The Medicare Savings Programs (MSPs) are mandatory Medicaid eligibility groups that assist low-income Medicare beneficiaries with some or all of their Parts A and B premiums and cost-sharing. State Medicaid agencies determine whether or not an individual is eligible for Medicaid coverage, including the MSPs.

The federal MSP income and resource standards (hereafter “limits”) are set by federal law and appear in subsection C.

States can, however, effectively raise these limits for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individuals (QI) eligibility groups above the federal statutory limits by disregarding amounts or certain types of income and resources. Some states have used this authority to effectively eliminate resources tests when determining eligibility for these MSP eligibility groups.

Be familiar with the MSP income and resource limits in the claimant’s state of residence to assist you with screening whom to refer to the state. Even if the individual’s income or resources appear somewhat higher than the state limits, encourage them to apply for the MSPs.

NOTE: CMS rounds up to the nearest dollar when computing the monthly income limits.

The Public Welfare (PW) accretion process allows Social Security Administration field offices (FOs) to establish Medicare Part B (Medical Insurance) through state payment of the Medicare Part B premiums (Part B buy-in), making the state responsible for paying the Medicare Part B premiums, instead of the individual.

The FO should initiate the PW accretion process for certain individuals who file and application for

• •

  • –

    Medicare Part A (Hospital Insurance), or

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    Title II benefits and are at least age 65, or

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    Medicare Part B; and

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    have Medicaid coverage that is included in the state buy-in agreement.

If an individual is enrolled in Part B, resides in an auto-accrete state, and is in current pay status for SSI (or a federally administered state supplement program (SSP), they are included in the state’s buy-in coverage group and automatically receive Medicaid.

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  If the FO did not obtain a Title II application at the same time the SSI application is taken, the Medicare Attainments and Leads Process (MALP) will initiate development for a Title II claim or automatically establish the Master Beneficiary Record (MBR) for an uninsured individual. For developing entitlement to Medicare, see HI 00810.010.

MCS Documentation:

Prepare a Report of Contact (RPOC) in the MCS claim segment or document in CCE stating, “Medicaid eligibility based on receipt of SSI payments,” and do not contact the Medicaid office (i.e., state public assistance agency) to verify Medicaid eligibility prior to starting a PW accretion.

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  If the MCS segment will not process through EC, complete an A101, transfer the A101 to the Processing Center (PC)and upload an SSA-5002 Report of Contact into the Evidence Portal (EP). On the SSA-5002, add the remark "Medicaid based on receipt of SSI payments."

CCE Documentation:

For auto-accrete states, see SI 01730.005; answer the Health Expenses and Third Party Liability Questions under the Benefits Leads tab within CCE, see MS 08119.020.

If a Medicare Part B applicant resides in an alert State, is an SSI recipient and indicates that they are eligible for Medicaid, verify the individual’s Medicaid eligibility with the appropriate State Medicaid agency. Failure to correctly verify the individual’s status may result in an erroneous PW accretion and a loss to the Medicare trust fund.

Medicaid Eligibility Verification

Verification of Medicaid eligibility may be based upon a telephone contact or, email communication between SSA and the appropriate state Medicaid Agency (for example, Idaho Department of Health and Welfare), or the database system from the appropriate state Medicaid agency. Document a SSA-5002 RPOC containing the following information and store it in Evidence Portal (EP):

1. 1. 

   The individual is eligible for Medicaid;

2. 2. 

   The Medicaid case number;

3. 3. 

   The Medicaid eligibility date (start date); and

4. 4. 

   The location of the state Medicaid agency furnishing the information and the name and telephone number of the contact person.

If an individual appears to have Medicaid and is not an SSI recipient, they may still be eligible for Part B buy-in if they reside in a state that includes all Medicaid beneficiaries in its buy-in coverage group. Prior to starting a PW accretion for these individuals, verify Medicaid eligibility with the appropriate state Medicaid agency. Follow the process in subsection C in this section.

If the individual appears to have Medicaid, is not an SSI recipient, and resides in a state that does not include all Medicaid beneficiaries in its buy-in agreement, do not use the PW accretion process. To determine if a state includes all Medicaid beneficiaries in its buy-in group, SSA FOs should reference the information in the chart in subsection E.

The table describes streamlined processes for CCE and MCS across 4 categories of states:

1. 1. 

   auto-accrete states that include all full-benefit Medicaid beneficiaries in buy-in;

2. 2. 

   auto-accrete states that include only full benefit Medicaid beneficiaries who receive cash assistance (or are deemed to receive it) in buy-in;

3. 3. 

   alert states that include all full-benefit Medicaid beneficiaries in buy-in; and

4. 4. 

   alert states that include only full benefit Medicaid beneficiaries who receive cash assistance (or are deemed to receive it) in buy-in.

Among these 4 categories, the table notes which states are Part A group payer states and have a federally administered SSP.

HI 00801.140 Premium-Part A Enrollments for Qualified Medicare Beneficiaries (QMBs) – Part A Buy-In States and Group Payer States

HI 00805.005 Eligibility for SMI

HI 00810.010 How the Medicare Attainments and Leads Process Works

MS 02003.003 Health Insurance – Title XIX/Medicaid (HI19)

MS 08119.020 – Health Expenses and Third Party Liability

RS 00204.025 Evidence Requirements for Establishing U.S. Lawful Presence