US Code

Public Law 119-73 (01/23/2026)

42 U.S.C. § 1395v

Agreements with States

(a)

Duty of Secretary; enrollment of eligible individuals

The Secretary shall, at the request of a State made before , 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)

Coverage of groups to which applicable

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.
45 U.S.C. 231section 1396a(f) of this titleExcept as provided in subsection (g), there shall be excluded from any coverage group any individual who is entitled to monthly insurance benefits under subchapter II or who is entitled to receive an annuity under the Railroad Retirement Act of 1974 [ et seq.]. Effective , and subject to , the Secretary shall, at the request of any State not eligible to participate in the State plan program established under subchapter XVI, continue in effect the agreement entered into under this section with such State subject to such modifications as the Secretary may by regulations provide to take account of the termination of any plans of such State approved under subchapters I, X, XIV, and XVI and the establishment of the supplemental security income program under subchapter XVI.
(c)

Eligible individuals

oFor 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 1395 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)

Monthly premiums; coverage periods

In the case of any individual enrolled pursuant to this section—
(1)
section 1395r of this title the monthly premium to be paid by the State shall be determined under (without any increase under subsection (b) thereof);
(2)
his coverage period shall begin on whichever of the following is the latest:
(A)
;
(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)
45 U.S.C. 231 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 [ et seq.].
(e)

Subsection (d)(3) terminations deemed resulting in section 1395p enrollment

section 1395p of this titlesection 1395p(c) of this titleAny 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 in the initial general enrollment period provided by . 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)

“Carrier” as including State agency; provisions facilitating deductions, coinsurance, etc., and leading to economy and efficiency of operation

1

1 See References in Text note below.
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)  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)

Subsection (b) exclusions from coverage groups

(1)
The Secretary shall, at the request of a State made before , 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)

Modifications respecting subsection (b) coverage groups

(1)
section 1396d(p)(1) of this title The Secretary shall, at the request of a State made before , 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 ).
(2)
section 1396d(p)(1) of this title 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 ) by substituting “second month following the first month” for “first month”.
(3)
section 1396a(a)(10)(E)(iii) of this title In this subsection, the term “qualified medicare beneficiary” also includes an individual described in .
(i)

Enrollment of qualified medicare beneficiaries

section 1395i–2(g) of this titleFor provisions relating to enrollment of qualified medicare beneficiaries under part A, see .

Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 312Pub. L. 89–384, § 4(a)80 Stat. 105Pub. L. 90–248, title II81 Stat. 900Pub. L. 93–233, § 18l87 Stat. 970Pub. L. 93–445, title III, § 30888 Stat. 1358Pub. L. 96–499, title IX94 Stat. 2642Pub. L. 98–21, title VI, § 606(a)(3)(E)97 Stat. 171Pub. L. 98–369, div. B, title III, § 2354(b)(15)98 Stat. 1101Pub. L. 100–360, title III, § 301(e)(1)102 Stat. 749Pub. L. 100–485, title VI, § 608(d)(14)(H)102 Stat. 2416Pub. L. 101–239, title VI, § 6013(b)103 Stat. 2164Pub. L. 101–508, title IV, § 4501(d)104 Stat. 1388–165(, title XVIII, § 1843, as added , , ; amended , (b), , ; , §§ 222(a), (b), (e), 241(e), , , 901, 917; (), , ; , , ; , §§ 945(e), 947(a), (c), , , 2643; , , ; , , ; , , ; , , ; , , ; , , .)

Editorial Notes

References in Text

act Aug. 29, 1935, ch. 812Pub. L. 93–445, title I, § 10188 Stat. 1305section 231 of Title 45section 231t of Title 45The Railroad Retirement Act of 1974, referred to in subsec. (d)(3)(B), is , as amended generally by , , , 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 , , and Tables.

Section 1395u(f) of this titlePub. L. 108–173, title IX, § 911(c)(5)117 Stat. 2384, referred to in subsec. (f), was repealed by , , .

Amendments

Pub. L. 101–5081990—Subsec. (h)(3). added par. (3).

Pub. L. 101–2391989—Subsec. (i). added subsec. (i).

Pub. L. 100–360, § 301(e)(1)(A)Pub. L. 100–485, § 608(d)(14)(H)(i)1988—Subsecs. (a), (g)(1). , formerly § 301(e)(1), as redesignated by , inserted “or after 1988” after “during 1981”.

Pub. L. 100–360, § 301(e)(1)(A)Pub. L. 100–485, § 608(d)(14)(H)(i)Subsec. (h)(1). , formerly § 301(e)(1), as redesignated by , inserted “or after 1988” after “during 1981”.

Pub. L. 100–360, § 301(e)(1)(B)Pub. L. 100–485, § 608(d)(14)(H)(ii), as added by , inserted cl. (A) designation after “include” and added cl. (B).

Pub. L. 100–360, § 301(e)(1)(C)Pub. L. 100–485, § 608(d)(14)(H)(ii)section 1396d(p)(1) of this titleSubsec. (h)(2). , as added by , inserted “(except in the case of qualified medicare beneficiaries, as defined in )” after “shall be applied”.

Pub. L. 98–3691984—Subsec. (d)(3)(B). substituted “1974” for “1937”.

Pub. L. 98–211983—Subsec. (d)(1). substituted “without any increase under subsection (b) thereof” for “without any increase under subsection (c) thereof”.

Pub. L. 96–499, § 945(e)1980—Subsec. (a). , inserted “or during 1981,” after “,”.

Pub. L. 96–499, § 947(a)Subsec. (e). , 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.

Pub. L. 96–499, § 945(e)Subsec. (g)(1). , inserted “or during 1981,” after “,”.

Pub. L. 96–499, § 947(c)(3)Subsec. (g)(2)(C). , 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.

Pub. L. 96–499, § 945(e)Subsec. (h)(1). , inserted “or during 1981,” after “,”.

Pub. L. 93–4451974—Subsec. (b). substituted “under the Railroad Retirement Act of 1974” for “or pension under the Railroad Retirement Act of 1937”.

Pub. L. 93–2331973—Subsec. (b). provided for continuation of State agreements for coverage of certain individuals in connection with establishment of supplemental security income program.

Pub. L. 90–248, § 222(b)(4)1968—, inserted “(or are eligible for medical assistance)” in section catchline.

Pub. L. 90–248, § 222(e)(1)Subsec. (a). , substituted “1970” for “1968”.

Pub. L. 90–248, § 241(e)(1)Subsec. (b)(2). , struck out “IV,” after “I,” and inserted “, and part A of subchapter IV” after “XVI”.

Pub. L. 90–248, § 222(e)(2)Subsec. (c). , struck out “and before ” after “such date” and “before January 1968” after “thereafter” just before the period.

Pub. L. 90–248, § 222(e)(3)Subsec. (d)(2)(D). , struck out “(not later than )” after “such date”.

Pub. L. 90–248, § 222(b)(1)Subsec. (d)(3)(A). , 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”.

Pub. L. 90–248, § 222(b)(2)Subsec. (f). , 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.

Pub. L. 90–248, § 222(b)(3)Subsec. (g)(1). , substituted “1970” for “1968”.

Pub. L. 90–248, § 222(a)Subsec. (h). , added subsec. (h).

Pub. L. 89–384, § 4(a)1966—Subsec. (b). , inserted reference to subsec. (g) in exclusionary provision.

Pub. L. 89–384, § 4(b)Subsec. (g). , added subsec. (g).

Statutory Notes and Related Subsidiaries

Effective Date of 1990 Amendment

Pub. L. 101–508section 4501(f) of Pub. L. 101–508section 1396a of this titleAmendment by applicable to calendar quarters beginning on or after , without regard to whether or not regulations to implement such amendment are promulgated by such date, see , set out as a note under .

Effective Date of 1989 Amendment

Pub. L. 101–239section 6013(c) of Pub. L. 101–239section 1395i–2 of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1988 Amendment

Pub. L. 100–485Pub. L. 100–360section 608(g)(1) of Pub. L. 100–485section 704 of this titleAmendment by effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, , see , set out as a note under .

Pub. L. 100–360, title III, § 301(e)(3)102 Stat. 750

section 1396a of this title“The amendment made by paragraph (1) [amending this section] shall take effect on , and the amendments made by paragraph (2) [amending ] shall take effect on .”
, , , provided that:

Effective Date of 1984 Amendment

Pub. L. 98–369section 2354(e)(1) of Pub. L. 98–369section 1320a–1 of this titleAmendment by effective , 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 , set out as a note under .

Effective Date of 1983 Amendment; Transitional Rule

Pub. L. 98–21section 606(c) of Pub. L. 98–21section 1395r of this titleAmendment by 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 , set out as a note under .

Effective Date of 1980 Amendment

Pub. L. 96–499, title IX, § 947(d)94 Stat. 2643

section 1395q of this title“The amendments made by this section [amending this section and ] apply to notices filed after the third calendar month beginning after the date of the enactment of this Act [].”
, , , provided that:

Effective Date of 1974 Amendment

Pub. L. 93–445section 603 of Pub. L. 93–445section 402 of this titleAmendment by effective , see , set out as a note under .

Effective Date of 1973 Amendment

Pub. L. 93–233Pub. L. 93–233, § 1887 Stat. 974Amendment by effective , see (z–3)(1), , .

Termination Period for Certain Individuals Covered Pursuant to State Agreements

Pub. L. 96–499, title IX, § 947(e)94 Stat. 2643

42 U.S.C. 1395j42 U.S.C. 1395v42 U.S.C. 1395q“The coverage period under part B of title XVIII of the Social Security Act [ et seq.] of an individual whose coverage period attributable to a State agreement under section 1843 of such Act [] 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 [] 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 [] 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.”
, , , provided that:

District of Columbia; Agreement of Commissioner With Secretary for Supplementary Medical Insurance

Pub. L. 90–227, § 281 Stat. 745

42 U.S.C. 1395v42 U.S.C. 1395o42 U.S.C. 139642 U.S.C. 1395“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 [] pursuant to which (1) eligible individuals (as defined in section 1836 of the Social Security Act) [] 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 [ et seq.] will be enrolled in the supplementary medical insurance program established under part B of title XVIII of the Social Security Act [ et seq.], and (2) provisions will be made for payment of the monthly premiums of such individuals for such program.”
, , , provided that: