Title 42, Part 435 — Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa

Purpose and applicability.

Basis.

Definitions and use of terms.

State plan requirements.

Scope.

Parents and other caretaker relatives.

Families terminated from AFDC because of increased earnings or hours of employment.

Families with Medicaid eligibility extended because of increased collection of spousal support.

Pregnant women.

Deemed newborn children.

Infants and children under age 19.

Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.

Individuals receiving SSI.

Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.

Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act.

Individuals eligible as qualified Medicare beneficiaries.

Individuals eligible as specified low-income Medicare beneficiaries.

Individuals eligible as qualifying individuals.

Individuals eligible as qualified disabled and working individuals.

Individuals receiving mandatory State supplements.

Individuals eligible as essential spouses in December 1973.

Institutionalized individuals who were eligible in December 1973.

Blind and disabled individuals eligible in December 1973.

Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).

Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.

State agency implementation requirements for one-time notice and annual review system.

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.

Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.

Coverage for certain aliens.

Children with adoption assistance, foster care, or guardianship care under title IV-E.

Former foster care children.

Pregnant women eligible for extended or continuous eligibility.

Continuous eligibility for hospitalized children.

Scope.

Individuals included in optional groups.

Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs.

Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions.

Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.

Optional eligibility for individuals needing treatment for breast or cervical cancer.

Eligibility for Medicaid limited to family planning and related services.

Individuals infected with tuberculosis.

Individuals receiving home and community-based services.

Individuals with MAGI-based income above 133 percent FPL.

Individuals receiving State plan home and community-based services.

Optional eligibility for parents and other caretaker relatives.

[Reserved]

Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories.

Other optional eligibility for reasonable classifications of individuals under age 21.

Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.

Optional eligibility for independent foster care adolescents.

Optional eligibility for individuals under age 21 who are under State adoption assistance agreements.

Optional targeted low-income children.

Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.

Individuals receiving only optional State supplements.

Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.

Individuals in institutions who are eligible under a special income level.

Scope.

General rules.

Medically needy coverage of individuals under age 21.

Medically needy coverage of parents and other caretaker relatives.

Medically needy coverage of the aged in States that cover individuals receiving SSI.

Medically needy coverage of the blind in States that cover individuals receiving SSI.

Medically needy coverage of the disabled in States that cover individuals receiving SSI.

Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.

Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI.

Protected medically needy coverage for blind and disabled individuals eligible in December 1973.

Coverage for certain aliens.

Scope.

General rules.

[Reserved]

State residence.

Applicant's choice of category.

Citizenship and noncitizen eligibility.

Types of acceptable documentary evidence of citizenship.

Scope.

Age requirements for the aged.

Definition of blindness.

Determinations of blindness.

Definition of disability.

Determinations of disability.

Scope.

Application of financial eligibility methodologies.

Financial responsibility of relatives and other individuals.

Application of modified adjusted gross income (MAGI).

[Reserved]

[Reserved]

[Reserved]

Assignment of rights to benefits.

Individuals in institutions who are eligible under a special income level.

General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.

Protected Medicaid eligibility for individuals eligible in December 1973.

Scope.

Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.

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.

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.

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.

Scope.

Medically needy income standard: General requirements.

Medically needy income standard: State plan requirements.

Income eligibility.

Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.

Medically needy resource standard: General requirements.

Medically needy resource standard: State plan requirements.

Medically needy resource eligibility.

§§ 435.850-435.852 [Reserved]

Scope.

Consistency with objectives and statutes.

Simplicity of administration.

Adherence of local agencies to State plan requirements.

Establishment of outstation locations to process applications for certain low-income eligibility groups.

Availability and accessibility of program information.

Opportunity to apply.

Application.

Assistance with application and renewal.

Automatic entitlement to Medicaid following a determination of eligibility under other programs.

Use of social security number.

Determination of eligibility.

Timely determination and redetermination of eligibility.

Case documentation.

Effective date.

Regularly scheduled renewals of Medicaid eligibility.

Notice of agency's decision concerning eligibility, benefits, or services.

Use of electronic notices.

Changes in circumstances.

Verification of SSNs.

Authorized representatives.

Continuous eligibility for children.

Requirements for States to submit certain data on redeterminations.

Reduction in FMAP for failure to submit certain data.

Furnishing Medicaid.

Basis and scope.

General requirements.

Verifying financial information.

Verification of information through an electronic service.

Use of information and requests of additional information from individuals.

Verification of other non-financial information.

Standardized formats for furnishing and obtaining information to verifying income and eligibility.

Delay of effective date.

Scope.

FFP for administration.

FFP for services.

FFP for redeterminations.

Beneficiaries overcoming certain conditions of eligibility.

Beneficiaries in institutions eligible under a special income standard.

Beneficiaries of optional State supplements only.

Categorically needy, medically needy, and qualified Medicare beneficiaries.

FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status.

Institutionalized individuals.

Definitions relating to institutional status.

Requirement for mandatory State supplements.

Requirement for maintenance of optional State supplement expenditures.

FFP for premium assistance for plans in the individual market.

Basis for presumptive eligibility.

Definitions related to presumptive eligibility.

Children covered under presumptive eligibility.

Presumptive eligibility for other individuals.

Presumptive eligibility determined by hospitals.

Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs.

Alignment with exchange initial open enrollment period.