The State buy-in program operates on a daily basis through automated data exchanges conducted among the States, SSA, and CMS. However problems do arise which cannot be resolved through the normal data exchange. These cases require processing by CMS Premium Module Clerical Support Staff in Central Office. The majority of buy-in problems will be reported by a Social Security district office or by individual States. However, other CMS components, the ROs, or intermediaries and carriers may report buy-in problems.

The form CMS-1957 (SSO Report of State Buy-In Problem) was developed to facilitate the resolution of problem cases relating to State buy-in. However, starting April 1, 2026, CMS no longer uses the physical form CMS-1957 and requires all users to submit state buy-in problems to CMS at the statebuyin@cms.hhs.gov. In most instances, the DO/BO will have become aware of a problem through a beneficiary complaint. Some of the more common types of buy-in problems which lend themselves to reporting to CMS are:

1. 1. 

   Part B Medicare claims denied due to failure of the individual to have Part B coverage or due to termination of Part B.

2. 2. 

   Erroneous Part B premium deduction from Social Security benefit check or continued direct billing for Part B premiums after the buy-in effective date.

3. 3. 

   Failure by SSA to start or to resume Part B premium deductions or direct billing after the date buy-in has terminated.

4. 4. 

   Erroneous termination of Part B coverage during a period of buy-in coverage.

5. 5. 

   SSI accretion and/or deletion actions in an accrete State.

1. 1. 

   Emails may be routed to the CMS Central Office for resolution of the problem. The SSA DO/ BO drafts an email with the subject line: SSO REPORT OF STATE BUY-IN PROBLEM-(Beneficiary's state of jurisdiction).

   Example: SSO REPORT OF STATE BUY-IN PROBLEM - New York

2. 2. 

   Subsequent processing of the request will depend upon verification of the buy-in eligibility status at the residing state.

3. 3. 

   The Social Security district office parallel to the State Agency is located in the State capital except in the following States:

   •  

     Delaware - Wilmington

     District of Columbia - Washington, D.C. (DT)

     Florida - Jacksonville

     Guam - Agana

     Maryland - Baltimore (DT)

     South Dakota - Huron

     Nevada - Reno

4. 4. 

   The State buy-in problems and inquiries are handled at Statebuy-in@cms.hhs.gov. Address:

   CMS

   Offices of Hearings and Inquiries (OHI)

   Medicare Ombudsman Group (MOG) Division of Medicare System Exceptions & Interfaces (DMSEI) Statebuy-in@cms.hhs.gov
   

Establish a holding file for the control copy of each state buy-in problem case initiated. This file may be used if a request for additional development is received. It will preclude redevelopment if the case is not corrected.

Annotate a followup date in the upper right hand corner of the control copy. Allow 30 business days (approximately 6 weeks) from the date of the case submission.