Category 1: Buy-in agreement includes all Medicaid groups (20 states:
AL, AZ, AR, CA, CO, DC, FL, GA, IN, IA, MD, MI, MS, NJ, NM, NC, OH, SC, WA,
WY)
* AL, AZ, CA, CO, NJ, NM, SC = group payer states
^ CA, IA, MI, NM, NJ = federal administration of state supp.
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Individuals who receive SSI and/or federally-administered state supplemental
payments (SSP)
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1.
Title II claim: Initiate state buy-in (use PW accretion), apply cash assistance (SSI/SSP) start date
(first date they are eligible for Part B and SSI). Don’t contact Medicaid as you may
verify SSI through the SSA system. Use SSI claim # or HUN (housed-under number). If
using MCS, use HI19 to initiate state buy-in. If using CCE, use Health Insurance screen,
choose “Currently Receiving Medicaid” and choose “Initiate State Buy-in.” Reminder
- For all initial claims, retroactivity for buy-in may not exceed 36 months.
-
2.
Concurrent claim Title II (and Medicare-only) and SSI for individuals ages 65 or older:
Use processes for Title II above.
Non-SSI Recipients (reminder they are included in the buy-in agreement and thus are eligible for Part
B buy-in).
-
3.
Title II or Medicare-only claim: Contact the Medicaid agency to verify current Medicaid enrollment. Once verified,
initiate buy-in and use the buy-in start date for non-cash assistance individuals
described above (e.g., if Sally is eligible for both Part B and Medicaid starting
January 1, start the PW accretion March 1). Use SSI claim # or HUN (housed-under number)
and document the contact information for the state. If using MCS, use HI19 to initiate
state buy-in. If using CCE, use Health Insurance screen, choose “Currently Receiving
Medicaid” and choose “Initiate State Buy-in.” Reminder - For all initial claims, retroactivity
for buy-in may not exceed 36 months.
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Category 2: Buy-in agreement only includes cash Assistance Medicaid groups (15 states:
DE, KY, LA, ME, MA, MT, NY, PA, RI, SD, TN, TX, VT, WV, WI)
* KY = group payer states
^ DE, PA, RI, VT = federal administration of state supp.
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Individuals who receive SSI and/or federally-administered
SSP
-
1.
Title II claim: Initiate state buy-in (use PW accretion), apply cash assistance (SSI/SSP) start date
(first date they are eligible for Part B and SSI). Don’t contact Medicaid as you may
verify SSI through the SSA system. Use SSI claim # or HUN (housed-under number). If
using MCS, use HI19 to initiate state buy-in. If using CCE, use Health Insurance screen,
choose “Currently Receiving Medicaid” and choose “Initiate State Buy-in.” Reminder
- For all initial claims, retroactivity for buy-in may not exceed 36 months.
-
2.
Concurrent claim Title II (and Medicare-only) and SSI for individuals ages 65 or
older: Use processes for Title II.
Non-SSI Recipients (reminder they are NOT included in the buy-in
agreement and thus are ineligible for Part B buy-in)
-
3.
Title II and Medicare-only claim: Take no action; do not contact the Medicaid agency, and do not initiate buy-in.
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Alert States
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Actions
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Category 3: Buy-in agreement includes ALL Medicaid groups (7 states:
AK, HI, KS, NV, OR, UT, VA)
* KS, UT, VA = group payer states
^ HI, NV = federal administration of state supp.
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Individuals who receive SSI and/or federally-administered state supplemental
payments (SSP)
-
1.
Title II and Medicare-only claim: Contact the Medicaid agency to verify Medicaid enrollment. Once verified, use start
date for cash assistance for buy-in start date (e.g., buy-in starts the first month
the individual is eligible for Part B, has SSI and is enrolled in Medicaid). Use SSI
claim # or HUN (housed-under number) and document the contact information for the
state. If using MCS, use HI19 to initiate state buy-in. If using CCE, use Health Insurance
screen, choose “Currently Receiving Medicaid” and choose “Initiate State Buy-in.”
Reminder - For all initial claims, retroactivity for buy-in may not exceed 36 months.
Non-SSI Recipients (reminder they
are included in the buy-in agreement and are thus eligible for Part B buy-in)
-
2.
Title II and Medicare-only claim: Contact the Medicaid agency to verify Medicaid enrollment. Once verified, use the
buy-in start date for non-cash assistance individuals described above (e.g., if Mr.
Smith is eligible for Part B and Medicaid start date in January, start the PW accretion
March 1). Use SSI claim # or HUN (housed-under number) and document the contact information
for the state. If using MCS, use HI19 to initiate state buy-in. If using CCE, use
Health Insurance screen, choose “Currently Receiving Medicaid” and choose “Initiate
State Buy-in.” Reminder - For initial claims, retroactivity for buy-in may not exceed
36 months.
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Category 4: Buy-in agreement ONLY includes cash Assistance Medicaid groups (9 states:
CT, ID, IL, MN, MO, NE, NH, ND, OK)
(IL, MO, NE group payer – may need conditional enrollment)
* IL, MO, NE = group payer states
^ N/A = federal administration of state supp.
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SSI Recipients
-
1.
Title II claim: Contact the Medicaid agency to verify Medicaid enrollment. Once verified, use start
date for cash assistance for buy-in start date (e.g., buy-in starts the first month
the individual is eligible for Part B and enrolled in Medicaid). Use SSI claim # or
HUN (housed-under number) and document the contact information for the state. If using
MCS, use HI19 to initiate state buy-in. If using CCE, use Health Insurance screen,
choose “Currently Receiving Medicaid” and choose “Initiate State Buy-in.” Reminder
- For initial claims, retroactivity may not exceed 36 months.
Non-SSI Recipients (reminder they are NOT included in the buy-in
agreement and thus are ineligible for Part B buy-in)
-
2.
Title II and Medicare-only claim: Take no action; do not contact the Medicaid agency, and do not initiate buy-in.
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