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Code of Federal Regulations Title 42. Public Health § 42.407.43 Buy-in groups available to Puerto Rico, Guam, the Virgin Islands, and American Samoa

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) Categories included in buy-in groups. The buy-in groups that are available to Puerto Rico, Guam, the Virgin Islands, and American Samoa, which are not covered by the SSI program, are described in paragraph (b) of this section in terms of the following categories:

(1) Category A:  Individuals receiving OAA, AB, APTD, or AFDC.

(2) Category B:  Individuals who, under the Act or any other provision of Federal law, are treated, for Medicaid eligibility purposes, as though they were receiving AFDC.

(3) Category C:  Individuals who, in accordance with § 436.112 of this chapter, are covered under the State's Medicaid plan despite the increase in social security benefits provided by Public Law 92–336.

(4) Category D:  Individuals who are Qualified Medicare Beneficiaries.  1

1 Rules for buy-in for premium hospital insurance for QMBs are set forth in § 406.26 of this chapter.

(5) Category E:  All other individuals who are eligible for Medicaid.

(b) Buy-in groups available. Puerto Rico, Guam, the Virgin Islands, and American Samoa may choose any of the following coverage groups:

(1) Group 1:  Categories A through E.

(2) Group 2:  Categories A through D.

(3) Group 3:  Categories A through C.

(4) Group 4:  Individuals in category D, and individuals in categories A and B who are not social security or railroad retirement beneficiaries.

(5) Group 5:  Individuals in categories A and B who are not social security or railroad retirement beneficiaries.

(6) Group 6:  Individuals in category D, individuals in category A who are receiving OAA, and individuals in category C who are included in that category (in accordance with § 436.112 of this chapter) because they received OAA for August 1972 or would have been eligible to receive OAA for that month if they had applied or had not been institutionalized.

(7) Group 7:  Individuals in category A who are receiving OAA, and individuals in category C who are included in that category (in accordance with § 436.112 of this chapter) because they received OAA for August 1972 or would have been eligible to receive OAA for that month if they had applied or had not been institutionalized.

(8) Group 8:  Individuals in category D and individuals in category A who are receiving OAA and are not social security or railroad retirement beneficiaries.

(9) Group 9:  Individuals in category A who are receiving OAA and are not social security or railroad retirement beneficiaries.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.407.43 Buy-in groups available to Puerto Rico, Guam, the Virgin Islands, and American Samoa - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-407-43/

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