Advocates working with dual eligible beneficiaries or individuals in Medicare Savings Programs frequently encounter issues around payment (“buy-in”) of Part B, and sometimes Part A, premiums by their state Medicaid program. 
CMS has recently issued a Manual for State Payment of Medicare Premiums, which describes in detail how the process of starting and ending state payment of Medicare premiums is designed to work. The Manual will be a very helpful resource for advocates when working with their state agency to untangle specific buy-in problems that arise for their clients. It replaces an outdated State Buy-in Manual, which has been retired. 
Release of the Manual also offers an opportunity for advocates to urge their states to improve practices in order to streamline the buy-in process and address systemic deficiencies. 
One area for improvement is the frequency of data exchange between states and CMS/SSA. Daily data exchange will be required of all states by April 1, 2022, but advocates should encourage their states to move more quickly to update their systems. Currently many states use weekly or even monthly exchange for some files. The status of state buy-in is here. CMS factsheets on MMA files and buy-in data files address the value of more frequent exchange.
Another relevant area for advocacy is encouraging states to enter into a Part A buy-in agreement with SSA, discussed in Sec. 1.2 of the Manual. Without a Part A buy-in agreement, individuals who do not have premium-free Part A can only enroll in the Qualified Medicare Beneficiary (QMB) program during certain enrollment periods. They often face long periods without needed coverage. Fourteen states currently do not have a Part A buy-in agreement: Alabama, Arizona, California, Colorado, Illinois, Kansas, Kentucky, Missouri, Nebraska, New Jersey, New Mexico, South Carolina, Utah, and Virginia. 
View the new Manual here.
Advocates with questions about the Manual or seeking technical assistance with specific buy-in issues can contact Justice in Aging at

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