Colorado Medicaid pays the Medicare Part B (Supplementary Medical Insurance (SMI)) premiums for ALL clients who are on any Medicaid or any Medicare Savings Program (MSP).
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 98,000 clients on Part B Buy-In and approximately 220 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? Is the TPL Code 01-26? 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