Effective Dates: 10/27/2022 - Present Previous | Next

TN 31 (10-22)

HI 01005.025 State Organizations

A. Welfare Organizations

States may pay Part A premiums for their cash welfare and/or Medicaid recipients. However, they must do so under a group payer arrangement. This means that they cannot “enroll” an individual for Part A coverage as they can for Part B coverage. A nonenrolled or terminated Part A enrollee must enroll during an IEP or a subsequent GEP and then request the State to accrete the individual. The enrollee must also complete a statement authorizing the State to pay Part A premiums on the enrollee's behalf. In addition, the State must assume responsibility for the payment of Part A premiums through the month it notifies SSA of a deletion. States which establish Part A payer arrangements with SSA are assigned group payer codes beginning with S and the first two numbers of the State's code. For example, California, with a State Part B agency code of 050 (see HI 01005.808), would be assigned a Part A group premium payer agency code of S05.

B. Non-Welfare Organizations

1. Part A Reporting Codes

Other State organizations, such as retirement systems, are assigned Part A reporting codes consisting of three positions-X, followed by two digits (see HI 01005.020).

2. Payment Of The Premium Part A Hospital Insurance (HI) And Part B Surcharge For Retirees Under The California State Teachers Retirement System (CalSTRS)--Action

The State of California is required to provide hospital insurance to retired State employees by paying the Part A premium on their behalf. The State also pays the Part B premium surcharge for individuals who are subject to a premium increase. The State will not pay the basic Part B premium. The State also will pay the Part A premium and any Part B surcharge effective July 2001 if the retirees enroll in Premium-HI.

If you are contacted by a retiree and the retiree is not already enrolled in Part A or Part B, take an application for premium-HI and Part B. If the individual is already enrolled in Part B but not enrolled in Part A, take an application for premium-HI and process it through the Postentitlement Operating System (POS).

For general enrollment period elections, the HI START date on the application or POS screen will be July 2001, which is when the State will start paying the premium. If an initial enrollment period (IEP) election HI START date is prior to July 2001, the beneficiary will be liable for premiums prior to July 2001. This should be discussed with the beneficiary and the beneficiary should consider filing in the IEP month that results in an enrollment month closest to July 2001 based on the IEP rules. (See HI 00805.165)

Inform the beneficiary that SSA will take and process the application for premium-HI, and that CMS and the State are making arrangements for the State to pay the premiums directly to CMS on beneficiary's behalf. Inform the beneficiary that the beneficiary will be responsible for any premiums due prior to July 2001.

Teleservice center representatives and SPIKES should handle calls from affected individuals who need to file for premium-HI as a claims referral and follow normal procedures for setting up an appointment.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601005025
HI 01005.025 - State Organizations - 10/27/2022
Batch run: 10/27/2022
Rev:10/27/2022