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