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:  June 14, 2013 
 
FROM:  Cindy Mann, Director 
Center for Medicaid and CHIP Services 
 
SUBJECT:  Annual Re-determination of Medicare Part D Low-Income Subsidy Deemed 
Status (Re-deeming) 
 
CMS CONTACT:  Amanda Rhee, 410-786-3888, Amanda.Rhee@cms.hhs.gov   
 
 
 
The Centers for Medicare & Medicaid Services (CMS) is now preparing for the annual 
redetermination of Medicare Part D low-income subsidy (LIS) deemed status, also known 
as re-deeming.   
 
The information below is 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 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. 
 
 
  CMCS Informational Bulletin  Page 2 
 
Process for Re-determining LIS Eligibility for Individuals who Automatically 
Qualify 
 
An individual determined or re-determined to be eligible for LIS from July 2012 through 
June 2013 will be deemed through December 31, 2013.  If, during the subsequent re-
determination process beginning in July 2013, 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 2014.   
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 2013 
 
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 2013, their eligibility will be extended to December 
31, 2014.  Additionally, a beneficiarys co-payment level for 2014 will be determined by 
type of dual eligibility, income, and institutional status reported in or after July 2013.   
 
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 2013, the person will be deemed 
eligible for LIS from August to December 2013 and re-deemed for all of 2014.  However, 
if a person is reported on the September MMA file as retroactively eligible for only May 
2013, the individual will only be deemed for LIS from May 2013 to December 2013.  The 
individual will not be re-deemed for 2014.  
 
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.  CMCS Informational Bulletin  Page 3 
 
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. 
 
Model versions of these notices, along with a beneficiary fact sheet and partner tip sheet, 
will be available in August at:   
http://www.cms.hhs.gov/LimitedIncomeandResources/LISNoticesMailings/list.asp#TopOfPage. 
 
Please note that individuals who continue to qualify for LIS without any changes to their 
copayment level in 2014 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 = 01/01/2014 
  Copay End Date = 12/31/2014 
 
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 2013 
MMA files will determine whether those beneficiaries will be deemed eligible for the low-
income subsidy for 2014. 
 
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. 
 
  CMCS Informational Bulletin  Page 4  
 
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, www.medicare.gov. 
 
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