrescriptionDrugCovContra/PartDManuals.html. 
 
Process for Re-determining LIS Eligibility for Individuals who Automatically 
Qualify 
 
An individual determined or re-determined to be eligible for LIS from July 2015 through 
June 2016  will  be  deemed  through  December  31,  2016.  If,  during  the  subsequent  re-
determination process beginning in July 2016, it is determined that an individual continues to be 
eligible for LIS for the next calendar year, the individual will automatically be redeemed for all 
of 2017.   
Page 2  CMCS Informational Bulletin 
 
 
Throughout the year, whether an individual is being deemed or re-deemed, CMS will use state 
Medicare Modernization Act (MMA) and SSA files to initiate the eligibility process in deeming 
and re-deeming full dual and partial dual eligible individuals and SSI-only eligible individuals. 
 
Newly LIS Eligible Individuals from July to December 2016 
 
Individuals reported as full-benefit dual eligible beneficiaries, partial dual eligible beneficiaries 
(QMB-only, SLMB-only, or QI), or SSI recipients for any month between July and December of 
the current year will have their LIS deemed status extended to December 31 of the next calendar 
year. For example, if a beneficiary is determined to have full or partial dual status in July 2016, 
their eligibility will be extended to December 31, 2017. Additionally, a beneficiarys co-payment 
level for 2017 will be determined by type of dual eligibility, income, and institutional status 
reported in or after July 2016. 
 
CMS will continue to look for individuals who states report as full or partial duals after July. 
Depending on how the state reports the individuals eligibility, the individual may or may not be 
deemed for the next calendar year. If the state reports eligibility only for a period before July of 
the current year, the individual will only be deemed for the current year. If the state reports 
eligibility for a period that includes July or any month after July, the individual will be deemed 
for the remainder of the current year and all of the next calendar year. For example, if a beneficiary 
is reported on a September MMA file as retroactively eligible for just the month of August 2016, 
the person will be deemed eligible for LIS from August to December 2016 and re-deemed for all 
of 2017. However, if a person is reported on the September MMA file as retroactively eligible for 
only May 2016, the individual will only be deemed for LIS from May 2016 to December 2016.  
The individual will not be automatically re-deemed for 2017. 
 
Notices to Beneficiaries 
 
In September, CMS and SSA will issue a joint mailing to beneficiaries whose deemed status will 
not continue into the next calendar year based on their absence from the July or August state MMA 
files or SSAs August file. This mailing will include a personalized letter on gray paper from CMS 
explaining their loss of LIS, an SSA application for extra help, and a postage-paid return envelope 
to assist the individual in re-establishing eligibility for the subsidy for the next calendar year. 
 
If any individual who receives a gray notice informing them of their loss of deemed status 
subsequently becomes newly eligible for Medicaid in future months, CMS will mail them a new 
letter on purple paper informing them that they now automatically qualify for LIS. 
 
In early October, individuals who will continue to have LIS, but will have a change in their co-
payment level in the next calendar year, will receive a personalized letter on orange paper from 
CMS outlining the changes that will be effective January 1.   
Page 3  CMCS Informational Bulletin 
 
 
Model versions of these notices, along with a beneficiary fact sheet and partner tip sheet, will be 
available in August at:  
https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/LIS-
Notices-and-Mailings.html  
 
Please note that individuals who continue to qualify for  LIS without any changes to their 
copayment level in 2017 will not receive a notice. 
 
CMS Notification to States 
 
In September, CMS will provide a file to states identifying residents who are being notified of 
their loss of deemed status effective January 1. The file layout is attached in Appendix A. We 
will notify you separately of the specific date that the file will be sent. 
 
CMS will also provide data on the MMA state response file on the re-deemed status of those 
reported on a given file.  For example, the results of data submitted by the state for re-deeming on 
July 12 will appear on the CMS-generated MMA response file that will be sent back to the state 
within an estimated 48 hours, or by July 14. The following data will appear in the response file 
when the beneficiary has been re-deemed: 
 
  Beneficiary Copay Type = D 
  Beneficiary Copay Level = 1, 2, or 3 
  Copay Start Date = 01/01/2017 
  Copay End Date = 12/31/2017 
 
What Do States Need to Do? 
 
We cannot overemphasize the importance of ensuring the accuracy and completeness of the state 
MMA files submitted starting in July for the process of re-determining deemed status. States 
inclusion or exclusion of beneficiaries from their July through December 2016 MMA files will 
determine  whether  those  beneficiaries  will  be  deemed  eligible  for  the  low-income  subsidy 
for 2017. 
 
