[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR407.43]



[Page 270]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 407_SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT

--Table of Contents

 

                    Subpart C_State Buy-In Agreements

 

Sec. 407.43  Buy-in groups available to Puerto Rico, Guam, the Virgin 

Islands, and American Samoa.



    (a) Categories included in buy-in groups. The buy-in groups that are 

available to Puerto Rico, Guam, the Virgin Islands, and American Samoa, 

which are not covered by the SSI program, are described in paragraph (b) 

of this section in terms of the following categories:

    (1) Category A: Individuals receiving OAA, AB, APTD, or AFDC.

    (2) Category B: Individuals who, under the Act or any other 

provision of Federal law, are treated, for Medicaid eligibility 

purposes, as though they were receiving AFDC.

    (3) Category C: Individuals who, in accordance with Sec. 436.112 of 

this chapter, are covered under the State's Medicaid plan despite the 

increase in social security benefits provided by Public Law 92-336.

    (4) Category D: Individuals who are Qualified Medicare 

Beneficiaries. \1\

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    \1\ Rules for buy-in for premium hospital insurance for QMBs are set 

forth in Sec. 406.26 of this chapter.

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    (5) Category E: All other individuals who are eligible for Medicaid.

    (b) Buy-in groups available. Puerto Rico, Guam, the Virgin Islands, 

and American Samoa may choose any of the following coverage groups:

    (1) Group 1: Categories A through E.

    (2) Group 2: Categories A through D.

    (3) Group 3: Categories A through C.

    (4) Group 4: Individuals in category D, and individuals in 

categories A and B who are not social security or railroad retirement 

beneficiaries.

    (5) Group 5: Individuals in categories A and B who are not social 

security or railroad retirement beneficiaries.

    (6) Group 6: Individuals in category D, individuals in category A 

who are receiving OAA, and individuals in category C who are included in 

that category (in accordance with Sec. 436.112 of this chapter) because 

they received OAA for August 1972 or would have been eligible to receive 

OAA for that month if they had applied or had not been 

institutionalized.

    (7) Group 7: Individuals in category A who are receiving OAA, and 

individuals in category C who are included in that category (in 

accordance with Sec. 436.112 of this chapter) because they received OAA 

for August 1972 or would have been eligible to receive OAA for that 

month if they had applied or had not been institutionalized.

    (8) Group 8: Individuals in category D and individuals in category A 

who are receiving OAA and are not social security or railroad retirement 

beneficiaries.

    (9) Group 9: Individuals in category A who are receiving OAA and are 

not social security or railroad retirement beneficiaries.



[56 FR 38082, Aug. 12, 1991]