§ 407.42 - Buy-in groups available to the 50 States, the District of Columbia, and the Northern Mariana Islands.

§ 407.42 Buy-in groups available to the 50 States, the District of Columbia, and the Northern Mariana Islands.

Cross Reference

Link to an amendment published at 87 FR 66507, Nov. 3, 2022.

(a) Categories included in the buy-in groups. The buy-in groups that are available to the Basic rule. The 50 States, the District of Columbia, and the Northern Mariana Islands are specified in must select one of the buy-in groups described in paragraph (b) of this section in terms in their buy-in agreements.

(b) Buy-in groups available -

(1) Group 1. Cash Assistance and Deemed Recipients of Cash Assistance: This buy-in group includes all of the following

categories

:

(

1

i)

Category A:

Individuals who

- (i) Receive

receive SSI or SSP or both

;

and

(ii) Are

are covered under the State's Medicaid state plan as categorically needy.

(

2

ii)

Category B:

Individuals who

- (i) Under

under the Act or any other provision of Federal

law

Law are treated, for Medicaid eligibility purposes, as though

they were

the individual was receiving SSI or SSP

;

and

(ii) Are

are covered under the State's Medicaid state plan as categorically needy.

(

3) Category C: Individuals who are receiving AFDC.

(4) Category D: Individuals who, under the Act or any other provision of Federal law, are treated, for Medicaid eligibility purposes, as though they were receiving AFDC.

(5) Category E: Individuals who

iii) At State option, individuals whom the State must consider to be recipients of AFDC. Individuals a State would be required to include in electing this option would be, but not limited to, individuals eligible for Medicaid on the basis of section 1931(b) of the Act or their receipt of adoption assistance, foster care or guardianship care under Part E of title IV of the Act, in accordance with § 435.

134

145 of this chapter

, are covered under the State's Medicaid plan despite the increase in social security benefits provided by Public Law 92-336

.

(

6) Category F: Individuals who are Qualified Medicare Beneficiaries.^[1]

(7) Category G: All other individuals who are eligible for Medicaid.

(b) Buy-in groups available. Any of the 50 States, the District of Columbia, and the Northern Mariana Islands may buy-in for one of the following groups:

(1) Group 1: Categories A through G.

(2) Group 2: Categories A through F.

(3) Group 3: Categories A through E.

(4) Group 4: Categories A, B, and F, individuals in categories C and D who are not social security or railroad retirement beneficiaries, and individuals in category E who are included in that category (in accordance with § 435.134 of this chapter) because they received OAA, AB, APTD, or AABD in August 1972 or would have been eligible to receive such cash assistance for that month if they had applied or had not been institutionalized.

(5) Group 5: Categories A and B, individuals in categories C and D who are not social security or railroad retirement beneficiaries, and individuals in category E who are included in that category (in accordance with § 435.134 of this chapter) because they received OAA, AB, APTD, or AABD in August 1972 or would have been eligible to receive such cash assistance for that month if they had applied or had not been institutionalized.

(6) Group 6: Categories A, B, and F, and individuals in category E who are included in that category (in accordance with § 435.134 of this chapter) because they received AABD in August 1972 or would have been eligible to receive AABD for that month if they had applied or had not been institutionalized. This option is available only to those States that had an AABD program as of December 31, 1973.

(7) Group 7: Categories A and B, and individuals in category E who are included in that category (in accordance with § 435.134 of this chapter) because they received AABD in August 1972 or would have been eligible to receive AABD for that month if they had applied or had not been institutionalized. This option is available only to those States that had an AABD program as of December 31, 1973.

[56 FR 38081, Aug. 12, 1991, as amended at 81 FR 86447, Nov. 30, 2016]

Footnotes - 407.42

^[1] Rules for buy-in for premium hospital insurance for QMBs are set forth in § 406.26 of this chapter.

2) Group 2. Cash Assistance and Deemed Recipients of Cash Assistance and three Medicare Savings Program eligibility groups. This buy-in group includes both of the following:

(i) Group 1.

(ii) Individuals enrolled in the -

(A) Qualified Medicare Beneficiary eligibility group described in § 435.123 of this chapter;

(B) Specified Low-Income Beneficiary eligibility group described in § 435.124 of this chapter; and

(C) Qualifying Individual eligibility group described in § 435.125 of this chapter.

(3) Group 3. All Medicaid Eligibility Groups: This buy-in group includes all individuals eligible for Medicaid.

[87 FR 66507, Nov. 3, 2022]