Each file must be documented to show that the welfare recipient was requested to apply
for HI and SMI but refused to do so. When the DO/BO contacts the recipient, they will
be advised that:
-
1.
By filing an application, they may establish entitlement to HI. This will enable them
to obtain needed medical care from most hospitals simply by presenting their health
insurance card.
-
2.
The filing of an application will permit SSA to determine whether they are eligible
for monthly benefits.
-
3.
Even if they refuse to file, the State may enroll them for SMI under the terms of
its agreement. Such enrollment will not give them HI protection.
If, after this is explained, the recipient still refuses to file, document the file
with an RC, or signed statement by the recipient, showing the basis for their refusal.
Notify the public assistance office that an CMS-4040 (Application for Enrollment in
Supplementary Medical Insurance Plan) is required to enroll the individual.
If the individual fails to respond to the DO/BO's efforts to contact them, the public
assistance office will attempt a personal contact (if it has not already done so)
before completing the CMS-4040. If the recipient refuses to file, a statement (on
the CMS-4040 or other writing) signed by an authorized welfare representative, showing
the reason the individual refused must be included in the file. The top margin of
the CMS-4040 received from the public assistance office is annotated by the DO/BO
“Enrolled pursuant to section 1843 of the Act.”
Although an CMS-4040 is an application form, its use in this case is not as an application,
but as a device for the State to transmit information which is needed to establish
the individual's eligibility for SMI. A signature or application by the individual
is not required for SMI enrollment under a State buy-in agreement.