Alternatively, states without a 1634 agreement establish Part B buy-in for SSI recipients on their own. States
that have not entered into 1634 Agreements are referred to as “Alert States.” The
Northern Marianas Islands, the only territory that has the SSI program, does not have
a 1634 agreement with SSA and is considered an “alert state.”
In alert states, SSI recipients must submit a separate application to the Medicaid
agency which determines eligibility for Medicaid benefits. CMS identifies SSI recipients
who are Medicare-eligible, then the state determines Medicaid eligibility and initiates
Part B buy-in enrollment for eligible individuals.
Alert states fall into two categories: SSI criteria states and 209(b) states.
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•
SSI Criteria States – Consider SSI recipients as eligible for Medicaid upon completion of a Medicaid
application.
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•
209(b) States – Apply more restrictive financial methodologies than SSI to determine eligibility
for Medicaid.
See the CMS Manual
for State Payment of Medicare Premiums, chapter 1, section 1.6.1.1 and chapter 2, section 2.5.1.