Title 42

PART 435

Part 435 - Eligibility In The States, District Of Columbia, The Northern Mariana Islands, And American Samoa

PART 435 - ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA Authority:Sec. 1102 of the Social Security Act (42 U.S.C. 1302). Source:43 FR 45204, Sept. 29, 1978, unless otherwise noted.

42:4.0.1.1.6.1SUBPART A
Subpart A - General Provisions and Definitions
42:4.0.1.1.6.1.48.1SECTION 435.2
   435.2 Purpose and applicability.
42:4.0.1.1.6.1.48.2SECTION 435.3
   435.3 Basis.
42:4.0.1.1.6.1.48.3SECTION 435.4
   435.4 Definitions and use of terms.
42:4.0.1.1.6.1.48.4SECTION 435.10
   435.10 State plan requirements.
42:4.0.1.1.6.2SUBPART B
Subpart B - Mandatory Coverage
42:4.0.1.1.6.2.48SUBJGRP 48
   Mandatory Coverage of Families and Children
42:4.0.1.1.6.2.48.1SECTION 435.100
   435.100 Scope.
42:4.0.1.1.6.2.48.2SECTION 435.110
   435.110 Parents and other caretaker relatives.
42:4.0.1.1.6.2.48.3SECTION 435.112
   435.112 Families terminated from AFDC because of increased earnings or hours of employment.
42:4.0.1.1.6.2.48.4SECTION 435.115
   435.115 Families with Medicaid eligibility extended because of increased collection of spousal support.
42:4.0.1.1.6.2.49SUBJGRP 49
   Mandatory Coverage of Pregnant Women, Children Under 19, and Newborn Children
42:4.0.1.1.6.2.49.5SECTION 435.116
   435.116 Pregnant women.
42:4.0.1.1.6.2.49.6SECTION 435.117
   435.117 Deemed newborn children.
42:4.0.1.1.6.2.50SUBJGRP 50
   Mandatory Coverage of Qualified Family Members
42:4.0.1.1.6.2.50.7SECTION 435.118
   435.118 Infants and children under age 19.
42:4.0.1.1.6.2.51SUBJGRP 51
   Mandatory Coverage for Individuals Age 19 Through 64
42:4.0.1.1.6.2.51.8SECTION 435.119
   435.119 Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.
42:4.0.1.1.6.2.52SUBJGRP 52
   Mandatory Coverage of the Aged, Blind, and Disabled
42:4.0.1.1.6.2.52.9SECTION 435.120
   435.120 Individuals receiving SSI.
42:4.0.1.1.6.2.52.10SECTION 435.121
   435.121 Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.
42:4.0.1.1.6.2.52.11SECTION 435.122
   435.122 Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act.
42:4.0.1.1.6.2.52.12SECTION 435.130
   435.130 Individuals receiving mandatory State supplements.
42:4.0.1.1.6.2.52.13SECTION 435.131
   435.131 Individuals eligible as essential spouses in December 1973.
42:4.0.1.1.6.2.52.14SECTION 435.132
   435.132 Institutionalized individuals who were eligible in December 1973.
42:4.0.1.1.6.2.52.15SECTION 435.133
   435.133 Blind and disabled individuals eligible in December 1973.
42:4.0.1.1.6.2.52.16SECTION 435.134
   435.134 Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).
42:4.0.1.1.6.2.52.17SECTION 435.135
   435.135 Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.
42:4.0.1.1.6.2.52.18SECTION 435.136
   435.136 State agency implementation requirements for one-time notice and annual review system.
42:4.0.1.1.6.2.52.19SECTION 435.137
   435.137 Disabled widows and widowers who would be eligible for SSI except for the increase in disability benefits resulting from elimination of the reduction factor under Pub. L. 98-21.
42:4.0.1.1.6.2.52.20SECTION 435.138
   435.138 Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.
