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West Virginia Income Maintenance Manual Chapter 25

West Virginia Income Maintenance Manual Page 5 Chapter 25 Medicaid Buy-In Procedures

Buy-in for an individual is terminated under any of the following circumstances: • Death • Upon becoming ineligible for SSI and not qualifying for a Deemed SSI group • Upon losing entitlement to Medicare due to the loss of disability • Upon becoming a resident of another state The Worker must close the SSI Medicaid case when the buy-in is terminated. If an individual is deleted from buy-in, and the Worker has not taken the appropriate action, the Worker will receive a system alert.

The DOHS pays the Medicare premiums for those persons specified in Chapter 25.2. 25.3.3.A Buy-In Unit's Responsibilities The Buy-In Unit must: • Add eligible individuals to the Buy-In Master List Tape. • Delete ineligible individuals. 25.3.3.B Worker's Responsibilities The Worker must: • Identify individuals eligible for Medicare and verify enrollment. • Correctly code the Medicare Claim Number in the eligibility system. • Update the client case when changes occur. This results in notification to the Buy-In Unit of any change that affects a client's buy-in status. NOTE: When the individual who loses SSI Medicaid qualifies for a Deemed SSI group, or for Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualified Individual-1 (QI-1) coverage, the Worker must notify the Medicare Buy-In Unit so that buy-in will continue without interruption.