Effective for most State and local government employees hired after
March 31, 1986 and not subject to Social Security coverage, remuneration for services
is subject to HI-only coverage unless otherwise excluded.
Employees who were hired prior to April 1, 1986, who are not covered by Social Security
and Medicare under a Section 218 Agreement or mandatory Social Security coverage,
are exempt from both Social Security and Medicare coverage and taxation. However,
States may extend HI-only coverage to those same State and local government employees
who were hired before April 1, 1986 by means of a HI-only coverage referendum.