There are four ways an individual can be deleted from the Buy-In system:
1. CMS/SSA Closing – These are initiated by the SSA based on information they have received, such as notice of death, moved out of state or deemed ineligible for Medicare by SSA.
2. Exchange 7 Auto-Closing when Unknown to eCIS – If a case is auto-accreted by CMS and the individual is not open in a MA or TANF cash assistance category, the Buy-In system will send a request to CMS to close Buy-In.
3. Exchange 7 Auto-Closing – When a Buy-In category is closed, a closing request is automatically sent to a special holding file in the Buy-In system. After 30-45 days, the Buy-In system checks the individual’s status in eCIS to determine if they are open or closed for MA benefits.
§ If the eCIS budget is closed and the individual is not open in any other MA or TANF category, the system will close Buy-In.
NOTE: The CAO should check the Exchange 7 Buy-In Match Results screen in the middle of the next month to make sure the individual was deleted from Buy-In. If Buy-In did not close, the CAO must process a manual delete to close Buy-In.
§ If the individual is open in any other MA or TANF category in eCIS, the system WILL NOT close Buy-In. It is the responsibility of the CAO to decide if the individual should be deleted from Buy-In and process a manual delete to close Buy-In.
4. Manual Closing – A manual delete is done on the Exchange 7 Buy-In Action Request screen in Exchange 7 and consists of three items: type (Part A or Part B), transaction code (’51’/ ‘53’ for deceased individuals) and (end) date.
Important:Due to Federal regulations governing “hardship” conditions, Buy-In can only be retroactively terminated up to two months from the current billing month. No overpayments can be done unless it is proven the individual intentionally falsified information.
Example: Buy-In eligibility ended 06/2016. In 03/2018, the CAO discovers Buy-In coverage was never closed. Since the current billing month is 03/2018, the CAO can only request termination retroactive to 01/2018.
Issued August 31, 2018