HI 00815.048 Establishing Buy-In Eligibility for Persons Who Refuse to Cooperate — CMS Accretions Under SSI Program

If an individual eligible for SSI payments refuses to file an application under title XVIII the DO/BO will complete a HCFA-4040 to enroll the individual. Once evidence as to age, U.S. citizenship (or lawful alien status), and residence in the U.S. is obtained (using Title II Rules), forward the file for processing (see HI 00815.045B). Each file must also be documented to show that the individual was requested to apply for HI and SMI but refused to do so. Complete the award form in accordance with HI 00815.045D.

If the individual also fails to cooperate in establishing that all SMI eligibility requirements are met, the State must assume the burden of proving the Individual’s SMI eligibility. If, after all sources of evidence have been exhausted, it has not been established that the eligibility requirements are met, the file should be forwarded for disallowance.