The state or the Centers for Medicare & Medicaid Services (CMS) can end (delete) a state’s payment of Medicare Part A or Part B premiums under the state’s buy-in agreement (also known as “Part A or Part B buy-in”) based on the circumstances indicated below, as outlined in the CMS Manual for the State Payment of Medicare Premiums, chapter 1, sections 1.14.2 and 1.13.2. States must notify CMS through a Medicare Part A and/or Medicare Part B deletion request when an individual loses eligibility for state buy-in coverage. The end of state buy-in has important implications for beneficiaries. For information about beneficiary impact and options for relief when buy-in ends, see HI 00815.042.

The Qualified Medicare Beneficiary (QMB) program is a Medicaid program through which states cover Part A and Part B premiums and cost-sharing for eligible low-income Medicare beneficiaries, as described in HI 00801.139. All states must pay Part A premiums for individuals who are enrolled in the QMB program and not entitled to "premium-free" Part A coverage. States can choose one of two methods to pay Part A premiums for QMBs:

1. 1. 

   Under their buy-in agreement,"Part A buy-in state" or

2. 2. 

   Through a group payer arrangement, "group payer state"

See HI 00801.140 for more information about the state payment of Part A premiums for QMBs.

The duration of the state's payment of Part A premiums ends with earliest of the events specified below:

Note: CMS may modify the effective stop date of a Part A buy-in termination (deletion) request submitted by a state based on processing rules described in the CMS Manual for the State Payment of Medicare Premiums, chapter 2, section 2.6.1.4. CMS terminates (deletes) Part A buy-in coverage effective at the end of the month in the month the state's deletion request is received, even if the individual lost eligibility in an earlier month.

Under their buy-in agreements, states pay the Part B premiums for certain Medicare-eligible Medicaid beneficiaries (members of their Part B buy-in coverage group). The state’s Part B buy-in coverage group includes multiple Medicaid eligibility categories identified in its buy-in agreement.

The Part B buy-in coverage period ends with the earliest of the events specified below:

Note: If the state determines an individual is no longer eligible for a Medicaid coverage group in the state Part B buy-in coverage group, the states must follow the steps described in section D below.

Note: CMS may modify the effective stop date of a Part B buy-in termination (deletion) request submitted by a state based. on processing rules as described in the CMS Manual for the State Payment of Medicare Premiums, chapter 2, section 2.6.1.3. Part B deletion requests cannot be earlier than two months before the month in which the state notifies CMS of the deletion, even if the individual lost eligibility in an earlier month.

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).