We strongly recommend that states use the information in our September Loss of Deemed Status 
file (which is attached as Appendix A) to screen these individuals for eligibility for Medicaid or 
any of the Medicare Savings Programs, or to work with them to apply for LIS. 
 
Additional Information 
 
CMS will continuously provide the resources and assistance people need to make sure that 
everyone  who qualifies for extra help receives help paying for Medicare prescription drug 
coverage.  In support of the effort, we are working with your offices, SSA, State Health Insurance 
and Assistance Programs (SHIPs), physicians, pharmacists, prescription drug plans, and hundreds 
of partner organizations across the country to reach beneficiaries with messages and guidance.  
Our customer service representatives at 1-800-MEDICARE are prepared to answer questions and 
to guide beneficiaries through the process of applying for LIS, and relevant information is posted 
on our consumer website, Medicare.gov.   
Page 4  CMCS Informational Bulletin 
 
 
CMS appreciates states continued assistance in ensuring that dual eligible beneficiaries have 
timely, affordable, and comprehensive coverage under the Medicare Part D prescription drug 
benefit. 
 
Attachment   
Appendix A - Exchange Name: DEEMLD 
 
Table 1: This is the first record of the file. It will only occur once. 
Table 2: This record will contain beneficiary information. It may occur multiple times. 
Table 3: This is the last record of the file. It will only occur once. 
 
Table 1: Annual State File for Beneficiaries Who Lost Deeming Status Header Record 
 
Data Field  Length  Position  Form  Valid Values 
at 
Header Code  6  1  ...  6  CHAR  DEEMLD 
State Code  2  7  8  CHAR  State Code 
Sending Entity  8  8  ...  16  CHAR  CMS   CMS + 5 spaces 
Run Date of the file  8  17  24  CHAR  CCYYMMDD 
Filler  576  25  ...  600  CHAR  spaces 
Record Length =  600 
Table 2: Annual State File for Beneficiaries Who Lost Deeming Status Detail Record 
 
Data Field  Length  Position  Format  Valid Values 
Record Type  3  1 ... 3  CHAR  DTL 
Beneficiarys Health Insurance Claim or  12  4 ... 15  CHAR   
Railroad Board Number 
Representative Payee Name  40  16 ... 55  CHAR  spaces if no Payee 
Beneficiarys Name  40  56 ... 95  CHAR   
Beneficiarys Address Line 1  40  96 ... 135  CHAR   
Beneficiarys Address Line 2  40  136 ... 175  CHAR   
Beneficiarys Address Line 3  40  176 ... 215  CHAR   
Beneficiarys Address Line 4  40  216 ... 255  CHAR   
Beneficiarys Address Line 5  40  256 ... 295  CHAR   
Beneficiarys Address Line 6  40  296 ... 335  CHAR   
Beneficiarys City  27  336 ... 362  CHAR   
Beneficiarys State  3  363 ... 365  CHAR   
Beneficiarys Zip Code  10  366 ... 375  CHAR   
Cluster Identification Code  14  376 ... 389  CHAR   
Beneficiarys Date of Birth  8  390 ... 397  CHAR  CCYYMMDD 
Beneficiarys Social Security Number  9  398 ... 406  CHAR  spaces if SSN does 
not exist 
Filler  132  407 ... 538  CHAR  spaces 
Co-Payment Level for Current Calendar  1  539 ... 539  CHAR  1, 2, or 3 
Year 
Co-Payment Level for Next Calendar Year  1  540 ... 540  CHAR  1, 2, or 3 
Reason Code for Current Calendar Year  2  541 ... 542  CHAR  1, 10, or 2A 
Reason Code for Next Calendar Year  2  543 ... 544  CHAR  1, 10, or 2A 
Start Date for Current Calendar Year  8  545 ... 552  CHAR  MMDDCCYY 
End Date for Next Calendar Year  8  553 ... 560  CHAR  MMDDCCYY 
Filler  40  561 ... 600  CHAR  spaces   
 
Data Field  Length  Position  Format  Valid Values 
Record Length =  600 
Table 3: Annual State File for Beneficiaries Who Lost Deeming Status Trailer Record 
 
Data Field  Length  Position  Format  Valid Values 
Trailer Code  6  1  ...   6  CHAR  TRLRLD 
State Code  2  7  ...   8  CHAR  State Code 
Sending Entity  8  9  ...   16  CHAR  CMS  CMS 
+ 5 spaces 
Run Date of File  8  17  ...   24  CHAR   
Filler  9  25  ...   33  CHAR  spaces 
Record Count  9  34  ...   42  ZD   
Filler  558  43  ...   600  CHAR  spaces 
Record Length =  600