Colorado Medicaid pays the Medicare Part B (Supplementary Medical Insurance (SMI)) premiums for clients who are on any Medicare Savings Program (MSP) and most Medicaid programs. Colorado does not pay Medicare premiums for clients who are on one of the five Medicaid programs that do not allow Medicare at the same time (MAGI-Adult, Breast and Cervical Cancer Program, Breast and Cervical Cancer Program-Presumptive Eligibility, Qualified Disabled Widow/Widower, Adults without Dependent Children) unless QMB or SLMB is added as a secondary program.
Most people get Medicare Part A (Hospital Insurance (HI)) for free. Colorado only pays the Part A premiums for individuals who need it if they meet the criteria for the Qualified Medicare Beneficiary (QMB) program. There are approximately 100,000 clients on Part B Buy-In and approximately 200 clients on Part A Buy-In. Medicare Part A & B Cost Avoidance saves Medicaid over $300 million per year.
- The first 20 pages are the Buy-In Basics.
- Appendix A can be ignored, unless you are techie-minded and curious about the various RIC types and record layouts of the files going back and forth between the State and CMS.
- Appendix B should be used like a dictionary. It contains all the Part B Buy-In transactions and their definitions from CMS’ State Buy-In Manual.
- Appendix C contains some troubleshooting tips.
- Training guide for Buy-In Basics and common scenarios
- Advanced tips
- Three steps needed to do Part A Buy-In
Frequently Asked Questions
When in doubt, contact the State Buy-In Officer.
Why did my client’s Buy-In stop?
Buy-in stops when the client’s medical eligibility spans (med spans) in MMIS indicate the client has lost eligibility for Buy-in.
I reopened my client’s case but Buy-In did not restart within a month. Why?
Things to check:
- CBMS Med Spans: Is the current med span open? Does the coding combination indicate a Buy-In-eligible program?
- Buy-In Summary screen: What is the most recent row (by date sent/received)? Refer to one of the training guides for a translation of what it means. Is the most recent RIC B a 1728? Did your client move back to Colorado from another state? If yes, contact the State Buy-In Officer.
- Demographic Data: Does CBMS individual demographic data match SSA Title 2 data on the 7 match criteria?
The Part B Buy-In payer code in SVES/SOLQ is not CO (060). How do we get it changed?
Verify the client is currently a Colorado resident and notify the State Buy-In Officer.
Contact: Sharon Brydon, State Buy-In Officer: 303-866-5402 / Sharon.Brydon@state.co.us