8006 - Buy-In Alert - Accretion Failed SSA Match Criteria - Urgent

This alert is generated when the state initiated Medicare Part A and/or Part B accretion is rejected by SSA because the recipient identification information does not match SSA records. MEDS initiates a second Part B accretion for anyone who:

Is active on MEDS in a potential Medicare covered Aid Code (13, 14, 16, 17, 18, 23, 24, 26, 27, 28, 63, 64, 66, 67 or 68), and
Is NOT identified as a Medicare ineligible alien, and
Has a HIC number on MEDS, or
Is age 65 or over, or
Is eligible in a blind or disabled aid category (20 or 60 series aid code).

If the second Part B accretion attempt does not match SSA records, CDHS is unable to confirm whether or not this recipient is entitled to Medicare.

Action Required

If the recipient is 65 years of age or older and:

Is an aged alien who is ineligible for Medicare because he/she has not met the 5 year residency requirement, review the Citizenship Status Detail page to ensure the INS Date of Entry is accurate so that a ‘9’ Medicare status code can be recorded on MEDS. Submit an SCD 1296 requesting the MTO to record the client’s INS entry date and the status code of ‘9’ if necessary.
Has not applied for Medicare, advise the recipient of the requirement to apply for Medicare coverage as a condition of Medi-Cal eligibility. Refer the recipient to the local SSA field office. Refer to MC HB Chapter 20: Medicare Coverage, Section Individuals Required to Apply for Medicare.

If the recipient is receiving Social Security Disability benefits (Title II) or is entitled to Medicare coverage:

If the HIC number and/or sex on MEDS is INCORRECT, submit a correction to update MEDS.
- If the data is CORRECT in CalSAWS, complete an SCD 1296 requesting the MTO generate an EW30 (Modify) transaction.
- If the data is INCORRECT in CalSAWS, make the necessary corrections on the Individual Demographics Detail page (for sex) and/or Medicare Detail page (for HIC number).
If the Name and/or birthdate on MEDS does not match the information on the recipient’s Medicare card or their Disability (Title II) award letter from SSA, report the name/birthdate information from the Medicare card or award letter to the Buy-In Unit by completing the online fillable form “State Medicare Buy-In Problem Form”. CDHS will update the name/birthdate information on MEDS for use in submitting future Buy-In accretion transaction, OR
If the recipient does not fit into one of the above categories (e.g., the recipient is under 65, is not in receipt of social security disability benefits, and does not have Medicare coverage):
- Remove information on the Medicare Detail page since the client is not receiving or conditionally eligible for Medicare Part A or B. CalSAWS will generate an EW12 (Modify) transaction to MEDS, removing the HIC number from the MEDS record.
- If the Medicare Detail page was not completed, submit an SCD1296 requesting the MTO to generate an EW30 (Modify) transaction to delete the HIC number on MEDS.

8006 - Buy-In Alert - Accretion Failed SSA Match Criteria - Urgent

Action Required

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