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.
.See 42 CFR §435.916(f). While the state is making this determination, the state must maintain Medicaid coverage
and must not terminate the beneficiary from buy-in. See 42 CFR § 435.930(b).Further, if the state determines the beneficiary continues to qualify under another
Part B buy-in group category, Part B buy-in coverage must continue without interruption.
SeeCMS 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. See 42 CFR § 435.916(d).
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 redetermination pursuant to 42 CFR § 435.916(f)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).