If a beneficiary enrolled in a Medicaid eligibility category included in the state’s
buy-in group experiences a change in circumstance and the state determines the beneficiary
ineligible for that Medicaid category, the state must promptly redetermine eligibility
on all other bases in order to determine if the beneficiary qualifies for a different
Medicaid category, including those included within the Part B buy-in coverage group.
While the state is making this determination, the state must maintain Medicaid coverage
and must not terminate the beneficiary from buy-in. Further, if the state determines
the beneficiary continues to qualify under another Medicaid eligibility group in the
buy-in coverage group, Part B buy-in coverage must continue without interruption.
See CMS Manual for the State Payment of Medicare Premiums, chapter 1, section
1.4 for additional information about state requirements under their buy-in agreements.
Note on loss of Supplemental Security Income (SSI): Loss of SSI constitutes a change in circumstances that may affect a beneficiary’s
Medicaid eligibility and thus triggers a redetermination.
CMS transmits an informational “SSI deletion” notification record to states upon notification
from SSA that a beneficiary has lost SSI eligibility.
The alert is not a notification that CMS has deleted the record or that the state
must submit a deletion transaction. Rather, the alert is intended to prompt the state
to conduct a Medicaid redetermination if the individual is no longer eligible for
the Medicaid eligibility group based on receipt of SSI (e.g., no longer has a qualifying
disability).