HI 00815.006 The State Buy-In Agreement
Any State participating in the Buy-In program has to have a signed Buy-In Agreement with the Secretary of Health and Human Services specifying the categories of Medicaid beneficiaries for whom it will pay Medicare premiums.
A. Supplemental Security Income (SSI) Auto-Accrete States
Prior to January 1974, the States made all Medicaid eligibility determinations and thus were responsible for all accretions and deletions in the Buy-In program.
When the SSI program was implemented in January 1974 the States were given the option of entering into a “1634 Agreement” with the Social Security Administration (SSA). The 1634 Agreement derives its name from the section of the Social Security Act that authorizes the Secretary of Health and Human Services to determine Medicaid eligibility for the aged, blind, or disabled based upon the beneficiaries’ entitlement to SSI benefits or federally—administered State supplemental payments.
A number of States entered into 1634 Agreements and as a consequence became automatic accrete (auto-accrete) States for purposes of State Buy-In. Each month, SSA transmits data exchange records for SSI beneficiaries to CMS’ Enrollment Database (EDB). Based upon information contained in the data exchange records, CMS accretes or deletes beneficiaries to the Buy-In rolls for auto-accrete States.
B. SSI Alert States (209.b States)
States that did not enter into 1634 Agreements are referred to as “Alert States” or “209.b States”. These States reserved the right to make their own Medicaid eligibility determinations and the State can use the SSI (Title XVI) standards or a more restrictive eligibility standard.
The “Alert States” or “209.b States” which use the SSI eligibility standards for Medicaid determinations generally require only a signed State Medicaid application after the beneficiary has filed for SSI.
States which opted to use a more restrictive standard for Medicaid eligibility require a complete State application regardless of SSI status.
Each month, SSA transmits data exchange records for SSI beneficiaries to CMS’ EDB. CMS will “alert” the State by transmitting a data exchange record advising the State of the beneficiaries’ SSI/Buy-In status. These informational records are used by the State to either accrete or delete the beneficiary to the State’s Buy-In rolls.
C. Part A of Title IV Aid to Families with Dependent Children (AFDC)
AFDC is a coverage group in all States with Buy-In agreements except Kentucky. Since AFDC is solely State administered, the States have accretion and deletion responsibility for beneficiaries entitled under this program.
D. Title XIX (Medicaid)
Medical Assistance Only (MAO) recipients are the non-cash category of Medicaid beneficiaries. Consequently, those States which included MAO as a coverage group in their Buy-In agreement have accretion and deletion responsibility for beneficiaries entitled under this program.