The same referendum and Modification rules for Social Security and Medicare coverage
under Section 218 apply to HI-only Agreements. For example, if the State is authorized
to conduct a divided-vote retirement system referendum, the State may use the divided-
vote procedure to provide HI coverage.
If a State or local government employee is covered mandatorily for Medicare when a
referendum is conducted for a HI-only Agreement for other employees of the same employing
entity, the employee is not eligible to vote in the referendum.
The required exclusions from Medicare coverage (see SL 50001.510B) also apply to HI-only Agreements. The State may elect Section 218 optional exclusions
(see SL 30001.357).
Medicare HI-only Agreements extend HI coverage to the individual employees and not
the position. Medicare coverage is otherwise mandatory for all employees hired on
or after April 1, 1986, regardless of their positions.