POMS Reference

HI 00815: State Enrollment of Eligible Individuals

Buy-in coverage ends with the earliest of the events specified in the following paragraphs:

  1. Death — Coverage ends on the last day of the month in which the individual dies.

  2. Loss of entitlement to Hospital Insurance benefits — If an individual is under age 65 and loses entitlement to Hospital Insurance, buy-in coverage ends on the last day of the last month for which he is entitled to Hospital Insurance benefits.

  3. Loss of eligibility in a coverage group — If an individual loses eligibility for inclusion in the State"s coverage group, his buy-in coverage ends on the last day of the month for which he is eligible for inclusion in the coverage group.

  4. Loss of eligibility for SSI in an accrete State — If CMS initially determined the individual"s eligibility for inclusion in the State"s coverage group as a result of SSI eligibility, CMS will terminate the individual"s buy-in coverage when it receives a termination record from the SSI system.

  5. Termination of buy-in agreement — If the State"s buy-in agreement is terminated, coverage ends on the last day of the month for which the agreement is in effect.