A. CMS Accretion Based on Receipt of SSI or Federally Administered State Supplement

The buy-in coverage period begins with the first month for which CMS determines the individual meets the eligibility requirements for inclusion in the coverage group. This is the first month the person is eligible for both Medicare and SSI or a federally administered State supplement and is a resident of a State which entered into a “1634 Agreement” and is an accrete State for Buy-in (see HI 00815.009 for listing of States).

B. State Accretions

1. For recipients of cash assistance either SSI, a State supplement, or Part A of title IV - reported to CMS by the State, the buy-in coverage period begins with the month reported by the State as the date the individual became a member of the coverage group; i.e., the first month the person is eligible for both Medicare and cash assistance and is a resident of the State. In the case of Guam or the Virgin Islands, the first day of the first month in which the individual is receiving money payments under an approved plan under Titles I, X, XIV, or Part A of Title IV.

2. For States which include non-cash title XIX MA Only in their agreement, buy-in coverage for an individual eligible for Medical Assistance Only begins the first day of the second month after the month in which the State makes the determination that the individual is eligible for Medical Assistance. For example, if a person files for Medicaid in October and the State determines that the individual is eligible for Medical Assistance Only (MAO) beginning in September, the buy-in effective date will be December. However, buy-in coverage is continuous for an individual who loses eligibility for cash assistance but whose Medicaid eligibility continues without interruption (see HI 00815.012 for policy on deemed cash receipients).

3. If an individual begins to receive cash for a month earlier than the month coverage as a Medical Assistance Only eligible would begin, the beginning date of buy-in coverage is the first month for which a cash payment was received.

C. Effect of Incorrect Report of Buy-In Eligibility

Each individual reported by the State as a new member of the State’s coverage group has buy-in coverage which begins in accordance with HI 00815.018B above even though the State report of coverage is erroneous. Once a person has been entered on the rolls by a State, the State cannot cancel the accretion but can only “delete” him from the rolls, i.e., terminate his buy-in coverage under HI 00815.021, which provides information on when a buy-in coverage period begins.