SSR 69-10: Section 1843(a) and (b).—Supplementary Medical Insurance Enrollment Under State Buy-In Agreements—Modification of Agreement—Coverage Groups to be Included
Where a State has in effect a Buy-in Agreement under section 1843 of the Social Security Act covering money- payment assistance recipients under title I[*] of the Act and seeks to modify its agreement to include persons age 65 and older receiving cash assistance under title X of the Act only, held such amendment is not permissible unless the State also includes persons 65 years of age and older who are receiving assistance under the other assistance titles enumerated in section 1843(b)(2) of the Act.
Part B of title XVIII of the Social Security Act, "Supplementary Medical Insurance Benefits for the Aged," established a voluntary program of medical insurance benefits for individuals 65 years of age or over who elect to enroll under it, financed from premium payments by enrollees together with contributions from funds appropriated by the Federal Government.
Provision is made in section 1843 of title XVIII of the Act whereby recipients of specified categories of cash public assistance may be enrolled under the SMI program and have their premiums paid by the State in which they live, pursuant to the following provisions of that section:
(a) The Secretary shall, at the request of a State made before January 1, 1970, enter into an agreement with such State pursuant to which all eligible individuals in either of the coverage groups described in subsection (b) (as specified in the agreement) will be enrolled under the program established by this part.
(b) An agreement entered into with any State pursuant to subsection (a) may be applicable to either of the following coverage groups:
(1) individuals receiving money payments under the plan of such State approved under title I or title XVI; or
(2) individuals receiving money payments under all of the plans of such State approved under titles I, X, XIV, and XVI and Part A of title IV.[**]
A State which has in effect a buy-in agreement that covers money-payment recipients under title I only, wishes to amend its agreement so as to include title X assistance recipients 65 years of age and older without including also all those persons 65 years of age and older receiving cash assistance under title IV (Part A), title XIV and title XVI. The question at issue is therefore whether the proposed amendment to the agreement, which would encompass only title X recipients who are 65 years old and older, would be permissible under the provisions of section 1843 quoted above.
The language of section 1843 is unambiguous, affording to a State the choice only of including in its buy-in agreement title I (or title XVI) recipients, or, as a package, all those persons who comprise comparable groups under all the assistance titles. This would mean that if title X recipients 65 years of age and older were to be included in the State's buy-in agreement, so, too, must title IV (Part A), title XIV and title XVI recipients 65 years of age and older. The legislative history likewise demonstrates that it was the intent of Congress that if a money-payment recipient under title X became cowered under a State's buy-in agreement, so, too, must the provisions of the agreement be extended to title IV (Part A), XIV and XVI money-payment recipients. Social Security Amendments of 1965, Report of Senate Finance Committee, No. 404, Part 1, p. 41.
As to whether a different result would be reached in the case of a title X program administered separately from the other assistance titles, there is nothing in the legislative history which would suggest that any different interpretation of section 1843(b)(2) would be justified.
It is accordingly held not permissible, under the terms of section 1843 of the Social Security Act, for a State to amend its buy-in agreement to include title X assistance recipients 65 years of age and older without also including all those persons 65 years of age and older receiving cash assistance under Part A of title IV, title XIV, and title XVI.
[*] The following are the assistance titles of the Social Security Act applicable to this ruling:
Title I-Provides for grants to States for old- age assistance (OAA) and medical assistance for the aged (MAA);
Title IV - Provides for grants to States for aid and services to needy families with children;
Title X - Provides for grants to States for aid to the blind;
Title XIV - Provides for grants to States for aid to the permanently and totally disabled;
Title XVI - Provides for grants to States for aid to the aged, blind, or disabled or for such aid and medical assistance for the aged.
[**] Title IV of the Social Security Act, as amended by section 235 of the Social Security Amendments of 1967 (P.L. 90-248), has become Part A of title IV. The amendment added a new Part B to title IV, not here applicable, containing the provisions on child welfare services which had formerly been part of title V of the Act.