2911.2 Medicare Entitlement and Impact on Medical Assistance Eligibility

Persons entitled to Medicare Part B must enroll in Medicare Part B as a condition of eligibility. Failure to cooperate with the enrollment process will result in ineligibility for assistance. For instances where potential entitlement has been identified, based on item 1 below, medical assistance eligibility continues as long as the individual is cooperating with the enrollment process. If the enrollment process is not successful and ineligibility for Medicare has been established, the agency may assist in the enrollment processes through processes described in item 3 below.

The following individuals are eligible for Medicare Part B: Individuals who are age 65 or over who have Medicare Part A (Hospital Insurance). All other individuals who are age 65 or over, who are United States residents, or aliens lawfully admitted for permanent residence and have resided in the U.S. continuously during the five years immediately preceding the month they apply for enrollment. (For the period 6/11/73 through 3/31/76, enrollees did not have to meet the alien residency requirement). Individuals under age 65 who have been receiving monthly Social Security disability benefits under Title II or railroad disability benefits for a certain period of time (usually 24 consecutive months). Individuals who are under age 65 who are eligible for Medicare Part A (Hospital Insurance) because they have chronic renal disease.

Enrollment of Eligible Individuals Who Were Not Enrolled In Part B: Persons who are entitled must enroll. The State Medicaid program has the authority to enroll recipient in Part B if the individual does not do so on their own. The method of state-enrollment is dependent upon the Part A enrollment status. Persons enrolled in Medicare Part A shall be enrolled in Medicare Part B through the buy-in process. This process is automated and does not usually require manual intervention to enroll the individual. Upon identification of Medicare Part A entitlement through the EATSS interface, a Part B entitlement date is determined entered in KEES.. This information is sent to the MMIS where it is processed according to general Part B buy-in rules. A buy-in accretion request is sent for the individual. From the buy-in file, CMS identifies the unenrolled individual and initiates enrollment of the individual in Part B. Persons who are not enrolled in Medicare A or Medicare Part B but appear to meet eligibility requirements, are referred to the Social Security Administration for enrollment. If SSA cannot take an application or if the individual refuses to cooperate, the following process is taken: The form, HCFA 1610-U2, Public Assistance Agency Information Request , is sent the appropriate SSA office. On the form, the worker indicates the form is being sent as a lead for Medicare B enrollment and a potential Medicare Part B entitlement date is indicated on the form. SSA will take an application from the beneficiary, if necessary. The results will be communicated back to the worker initially sending the 1610. If the beneficiary cooperates and is eligible for Part B, he will be enrolled and accreted to buy-in. If the beneficiary does not cooperate, the agency is authorized to complete an enrollment application for Medicaid. The beneficiary shall be notified of the agencies action and may request termination of Medicaid coverage if he does not wish to be enrolled in Medicare Part B.

The HCFA-4040, Request for Enrollment in Supplemental Medical Insurance , is sent to enroll the Medicaid beneficiary in Medicare Part B. The enrollee does not need to sign the application, the eligibility worker completes the signature block and annotates the form to show the information came from the case record. The following documentation must be submitted with the application: Proof of age by a birth certificate or record of baptism before age five. Proof of citizenship or residency. If the individual was born in the United States, no proof of citizenship or residency is required. If the individual was born outside of the United States, a certification must be submitted which describes the evidence used to establish residency or citizenship.

The completed form and related documentation should be sent to the Social Security office which services the beneficiary's address.

After SSA establishes a Medicare claim number for the individual's Medicare record, the individual will be entitled to buy-in. The individual will be accreted to buy-in once KEES has been updated and a record is sent to MMIS and eligibility is approved.