Identification Number:
HI 00815 TN 29
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODEPPIN
Title:State Enrollment of Eligible Individuals
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 15 – State Enrollment of Eligible Individuals
Transmittal No. 29, 07/14/2020

Audience

PSC: BA, CA, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, BIES, CR, EIE, ERE, FCR, PETL, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, DSE, LCC, PAS, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

ODEPPIN

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal with no change to policy or procedure.

Summary of Changes

HI 00815.009 State Buy-In Coverage Chart

Footnote updated to 07/16

HI 00815.009 State Buy-In Coverage Chart

A. State Buy-In Agreements

All State Buy-In Agreements were effective July 1, 1966, except for the following:

State

Agreement date

Alaska

October 1, 1982

Oregon

January 1, 1984

Louisiana

July 1, 1985

Wyoming

April 1, 1989

Wyoming's previous State Buy-In Agreement was effective from July 1, 1966 through July 31, 1967; and the Commonwealth of the Northern Mariana Islands was effective on July 1, 1989.

A number of states, which have bought in for all of their medical assistance recipients under Title XIX, do not provide Title XIX approved medical assistance to the medically needy. In those states, the only noncash recipients who are eligible for State Buy-in (the Medical Assistance Only (MAO) category) are noncash recipients who are categorically needy; e.g., certain institutionalized individuals.

States with 1634 agreements are known as Supplemental Security Income (SSI) auto accrete states and those states which make all their own Medicaid eligibility determinations are known as 209 (b), or SSI alert, states. States using SSI standards, but making their own State Buy-in determinations, are shown as alert*. All states, except Kentucky (180), include Part A of Title IV, Temporary Assistance to Needy Families (formerly Aid to Families with Dependent Children (AFDC) in their State Buy-in coverage groups. The following chart shows the SSI status of each state:

AGENCY CODE

STATE

SSI STATUS ACCRETE OR ALERT

STATE SUPP.

TITLE XIX MA ONLY

MAN.

OPT.

010

Alabama[1]

Accrete

N/A

State

01/01/92

020

Alaska

Alert*

State

State

10/01/82

030

Arizona

Accrete

State

N/A

01/01/82

040

Arkansas

Accrete

Federal

N/A

01/01/70

050

California

Accrete

Federal

Federal

01/01/70

060

Colorado[2]

Accrete

State

State

03/01/69

640

Commonwealth of the Northern Mariana Islands

Alert

N/A

N/A

01/01/89

070

Connecticut

Alert

N/A

State

N/A

080

Delaware

Accrete

Federal

Federal

/State

N/A

090

District of Columbia

Accrete

Federal

Federal

08/01/69

100

Florida

Accrete

N/A

State

02/01/70

110

Georgia

Accrete

Federal

State

04/01/68

650

 

 

Guam

Title I, IV, X, XIV, XIX[3]

N/A

N/A

07/01/68

120

Hawaii

Alert

N/A

Federal

01/01/70

130

 

 

Idaho

Alert*

State

State

04/01/68 through 02/28/83

140

Illinois

Alert

State

State

N/A

150

Indiana[4]

Accrete

N/A

State

01/01/70

160

Iowa

Accrete

Federal

Federal/

State

01/01/70

170

Kansas

Alert*

Federal

State

04/01/68

180

Kentucky

Accrete

N/A

State

N/A

190

Louisiana

Accrete

Federal

State

N/A

200

Maine

Accrete

State

State

04/01/68 through 08/31/74

210

Maryland[5]

Alert*

Federal

State

01/01/72

220

Mass. - DMA[6]

Accrete

State

State

N/A

230

Michigan[7]

Accrete

Federal

Federal/

State

08/01/81

240

Minnesota

Alert

N/A

State

N/A

250

Mississippi[8]

