In general, an individual’s state buy-in coverage start date depends on the Medicaid eligibility group in which an individual is enrolled.

The exception is for individuals covered by a new or modified buy-in agreement. Buy-in coverage can begin no sooner than three months after the effective date of a new or modified buy-in agreement.

For more information about the start date of buy-in coverage, see CMS Manual for State Payment of Medicare Premiums, chapter 1, sections 1.13.1 and 1.14.1 and appendix 1.C.

Part A Buy-in for the Medicare Saving Program (MSP) Qualified Medicare Beneficiary (QMB) eligibility group begins the month the individual is enrolled in premium Part A and QMB.

See also the chart in Section D. for an explanation of these provisions.

Individuals who Receive or are Deemed to Receive Cash Assistance or are Enrolled in an MSP.

Part B buy-in generally begins the first month in which the individual meets the requirements both for eligibility in the buy-in coverage group (i.e., the start date of the individual’s Medicaid coverage) and eligibility for Medicare Part B for:

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  Medicaid beneficiaries who are cash assistance recipients or who are deemed to be recipients of cash assistance; and

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  Individuals enrolled in the following three MSP groups:

  • –

    QMB;

  • –

    Specified Low-Income Medicare Beneficiary (SLMB); and

  • –

    Qualifying Individual (QI).

Part B buy-in begins the second month after the individual meets the requirements for both:

• •

  eligibility in the buy-in group (i.e., the start date of the individual’s Medicaid coverage) and

• •

  eligibility for Medicare Part B for all other Medicaid eligibility groups included in the buy-in agreement.

See the chart below for buy-in start dates as outlined in the CMS Manual for State Payment of Medicare Premiums, chapter 1, appendix 1.C.

Start dates may be adjusted if:

• •

  the individual is covered by a new or modified buy-in agreement (coverage can start no sooner than three months after the effective date of a new or modified buy-in agreement); or

• •

  to avoid retroactive payments beyond 36 months (or different limits approved by CMS) after January 1, 2024.

  Medicaid Eligibility Group	Part A Buy-in Start Date	Part B Buy-in Start Date
  Cash assistance (SSI/SSPs) and deemed recipients of cash assistance who are categorically needy	N/A	Part B buy-in starts the first day of the month an individual qualifies for Medicare Part B and is eligible for Medicaid. In auto-accrete states, Part B buy-in starts the first month the individual is both entitled to SSI and eligible for Part B. In alert states, Part B buy-in starts the first month an SSI recipient is eligible for Medicaid and Part B. 42 CFR § 407.47(b)
  QMB	Part A buy-in starts the month an individual is enrolled in premium Part A and has QMB status. 42 CFR § 406.26(b) In Group Payer states only: If an individual enrolls during the General Enrollment Period or later, as early as the first day of the month after enrollment in either actual or conditional Part A.	Part B buy-in starts the first day of the month an individual qualifies for Medicare and has QMB status. 42 CFR § 407.47(c)
  SLMB	N/A	Part B buy-in starts the first day of the month an individual qualifies for Medicare and is a member of the coverage group. 42 CFR § 407.47(c)
  QI	N/A	Part B buy-in starts the first day of the month an individual qualifies for Medicare and is a member of the coverage group. 42 CFR § 407.47(c)
  Other Full-benefit Medicaid Eligibility Categories[1] [2]	N/A	Part B buy-in starts the first day of the second month after an individual qualifies for Medicare and is a member of the coverage group. 42 CFR § 407.47(d)

If a state erroneously reports an individual as a member of its buy-in coverage group, buy-in coverage nevertheless begins in accordance with HI 00815.018B and HI 00815.018C.

Once a State enrolls an individual in buy-in, the State cannot cancel the enrollment retroactively. (A cancellation of the entire enrollment may only occur during the same Current Operating Month (COM) that buy-in was established). However, the state can subsequently terminate the individual’s buy-in coverage as described in HI 00815.021, which outlines when buy-in ends.

Please refer to SM 03040.245 for Special Situations and HI 00815.030 for Procedures to Develop buy-In Coverage in Initial Claims.