CMS Announcement: Disenrollment from Medicare Advantage and Prescription Drug Plans of Medicare Enrollees Who Are Incarcerated or Not Lawfully Present in the United States
On, November 2, 2021, CMS issued a memorandum to Medicare Advantage and Prescription Drug Plans to provide information about enrollment and disenrollment for individuals who are incarcerated or not lawfully present in the United States. On June 26, 2022, CMS plans to disenroll individuals in accordance with eligibility requirements codified in 42 CFR §§ 417.422, 422.50, and 423.30.
States will see these changes in the CMS MMA or TBQ response file they receive after that date. States that have programs to align Medicaid with Medicare plan enrollment for dually eligible individuals may want to review CMS data for Medicare plan disenrollment, and going forward, for Medicare eligibility status on incarceration and lawful presence. Key fields within the CMS response file include:
States can find the fields on the MMA Response File Detail layout in section 7.5 of the MAPD State User Guide (SUG):
Disenrollment from Medicare plans
- Items 143-144 Beneficiary Managed Care (MCO) Enrollment Start/End Date
- Item 145 Beneficiary MCO Number (contract level) (Occurrence 1)
- Items 146-154 will display Occurrences 2-10
- Item 155 Group Health Plan Enrollment Start Date (Occurrence 1)
- Items 156-157 Plan Benefit Package (PBP) Enrollment Start/End Date (Occurrence 1)
- Item 158 Plan Benefit Package Number
- Item 159 Plan Benefit Package Coverage Type Code (Occurrence 1)
- Items 160-168 will display PBP Enrollment Occurrences 2-10
Change in Medicare plan eligibility status
- Item 237 Medicare Plan Ineligibility Due to Incarceration Start Date (Occurrence 1).
- Items 274-291 will display Occurrences 2-10
- Item 292 Medicare Plan Ineligibility Due to Not Lawful Presence Start Date (Occurrence 1)
- Items 293-311 will display Occurrences 2-10
States can find the fields on the TBQ Response File Detail file layout, section 11.3 of the MAPD State User Guide (SUG):
Disenrollment from Medicare plans
- Items 89-90 Beneficiary Managed Care Organization (MCO) Start/End Date (Occurrence 1)
- Item 91 Beneficiary MCO contract number
- Items 92-100 will display Managed Care Organization Occurrences 2-10
- Item 101 Group Health Plan Enrollment Effective Date
- Items 102-103 Plan Benefit Package Start/End Date
- Item 104 Plan Benefit Package Number
- Item 105 Plan Benefit Package Coverage Type Code
- Items 106-114 will display Plan Benefit Package Election Occurrences 2-10
Change in Medicare plan eligibility status
- Items 184-185 Medicare Plan Ineligibility Due to Incarceration start/end Date (Occurrence 1)
- Items 218-235 will display Occurrences 2-10.
- Items 236-255 Medicare Plan Ineligibility Due to Not Lawful Presence Start (Occurrences 1-10)
Please contact the Medicare-Medicaid Coordination Office (MMCO) here with questions.