42:4.0.1.1.6.2.53SUBJGRP 53
   Mandatory Coverage of Certain Aliens
42:4.0.1.1.6.2.53.21SECTION 435.139
   435.139 Coverage for certain aliens.
42:4.0.1.1.6.2.54SUBJGRP 54
   Mandatory Coverage of Adoption Assistance and Foster Care Children
42:4.0.1.1.6.2.54.22SECTION 435.145
   435.145 Children with adoption assistance, foster care, or guardianship care under title IV-E.
42:4.0.1.1.6.2.54.23SECTION 435.150
   435.150 Former foster care children.
42:4.0.1.1.6.2.55SUBJGRP 55
   Mandatory Coverage of Special Groups
42:4.0.1.1.6.2.55.24SECTION 435.170
   435.170 Pregnant women eligible for extended or continuous eligibility.
42:4.0.1.1.6.2.55.25SECTION 435.172
   435.172 Continuous eligibility for hospitalized children.
42:4.0.1.1.6.3SUBPART C
Subpart C - Options for Coverage
42:4.0.1.1.6.3.56SUBJGRP 56
   Options for Coverage of Families and Children and the Aged, Blind, and Disabled
42:4.0.1.1.6.3.56.1SECTION 435.200
   435.200 Scope.
42:4.0.1.1.6.3.56.2SECTION 435.201
   435.201 Individuals included in optional groups.
42:4.0.1.1.6.3.56.3SECTION 435.210
   435.210 Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs.
42:4.0.1.1.6.3.56.4SECTION 435.211
   435.211 Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions.
42:4.0.1.1.6.3.56.5SECTION 435.212
   435.212 Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
42:4.0.1.1.6.3.56.6SECTION 435.213
   435.213 Optional eligibility for individuals needing treatment for breast or cervical cancer.
42:4.0.1.1.6.3.56.7SECTION 435.214
   435.214 Eligibility for Medicaid limited to family planning and related services.
42:4.0.1.1.6.3.56.8SECTION 435.215
   435.215 Individuals infected with tuberculosis.
42:4.0.1.1.6.3.56.9SECTION 435.217
   435.217 Individuals receiving home and community-based services.
42:4.0.1.1.6.3.56.10SECTION 435.218
   435.218 Individuals with MAGI-based income above 133 percent FPL.
42:4.0.1.1.6.3.56.11SECTION 435.219
   435.219 Individuals receiving State plan home and community-based services.
42:4.0.1.1.6.3.57SUBJGRP 57
   Options for Coverage of Families and Children
42:4.0.1.1.6.3.57.12SECTION 435.220
   435.220 Optional eligibility for parents and other caretaker relatives.
42:4.0.1.1.6.3.57.13SECTION 435.221
   435.221 [Reserved]
42:4.0.1.1.6.3.57.14SECTION 435.222
   435.222 Optional eligibility for reasonable classifications of individuals under age 21.
42:4.0.1.1.6.3.57.15SECTION 435.225
   435.225 Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
42:4.0.1.1.6.3.57.16SECTION 435.226
   435.226 Optional eligibility for independent foster care adolescents.
42:4.0.1.1.6.3.57.17SECTION 435.227
   435.227 Optional eligibility for individuals under age 21 who are under State adoption assistance agreements.
42:4.0.1.1.6.3.57.18SECTION 435.229
   435.229 Optional targeted low-income children.
42:4.0.1.1.6.3.58SUBJGRP 58
   Options for Coverage of the Aged, Blind, and Disabled
42:4.0.1.1.6.3.58.19SECTION 435.230
   435.230 Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.
42:4.0.1.1.6.3.58.20SECTION 435.232
   435.232 Individuals receiving only optional State supplements.
42:4.0.1.1.6.3.58.21SECTION 435.234
   435.234 Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.
42:4.0.1.1.6.3.58.22SECTION 435.236
   435.236 Individuals in institutions who are eligible under a special income level.
42:4.0.1.1.6.4SUBPART D
Subpart D - Optional Coverage of the Medically Needy
42:4.0.1.1.6.4.59.1SECTION 435.300
   435.300 Scope.
42:4.0.1.1.6.4.59.2SECTION 435.301
   435.301 General rules.
42:4.0.1.1.6.4.59.3SECTION 435.308
   435.308 Medically needy coverage of individuals under age 21.
42:4.0.1.1.6.4.59.4SECTION 435.310
   435.310 Medically needy coverage of parents and other caretaker relatives.
42:4.0.1.1.6.4.59.5SECTION 435.320
   435.320 Medically needy coverage of the aged in States that cover individuals receiving SSI.
42:4.0.1.1.6.4.59.6SECTION 435.322
   435.322 Medically needy coverage of the blind in States that cover individuals receiving SSI.
42:4.0.1.1.6.4.59.7SECTION 435.324
   435.324 Medically needy coverage of the disabled in States that cover individuals receiving SSI.
42:4.0.1.1.6.4.59.8SECTION 435.326
   435.326 Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
42:4.0.1.1.6.4.59.9SECTION 435.330
   435.330 Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI.
