42 CFR § 435.212 - Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.

---
identifier: "/us/cfr/t42/s435.212"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 435.212 - Individuals who would be ineligible if they were not enrolled in an MCO or PCCM."
title_number: 42
title_name: "Public Health"
section_number: "435.212"
section_name: "Individuals who would be ineligible if they were not enrolled in an MCO or PCCM."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "435"
part_name: "ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "43 FR 45204, Sept. 29, 1978, unless otherwise noted."
cfr_part: "435"
---


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

The State agency may provide that a beneficiary who is enrolled in an MCO or PCCM and who becomes ineligible for Medicaid is considered to continue to be eligible—

(a) For a period specified by the agency, ending no later than 6 months from the date of enrollment; and

(b) Except for family planning services (which the beneficiary may obtain from any qualified provider) only for services furnished to him or her as an MCO enrollee.

[56 FR 8849, Mar. 1, 1991, as amended at 67 FR 41095, June 14, 2002]