Accrete

Federal

N/A

01/01/70

260

Missouri

Alert

State

State

N/A

270

Montana

Accrete

Federal

Federal

03/01/70

through 02/28/92

280

Nebraska

Alert

State

State

04/01/68

through 03/31/69

290

Nevada

Alert*

N/A

Federal

05/01/69

300

New Hampshire

Alert

State

State

N/A

310

New Jersey

Accrete

Federal

Federal

01/01/70

320

New Mexico

Accrete

State

State

01/01/70

330

New York[9]

Accrete

Federal

Federal/

State

N/A

340

North Carolina[10]

Accrete

State

State

01/01/70

350

North Dakota

Alert

N/A

State

N/A

360

Ohio[11]

Accrete

Federal

State

04/01/68

 

370

Oklahoma

Alert

State

State

N/A

380

Oregon

Alert

State

State

01/01/84

390

Pennsylvania

Accrete

Federal

Federal/

State

N/A

400

Puerto Rico

N/A

N/A

N/A

N/A

410

Rhode Island

Accrete

N/A

Federal

N/A

420

South Carolina

Accrete

N/A

State

07/01/68

430

South Dakota

Accrete

Federal

State

N/A

440

Tennessee

Accrete

Federal

N/A

12/01/69

through 03/31/76

450

Texas

Accrete

N/A

State

04/01/68

through

06/30/90

460

Utah

Alert

N/A

Federal

10/01/71

470

Vermont[12]

Accrete

N/A

Federal

N/A

480

 

 

Virgin Islands

Title I, IV, X, XIV, XIX[13]

N/A

N/A

09/01/68 through

06/30/93

490

Virginia

Alert

N/A

State

09/01/69

500

Washington[14]

Accrete

State

State

05/01/68

510

West Virginia

Accrete

N/A

N/A

N/A

520

Wisconsin[15]

Accrete

N/A

State

04/01/82

through 07/31/83

530

Wyoming

Accrete

State

State

04/01/89

B. References

  • HI 00810.010 How the Medicare Attainments and Leads Process Works

  • HI 00815.018 When A Buy-In Coverage Period Begins, Subsection A. CMS Accretion Based on Receipt of SSI or Federally Administered State Supplement

  • HI 00815.030 SSA DO/BO Procedures to Develop Buy-In Coverage in Initial Claims Cases — The Public Welfare Accretion Procedure, Subsection A. General, and Subsection C. The PW Process in an Alert State and the PW Process for Non-SSI Recipients in All States

  • HI 00815.055 Establishing State Buy-In Eligibility for Railroad Retirement Board (RRB) Annuitants

  • HI 00815.082 SSA DO/BO Procedures for Resolving Individual Buy-In Problem Cases Due to Problem with SSR-MBR Interface, Subsection A. Premium Collection for Individual Is Continuing or Claims for Part B Reimbursement Are Denied

  • SM 00381.005 Processing Environmental Health Hazard (EHH) Medicare Claims in MCS, Subsection B.4. Health Insurance (HIHI), Health Insurance Third Party (HITP), and Health Insurance for Title XIX and Medicaid (HI19) screens

  • SM 00381.006 Processing Simultaneous Claims for EHH Medicare and for Disability Insurance Benefit (DIB) in MCS, Subsection B.2. Health Insurance (HIHI), Health Insurance Third Party (HITP), and Health Insurance-Title XIX and Medicaid (HI19) screens

  • SM 00850.190 SMI Third Party Identification Code (CODE)

  • SM 03040.040 State Buy-in on Initial Awards, Subsection B. Procedure – entering HI19 data

  • SM 10802.040 Reading and Interpreting the MBR Portion of the Full Version Third-Party Query (TPQY) Response, Subsection P.1. Line 19

  • TC 24001.030 Supplementary Medical Insurance (SMI) Eligibility and Enrollment, Subsection C. State Buy-in Exception to SMI Enrollment Periods

  • TC 24035.080 Resolving State Buy-In Problems, Subsection C. Procedure


HI 00815 TN 29 - State Enrollment of Eligible Individuals - 7/14/2020