42:4.0.1.1.6.4.59.10SECTION 435.340
   435.340 Protected medically needy coverage for blind and disabled individuals eligible in December 1973.
42:4.0.1.1.6.4.59.11SECTION 435.350
   435.350 Coverage for certain aliens.
42:4.0.1.1.6.5SUBPART E
Subpart E - General Eligibility Requirements
42:4.0.1.1.6.5.59.1SECTION 435.400
   435.400 Scope.
42:4.0.1.1.6.5.59.2SECTION 435.401
   435.401 General rules.
42:4.0.1.1.6.5.59.3SECTION 435.402
   435.402 [Reserved]
42:4.0.1.1.6.5.59.4SECTION 435.403
   435.403 State residence.
42:4.0.1.1.6.5.59.5SECTION 435.404
   435.404 Applicant's choice of category.
42:4.0.1.1.6.5.59.6SECTION 435.406
   435.406 Citizenship and non-citizen eligibility.
42:4.0.1.1.6.5.59.7SECTION 435.407
   435.407 Types of acceptable documentary evidence of citizenship.
42:4.0.1.1.6.6SUBPART F
Subpart F - Categorical Requirements for Eligibility
42:4.0.1.1.6.6.59SUBJGRP 59
   Age
42:4.0.1.1.6.6.59.1SECTION 435.500
   435.500 Scope.
42:4.0.1.1.6.6.59.2SECTION 435.520
   435.520 Age requirements for the aged.
42:4.0.1.1.6.6.60SUBJGRP 60
   Blindness
42:4.0.1.1.6.6.60.3SECTION 435.530
   435.530 Definition of blindness.
42:4.0.1.1.6.6.60.4SECTION 435.531
   435.531 Determinations of blindness.
42:4.0.1.1.6.6.61SUBJGRP 61
   Disability
42:4.0.1.1.6.6.61.5SECTION 435.540
   435.540 Definition of disability.
42:4.0.1.1.6.6.61.6SECTION 435.541
   435.541 Determinations of disability.
42:4.0.1.1.6.7SUBPART G
Subpart G - General Financial Eligibility Requirements and Options
42:4.0.1.1.6.7.62.1SECTION 435.600
   435.600 Scope.
42:4.0.1.1.6.7.62.2SECTION 435.601
   435.601 Application of financial eligibility methodologies.
42:4.0.1.1.6.7.62.3SECTION 435.602
   435.602 Financial responsibility of relatives and other individuals.
42:4.0.1.1.6.7.62.4SECTION 435.603
   435.603 Application of modified adjusted gross income (MAGI).
42:4.0.1.1.6.7.62.5SECTION 435.604
   435.604 [Reserved]
42:4.0.1.1.6.7.62.6SECTION 435.606
   435.606 [Reserved]
42:4.0.1.1.6.7.62.7SECTION 435.608
   435.608 Applications for other benefits.
42:4.0.1.1.6.7.62.8SECTION 435.610
   435.610 Assignment of rights to benefits.
42:4.0.1.1.6.7.62.9SECTION 435.622
   435.622 Individuals in institutions who are eligible under a special income level.
42:4.0.1.1.6.7.62.10SECTION 435.631
   435.631 General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.
42:4.0.1.1.6.7.62.11SECTION 435.640
   435.640 Protected Medicaid eligibility for individuals eligible in December 1973.
42:4.0.1.1.6.8SUBPART H
Subpart H - Specific Post-Eligibility Financial Requirements for the Categorically Needy
42:4.0.1.1.6.8.62.1SECTION 435.700
   435.700 Scope.
42:4.0.1.1.6.8.62.2SECTION 435.725
   435.725 Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.
42:4.0.1.1.6.8.62.3SECTION 435.726
   435.726 Post-eligibility treatment of income of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care.
42:4.0.1.1.6.8.62.4SECTION 435.733
   435.733 Post-eligibility treatment of income of institutionalized individuals in States using more restrictive requirements than SSI: Application of patient income to the cost of care.
42:4.0.1.1.6.8.62.5SECTION 435.735
   435.735 Post-eligibility treatment of income and resources of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care.
42:4.0.1.1.6.9SUBPART I
Subpart I - Specific Eligibility and Post-Eligibility Financial Requirements for the Medically Needy
42:4.0.1.1.6.9.62SUBJGRP 62
   Medically Needy Income Standard
42:4.0.1.1.6.9.62.1SECTION 435.800
   435.800 Scope.
42:4.0.1.1.6.9.62.2SECTION 435.811
   435.811 Medically needy income standard: General requirements.
42:4.0.1.1.6.9.62.3SECTION 435.814
   435.814 Medically needy income standard: State plan requirements.
42:4.0.1.1.6.9.63SUBJGRP 63
   Medically Needy Income Eligibility
42:4.0.1.1.6.9.63.4SECTION 435.831
   435.831 Income eligibility.
42:4.0.1.1.6.9.63.5SECTION 435.832
   435.832 Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.
42:4.0.1.1.6.9.64SUBJGRP 64
   Medically Needy Resource Standard
42:4.0.1.1.6.9.64.6SECTION 435.840
   435.840 Medically needy resource standard: General requirements.
42:4.0.1.1.6.9.64.7SECTION 435.843
   435.843 Medically needy resource standard: State plan requirements.
42:4.0.1.1.6.9.65SUBJGRP 65
   Determining Eligibility on the Basis of Resources
42:4.0.1.1.6.9.65.8SECTION 435.845
   435.845 Medically needy resource eligibility.
42:4.0.1.1.6.9.65.9SECTION 435.850-435.852
   435.850-435.852 [Reserved]
42:4.0.1.1.6.10SUBPART J
Subpart J - Eligibility in the States and District of Columbia
42:4.0.1.1.6.10.66SUBJGRP 66
   General Methods of Administration
42:4.0.1.1.6.10.66.1SECTION 435.900
   435.900 Scope.
42:4.0.1.1.6.10.66.2SECTION 435.901
   435.901 Consistency with objectives and statutes.
42:4.0.1.1.6.10.66.3SECTION 435.902
   435.902 Simplicity of administration.
42:4.0.1.1.6.10.66.4SECTION 435.903
   435.903 Adherence of local agencies to State plan requirements.
42:4.0.1.1.6.10.66.5SECTION 435.904
   435.904 Establishment of outstation locations to process applications for certain low-income eligibility groups.
42:4.0.1.1.6.10.67SUBJGRP 67
   Applications
42:4.0.1.1.6.10.67.6SECTION 435.905
   435.905 Availability and accessibility of program information.
42:4.0.1.1.6.10.67.7SECTION 435.906
   435.906 Opportunity to apply.
42:4.0.1.1.6.10.67.8SECTION 435.907
   435.907 Application.
42:4.0.1.1.6.10.67.9SECTION 435.908
   435.908 Assistance with application and renewal.
42:4.0.1.1.6.10.67.10SECTION 435.909
   435.909 Automatic entitlement to Medicaid following a determination of eligibility under other programs.
42:4.0.1.1.6.10.67.11SECTION 435.910
   435.910 Use of social security number.
42:4.0.1.1.6.10.68SUBJGRP 68
   Determination of Medicaid Eligibility
42:4.0.1.1.6.10.68.12SECTION 435.911
   435.911 Determination of eligibility.
42:4.0.1.1.6.10.68.13SECTION 435.912
   435.912 Timely determination of eligibility.
42:4.0.1.1.6.10.68.14SECTION 435.914
   435.914 Case documentation.
42:4.0.1.1.6.10.68.15SECTION 435.915
   435.915 Effective date.
42:4.0.1.1.6.10.69SUBJGRP 69
   Redeterminations of Medicaid Eligibility
42:4.0.1.1.6.10.69.16SECTION 435.916
   435.916 Periodic renewal of Medicaid eligibility.
42:4.0.1.1.6.10.69.17SECTION 435.917
   435.917 Notice of agency's decision concerning eligibility, benefits, or services.
42:4.0.1.1.6.10.69.18SECTION 435.918
   435.918 Use of electronic notices.
42:4.0.1.1.6.10.69.19SECTION 435.920
   435.920 Verification of SSNs.
42:4.0.1.1.6.10.69.20SECTION 435.923
   435.923 Authorized representatives.
42:4.0.1.1.6.10.69.21SECTION 435.926
   435.926 Continuous eligibility for children.
42:4.0.1.1.6.10.70SUBJGRP 70
   Furnishing Medicaid
42:4.0.1.1.6.10.70.22SECTION 435.930
   435.930 Furnishing Medicaid.
42:4.0.1.1.6.10.71SUBJGRP 71
   Income and Eligibility Verification Requirements
42:4.0.1.1.6.10.71.23SECTION 435.940
   435.940 Basis and scope.
42:4.0.1.1.6.10.71.24SECTION 435.945
   435.945 General requirements.
42:4.0.1.1.6.10.71.25SECTION 435.948
   435.948 Verifying financial information.
42:4.0.1.1.6.10.71.26SECTION 435.949
   435.949 Verification of information through an electronic service.
42:4.0.1.1.6.10.71.27SECTION 435.952
   435.952 Use of information and requests of additional information from individuals.
42:4.0.1.1.6.10.71.28SECTION 435.956
   435.956 Verification of other non-financial information.
42:4.0.1.1.6.10.71.29SECTION 435.960
   435.960 Standardized formats for furnishing and obtaining information to verifying income and eligibility.
42:4.0.1.1.6.10.71.30SECTION 435.965
   435.965 Delay of effective date.
42:4.0.1.1.6.11SUBPART K
Subpart K - Federal Financial Participation
42:4.0.1.1.6.11.72SUBJGRP 72
   FFP in Expenditures for Determining Eligibility and Providing Services
42:4.0.1.1.6.11.72.1SECTION 435.1000
   435.1000 Scope.
42:4.0.1.1.6.11.72.2SECTION 435.1001
   435.1001 FFP for administration.
42:4.0.1.1.6.11.72.3SECTION 435.1002
   435.1002 FFP for services.
42:4.0.1.1.6.11.72.4SECTION 435.1003
   435.1003 FFP for redeterminations.
42:4.0.1.1.6.11.72.5SECTION 435.1004
   435.1004 Beneficiaries overcoming certain conditions of eligibility.
42:4.0.1.1.6.11.73SUBJGRP 73
   Limitations on FFP
42:4.0.1.1.6.11.73.6SECTION 435.1005
   435.1005 Beneficiaries in institutions eligible under a special income standard.
42:4.0.1.1.6.11.73.7SECTION 435.1006
   435.1006 Beneficiaries of optional State supplements only.
42:4.0.1.1.6.11.73.8SECTION 435.1007
   435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries.
42:4.0.1.1.6.11.73.9SECTION 435.1008
   435.1008 FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status.
42:4.0.1.1.6.11.73.10SECTION 435.1009
   435.1009 Institutionalized individuals.
42:4.0.1.1.6.11.73.11SECTION 435.1010
   435.1010 Definitions relating to institutional status.
42:4.0.1.1.6.11.74SUBJGRP 74
   Requirements for State Supplements
42:4.0.1.1.6.11.74.12SECTION 435.1011
   435.1011 Requirement for mandatory State supplements.
42:4.0.1.1.6.11.74.13SECTION 435.1012
   435.1012 Requirement for maintenance of optional State supplement expenditures.
42:4.0.1.1.6.11.75SUBJGRP 75
   FFP for Premium Assistance
42:4.0.1.1.6.11.75.14SECTION 435.1015
   435.1015 FFP for premium assistance for plans in the individual market.
42:4.0.1.1.6.12SUBPART L
Subpart L - Options for Coverage of Special Groups under Presumptive Eligibility
42:4.0.1.1.6.12.76.1SECTION 435.1100
   435.1100 Basis for presumptive eligibility.
42:4.0.1.1.6.12.76.2SECTION 435.1101
   435.1101 Definitions related to presumptive eligibility.
42:4.0.1.1.6.12.76.3SECTION 435.1102
   435.1102 Children covered under presumptive eligibility.
42:4.0.1.1.6.12.76.4SECTION 435.1103
   435.1103 Presumptive eligibility for other individuals.
42:4.0.1.1.6.12.76.5SECTION 435.1110
   435.1110 Presumptive eligibility determined by hospitals.
42:4.0.1.1.6.13SUBPART M
Subpart M - Coordination of Eligibility and Enrollment Between Medicaid, CHIP, Exchanges and Other Insurance Affordability Programs
42:4.0.1.1.6.13.76.1SECTION 435.1200
   435.1200 Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs.
42:4.0.1.1.6.13.76.2SECTION 435.1205
   435.1205 Alignment with exchange initial open enrollment period.