[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: 42CFR407.47]



[Page 271]

 

                         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. 407.47  Beginning of coverage under a State buy-in agreement.



    (a) General rule. The beginning of an individual's coverage period 

depends on two factors:

    (1) The individual's meeting the SMI eligibility requirements and 

the requirements for being a member of the buy-in group; and

    (2) The effective date of the buy-in agreement or agreement 

modification that covers the group to which the individual belongs, and 

which may not be earlier than the third month after the month in which 

the agreement or modification is executed.

    (b) Application of general rule: Medicaid eligibles who are, or are 

treated as, cash assistance recipients. For Medicaid eligibles who are, 

or are treated as, cash assistance recipients (that is, are members of 

categories A through E of Sec. 407.42(a) or categories A through C of 

Sec. 407.43(a)), coverage begins with the later of the following:

    (1) The first month in which the individual--

    (i) Meets the SMI eligibility requirements specified in Sec. 

407.10; and

    (ii) Is a member of one of those categories.

    (2) The month in which the buy-in agreement is effective.

    (c) Application of general rule: Qualified Medicare Beneficiaries. 

For individuals who are QMBs (that is, are members of category F of 

Sec. 407.42 or category D of Sec. 407.43(a)), coverage begins with the 

later of the following:

    (1) The first month in which the individual meets the SMI 

eligibility requirements specified in Sec. 407.10, and has QMB status.

    (2) The month in which the buy-in agreement or agreement 

modification covering QMBs is effective.

    (d) Application of general rule: Other individuals eligible for 

Medicaid. For individuals who are members of category G of Sec. 

407.42(a) or category E of Sec. 407.43(a), coverage begins with the 

later of the following:

    (1) The second month after the month in which the individual--

    (i) Meets the SMI eligibility requirements specified in Sec. 

407.10; and

    (ii) Is determined to be eligible for Medicaid.

    (2) The month in which the buy-in agreement or agreement 

modification is effective.

    (e) Coverage based on erroneous report. If the State erroneously 

reports to SSA that an individual is a member of its coverage group, the 

rules of paragraphs (a) through (d) of this section apply, and coverage 

begins as though the individual were in fact a member of the group. 

Coverage will end only as provided in Sec. 407.48.



[56 FR 38082, Aug. 12, 1991]