Medicaid Policy
Medicaid Policy
Medicaid recipients who are eligible to receive Part B Medicare must be enrolled, or must apply for Part B. The State pays the Part B premium for individuals eligible for Medicaid or a Medicare Cost-Sharing program.
1. Individuals who have been issued a Medicare number and are receiving premium-free Medicare Part A, but who have declined Part B will be enrolled through the automated BUY-IN system after they are approved for Medicaid or a Medicare Cost-Sharing program. The person's Medicare number shows the person is eligible and allows the automatic enrollment of the individual. They do not need to go to the Social Security office to enroll.
2. Individuals who are receiving a Title II benefit such as SSA disability or retirement will become eligible for Medicare automatically. Their Medicare eligibility begins once they turn age 65 or have received disability benefits for 24 months. They do not have to apply for Medicare.
3. Medicaid recipients who are not eligible for premium-free Part A Medicare and who are not on Part B must apply for Medicare Part B when they reach age 65. This includes individuals receiving only SSI payments. Resident non-citizens must be at least 65 and have lived in the U.S. for 5 years to qualify for Medicare. Do not require individuals to apply for Part A Medicare if they will owe a premium. These individuals must apply for Part B Medicare through Social Security Administration.
a. Approve Medicaid pending the application for Part B for an otherwise eligible individual.
b. Notify the recipient of the requirement, provide the information they need to apply, and allow at least 30 days for the individual to apply for Part B.
c. Close the Medicaid case if an individual fails to apply after being notified of this requirement, and has not asked for more time to apply.
3. Individuals whose SSDI benefits end, but who are still receiving Medicare benefits are generally still considered disabled by SSA. They can continue to be eligible for Disabled Medicaid if the individual is still disabled. Decide why SSDI benefits ended (303-2).
4. Individuals who are entitled to or receiving Medicare are not eligible for Medicaid under the Adult Expansion program. Eligibility under this group ends when a recipient becomes entitled to Medicare.
See 223-1 in Resource section for information on who is eligible and how enrollment occurs.