Page 122

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |122 Effective Month: September 2018 SSI Recipients – DEI is “Q” (because all SSI recipients are below 100% of the poverty level). The Buy-In effective date is the month the recipient is eligible for both Medicare & Medicaid. For someone moving to MS from another state, the effective date for MS buy-in is the month the recipient is eligible for SSI in MS. In addition, buy-in coverage is continuous for a Medicare/Medicaid recipient who loses eligibility for SSI, but Medicaid eligibility continues without interruption in a Medicaid-only COE (other than a COE that prohibits buy-in). There can be no gaps between the SSI termination date and the Medicaid-only effective date in order for the following buy-in rules of continuous eligibility to take place: • An SSI recipient who loses SSI but is approved for QMB, with no gap in eligibility, will have continuous buy-in for Part A (if applicable) and Part B and will not be subject to the “month after the month of approval” rule. • An SSI recipient who loses SSI but is approved in a LTC COE with no gap will have continuous buy-in for their Part B premiums rather than have buy-in start in the 2nd month after approval. (This applies to Part A buy-in as well provided income is below 100% FPL.) Reinstatements of Medicaid-only eligibility will also have buy-in reinstated for the same time period. The Buy-In process involves DOM’s coordination with CMS & SSA and usually takes 3 months before the Medicare premiums are no longer deducted from the recipient’s Social Security or RRB check. The recipient is notified in writing by SSA when the Buy-In process has been finalized (the letter informs the individual that the state is now paying their Medicare premium). A recipient will be reimbursed retroactive to the appropriate effective date of Buy- In for any Part B (and Part A) premiums that are due for reimbursement. The reimbursement, if any, will be deposited into the same account that the Social Security or RRB check is deposited. These are the rules for the buy-in effective dates as they currently exist. It is appropriate for Specialists to inform an applicant or recipient of these rules so that they will know buy-in is a post-eligibility process that takes time. Be sure to address effective dates as it applies to the individual’s dual eligibility status. In order for Buy-In to work smoothly, a Specialist must always use: