Medicare Enrollment Guidelines for Medicaid Members with End Stage Renal Disease (ESRD)

Here are some steps you can take to help members get access to Medicare:

1. Understand the eligibility requirements: A Medicaid member may be eligible for Medicare no matter how old they are if:
   1. Their kidneys no longer work
   2. They need regular dialysis or a kidney transplant
   3. They are eligible for/currently receive Social Security or Railroad Retirement benefits, or are the spouse/dependent of a person who meets either of the requirements above
2. Fill out the CMS 2728 form: The CMS 2728 form is the primary documentation that records a member has End Stage Renal Disease. Providers have 45 days from the date a patient started dialysis to submit a completed 2728 form to the Social Security Administration (SSA) and is required even if the patient chooses not to apply for or will not qualify for Medicare.
   1. Providers using End Stage Renal Disease Quality Reporting System (EQRS): Providers can submit the 2728 form digitally via EQRS and print a copy for the member
   2. Providers without EQRS: Providers should download a copy of the 2728 form and assist members in submitting it to their local SSA office
   3. The Patient’s signature is required to complete the CMS 2728 form
3. Connect members with their local SSA to learn more about applying for Medicare
4. Share Medicare resources with Healthfirst members: The Medicare Rights Center has a variety of independent resources that can help a member understand Medicare basics

Resources

• End Stage Renal Disease | New York State Department of Health
• Social Security Administration (SSA) Office Locator
• CMS 2728 Form | ESRD Medical Evidence Report Medicare Entitlement and/or Patient Registration

Questions?

If you have questions, please contact your network account manager, or Healthfirst Provider Services at 1-888-801-1660, Monday to Friday, 8:30am–5:30pm.