Title 42 — The Public Health and WelfareRelease 119-73not60
§1395v Agreements with States
Title 42 › Chapter 7— SOCIAL SECURITY › Subchapter XVIII— HEALTH INSURANCE FOR AGED AND DISABLED › Part B— Supplementary Medical Insurance Benefits for Aged and Disabled › § 1395v
Summary
The Secretary must, when a State asks (if the request was made before January 1, 1970, or in 1981 or after 1988), make a deal with that State so people in certain groups will be enrolled in the program under this part. The deal can cover either people getting state cash payments under one set of plans or a larger group getting payments under several state plans (subchapters I, X, XIV, XVI, and part A of IV). A person counts as eligible only if they are an eligible individual under the referenced rule when the deal starts or become eligible later. They count as getting the state money payments if they get those payments in the month the deal starts or any month after. For people enrolled this way, the State pays the monthly premium set by section 1395r (with no extra increase). Coverage starts on the latest of July 1, 1966; the first day of the third month after the State’s deal starts; the first day of the first month the person is both eligible and in the covered group; or a date the deal names. Coverage ends when the person stops getting the specified state payments (and, if the deal was changed to include medical assistance, stops being eligible for that) or the month before they start getting monthly benefits under subchapter II or a Railroad Retirement annuity. If coverage ends for those reasons, the person is treated as if they enrolled in the initial general enrollment period under section 1395p(c). The Secretary must also, if asked in the same date ranges, agree to changes that narrow or broaden the covered groups (including adding people eligible for Medicaid under subchapter XIX or qualified Medicare beneficiaries), and the deal can let the State agency act as the “carrier” and handle payment and billing tasks.
Full Legal Text
Title 42, §1395v
The Public Health and Welfare — Source: USLM XML via OLRC
(a)The Secretary shall, at the request of a State made before January 1, 1970, or during 1981 or after 1988, 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 subchapter I or subchapter XVI; or
(2)individuals receiving money payments under all of the plans of such State approved under subchapters I, X, XIV, and XVI, and part A of subchapter IV.
(c)For purposes of this section, an individual shall be treated as an eligible individual only if he is an eligible individual (within the meaning of section 1395o of this title) on the date an agreement covering him is entered into under subsection (a) or he becomes an eligible individual (within the meaning of such section) at any time after such date; and he shall be treated as receiving money payments described in subsection (b) if he receives such payments for the month in which the agreement is entered into or any month thereafter.
(d)In the case of any individual enrolled pursuant to this section—
(1)the monthly premium to be paid by the State shall be determined under section 1395r of this title (without any increase under subsection (b) thereof);
(2)his coverage period shall begin on whichever of the following is the latest:
(A)July 1, 1966;
(B)the first day of the third month following the month in which the State agreement is entered into;
(C)the first day of the first month in which he is both an eligible individual and a member of a coverage group specified in the agreement under this section; or
(D)such date as may be specified in the agreement; and
(3)his coverage period attributable to the agreement with the State under this section shall end on the last day of whichever of the following first occurs:
(A)the month in which he is determined by the State agency to have become ineligible both for money payments of a kind specified in the agreement and (if there is in effect a modification entered into under subsection (h)) for medical assistance, or
(B)the month preceding the first month for which he becomes entitled to monthly benefits under subchapter II or to an annuity or pension under the Railroad Retirement Act of 1974 [45 U.S.C. 231 et seq.].
(e)Any individual whose coverage period attributable to the State agreement is terminated pursuant to subsection (d)(3) shall be deemed for purposes of this part (including the continuation of his coverage period under this part) to have enrolled under section 1395p of this title in the initial general enrollment period provided by section 1395p(c) of this title. The coverage period under this part of any such individual who (in the last month of his coverage period attributable to the State agreement or in any of the following six months) files notice that he no longer wishes to participate in the insurance program established by this part, shall terminate at the close of the month in which the notice is filed.
(f)With respect to eligible individuals receiving money payments under the plan of a State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV, or eligible to receive medical assistance under the plan of such State approved under subchapter XIX, if the agreement entered into under this section so provides, the term “carrier” as defined in section 1395u(f) 11 See References in Text note below. of this title also includes the State agency, specified in such agreement, which administers or supervises the administration of the plan of such State approved under subchapter I, XVI, or XIX. The agreement shall also contain such provisions as will facilitate the financial transactions of the State and the carrier with respect to deductions, coinsurance, and otherwise, and as will lead to economy and efficiency of operation, with respect to individuals receiving money payments under plans of the State approved under subchapters I, X, XIV, and XVI, and part A of subchapter IV, and individuals eligible to receive medical assistance under the plan of the State approved under subchapter XIX.
(g)(1)The Secretary shall, at the request of a State made before January 1, 1970, or during 1981 or after 1988, enter into a modification of an agreement entered into with such State pursuant to subsection (a) under which the second sentence of subsection (b) shall not apply with respect to such agreement.
(2)In the case of any individual who would (but for this subsection) be excluded from the applicable coverage group described in subsection (b) by the second sentence of such subsection—
(A)subsections (c) and (d)(2) shall be applied as if such subsections referred to the modification under this subsection (in lieu of the agreement under subsection (a)), and
(B)subsection (d)(3)(B) shall not apply so long as there is in effect a modification entered into by the State under this subsection.
(h)(1)The Secretary shall, at the request of a State made before January 1, 1970, or during 1981 or after 1988, enter into a modification of an agreement entered into with such State pursuant to subsection (a) under which the coverage group described in subsection (b) and specified in such agreement is broadened to include (A) individuals who are eligible to receive medical assistance under the plan of such State approved under subchapter XIX, or (B) qualified medicare beneficiaries (as defined in section 1396d(p)(1) of this title).
(2)For purposes of this section, an individual shall be treated as eligible to receive medical assistance under the plan of the State approved under subchapter XIX if, for the month in which the modification is entered into under this subsection or for any month thereafter, he has been determined to be eligible to receive medical assistance under such plan. In the case of any individual who would (but for this subsection) be excluded from the agreement, subsections (c) and (d)(2) shall be applied as if they referred to the modification under this subsection (in lieu of the agreement under subsection (a)), and subsection (d)(2)(C) shall be applied (except in the case of qualified medicare beneficiaries, as defined in section 1396d(p)(1) of this title) by substituting “second month following the first month” for “first month”.
(3)In this subsection, the term “qualified medicare beneficiary” also includes an individual described in section 1396a(a)(10)(E)(iii) of this title.
(i)For provisions relating to enrollment of qualified medicare beneficiaries under part A, see section 1395i–2(g) of this title.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
The Railroad Retirement Act of 1974, referred to in subsec. (d)(3)(B), is act Aug. 29, 1935, ch. 812, as amended generally by Pub. L. 93–445, title I, § 101, Oct. 16, 1974, 88 Stat. 1305, which is classified generally to subchapter IV (§ 231 et seq.) of chapter 9 of Title 45, Railroads. For further details and complete classification of this Act to the Code, see Codification note set out preceding section 231 of Title 45, section 231t of Title 45, and Tables. section 1395u(f) of this title, referred to in subsec. (f), was repealed by Pub. L. 108–173, title IX, § 911(c)(5), Dec. 8, 2003, 117 Stat. 2384.
Amendments
1990—Subsec. (h)(3). Pub. L. 101–508 added par. (3). 1989—Subsec. (i). Pub. L. 101–239 added subsec. (i). 1988—Subsecs. (a), (g)(1). Pub. L. 100–360, § 301(e)(1)(A), formerly § 301(e)(1), as redesignated by Pub. L. 100–485, § 608(d)(14)(H)(i), inserted “or after 1988” after “during 1981”. Subsec. (h)(1). Pub. L. 100–360, § 301(e)(1)(A), formerly § 301(e)(1), as redesignated by Pub. L. 100–485, § 608(d)(14)(H)(i), inserted “or after 1988” after “during 1981”. Pub. L. 100–360, § 301(e)(1)(B), as added by Pub. L. 100–485, § 608(d)(14)(H)(ii), inserted cl. (A) designation after “include” and added cl. (B). Subsec. (h)(2). Pub. L. 100–360, § 301(e)(1)(C), as added by Pub. L. 100–485, § 608(d)(14)(H)(ii), inserted “(except in the case of qualified medicare beneficiaries, as defined in section 1396d(p)(1) of this title)” after “shall be applied”. 1984—Subsec. (d)(3)(B). Pub. L. 98–369 substituted “1974” for “1937”. 1983—Subsec. (d)(1). Pub. L. 98–21 substituted “without any increase under subsection (b) thereof” for “without any increase under subsection (c) thereof”. 1980—Subsec. (a). Pub. L. 96–499, § 945(e), inserted “or during 1981,” after “
January 1, 1970,”. Subsec. (e). Pub. L. 96–499, § 947(a), inserted provision that the coverage period under this part of any individual who filed notice that he no longer wished to participate in the insurance program established by this part was to terminate at the close of the month in which the notice was filed. Subsec. (g)(1). Pub. L. 96–499, § 945(e), inserted “or during 1981,” after “
January 1, 1970,”. Subsec. (g)(2)(C). Pub. L. 96–499, § 947(c)(3), struck out cl. (C) which authorized individuals facing exclusion from the applicable coverage group to terminate their enrollment under this part by the filing of a notice indicating he no longer wished to participate in the insurance program established by this part. Subsec. (h)(1). Pub. L. 96–499, § 945(e), inserted “or during 1981,” after “
January 1, 1970,”. 1974—Subsec. (b). Pub. L. 93–445 substituted “under the Railroad Retirement Act of 1974” for “or pension under the Railroad Retirement Act of 1937”. 1973—Subsec. (b). Pub. L. 93–233 provided for continuation of State agreements for coverage of certain individuals in connection with establishment of supplemental security income program. 1968—Pub. L. 90–248, § 222(b)(4), inserted “(or are eligible for medical assistance)” in section catchline. Subsec. (a). Pub. L. 90–248, § 222(e)(1), substituted “1970” for “1968”. Subsec. (b)(2). Pub. L. 90–248, § 241(e)(1), struck out “IV,” after “I,” and inserted “, and part A of subchapter IV” after “XVI”. Subsec. (c). Pub. L. 90–248, § 222(e)(2), struck out “and before
January 1, 1968” after “such date” and “before January 1968” after “thereafter” just before the period. Subsec. (d)(2)(D). Pub. L. 90–248, § 222(e)(3), struck out “(not later than
January 1, 1968)” after “such date”. Subsec. (d)(3)(A). Pub. L. 90–248, § 222(b)(1), substituted “ineligible both for money payments of a kind specified in the agreement and (if there is in effect a modification entered into under subsection (h)) for medical assistance” for “ineligible for money payments of a kind specified in the agreement”. Subsec. (f). Pub. L. 90–248, § 222(b)(2), inserted “or eligible to receive medical assistance under the plan of such State approved under subchapter XIX” and “, and individuals eligible to receive medical assistance under the plan of the State approved under subchapter XIX” after “or part A of subchapter IV” and “, and part A of subchapter IV”, respectively. Pub. L. 90–248, § 241(e)(2), struck out “IV,” before “X,” in two places, and inserted “or part A of subchapter IV,” after “XVI,” first place it appears in first sentence and “, and part A of subchapter IV” after “XVI” in second sentence. Subsec. (g)(1). Pub. L. 90–248, § 222(b)(3), substituted “1970” for “1968”. Subsec. (h). Pub. L. 90–248, § 222(a), added subsec. (h). 1966—Subsec. (b). Pub. L. 89–384, § 4(a), inserted reference to subsec. (g) in exclusionary provision. Subsec. (g). Pub. L. 89–384, § 4(b), added subsec. (g).
Statutory Notes and Related Subsidiaries
Effective Date
of 1990 AmendmentAmendment by Pub. L. 101–508 applicable to calendar quarters beginning on or after Jan. 1, 1991, without regard to whether or not
Regulations
to implement such amendment are promulgated by such date, see section 4501(f) of Pub. L. 101–508, set out as a note under section 1396a of this title.
Effective Date
of 1989 AmendmentAmendment by Pub. L. 101–239 effective Jan. 1, 1990, see section 6013(c) of Pub. L. 101–239, set out as a note under section 1395i–2 of this title.
Effective Date
of 1988 AmendmentAmendment by Pub. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Pub. L. 100–485, set out as a note under section 704 of this title. Pub. L. 100–360, title III, § 301(e)(3),
July 1, 1988, 102 Stat. 750, provided that: “The amendment made by paragraph (1) [amending this section] shall take effect on
January 1, 1989, and the
Amendments
made by paragraph (2) [amending section 1396a of this title] shall take effect on July 1, 1989.”
Effective Date
of 1984 AmendmentAmendment by Pub. L. 98–369 effective July 18, 1984, but not to be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date, see section 2354(e)(1) of Pub. L. 98–369, set out as a note under section 1320a–1 of this title.
Effective Date
of 1983 Amendment; Transitional RuleAmendment by Pub. L. 98–21 applicable to premiums for months beginning with January 1984, but for months after June 1983 and before January 1984, the monthly premium for June 1983 shall apply to individuals enrolled under parts A and B of this subchapter, see section 606(c) of Pub. L. 98–21, set out as a note under section 1395r of this title.
Effective Date
of 1980 Amendment Pub. L. 96–499, title IX, § 947(d), Dec. 5, 1980, 94 Stat. 2643, provided that: “The
Amendments
made by this section [amending this section and section 1395q of this title] apply to notices filed after the third calendar month beginning after the date of the enactment of this Act [Dec. 5, 1980].”
Effective Date
of 1974 AmendmentAmendment by Pub. L. 93–445 effective Jan. 1, 1975, see section 603 of Pub. L. 93–445, set out as a note under section 402 of this title.
Effective Date
of 1973 AmendmentAmendment by Pub. L. 93–233 effective Jan. 1, 1974, see Pub. L. 93–233, § 18(z–3)(1), Dec. 31, 1973, 87 Stat. 974. Termination Period for Certain Individuals Covered Pursuant to State Agreements Pub. L. 96–499, title IX, § 947(e), Dec. 5, 1980, 94 Stat. 2643, provided that: “The coverage period under part B of title XVIII of the Social Security Act [42 U.S.C. 1395j et seq.] of an individual whose coverage period attributable to a State agreement under section 1843 of such Act [42 U.S.C. 1395v] is terminated and who has filed notice before the end of the third calendar month beginning after the date of the enactment of this Act [Dec. 5, 1980] that he no longer wishes to participate in the insurance program established by part B of title XVIII shall terminate on the earlier of (1) the day specified in section 1838 [42 U.S.C. 1395q] without the
Amendments
made by this section, or (2) (unless the individual files notice before the day specified in this clause that he wishes his coverage period to terminate as provided in clause (1)) the day on which his coverage period would terminate if the individual filed notice in the fourth calendar month beginning after the date of the enactment of this Act.” District of Columbia; Agreement of Commissioner With Secretary for Supplementary Medical Insurance Pub. L. 90–227, § 2, Dec. 27, 1967, 81 Stat. 745, provided that: “The Commissioner [now Mayor of District of Columbia] may enter into an agreement (and any modifications of such agreement) with the Secretary under section 1843 of the Social Security Act [42 U.S.C. 1395v] pursuant to which (1) eligible individuals (as defined in section 1836 of the Social Security Act) [42 U.S.C. 1395o] who are eligible to receive medical assistance under the District of Columbia’s plan for medical assistance approved under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.] will be enrolled in the supplementary medical insurance program established under part B of title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], and (2) provisions will be made for payment of the monthly premiums of such individuals for such program.”
Reference
Citations & Metadata
Citation
42 U.S.C. § 1395v
Title 42 — The Public Health and Welfare
Last Updated
Apr 5, 2026
Release point: 119-73not60