42 CFR § 441.454 - Use of cash.

---
identifier: "/us/cfr/t42/s441.454"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 441.454 - Use of cash."
title_number: 42
title_name: "Public Health"
section_number: "441.454"
section_name: "Use of cash."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "441"
part_name: "SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES"
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 45229, Sept. 29, 1978, unless otherwise noted."
cfr_part: "441"
---


# 441.454 Use of cash.

(a) States have the option of disbursing cash prospectively to participants, or their representatives, as applicable, self-directing their PAS.

(b) States that choose to offer the cash option must ensure compliance with all applicable requirements of the Internal Revenue Service, including, but not limited to, retaining required forms and payment of FICA, FUTA and State unemployment taxes.

(c) States must permit participants, or their representatives, as applicable, using the cash option to choose to use the financial management entity for some or all of the functions described in § 441.484(c).

(d) States must make available a financial management entity to a participant, or the participant's representative, if applicable, who has demonstrated, after additional counseling, information, training, or assistance, that the participant cannot effectively manage the cash option described in paragraph (a) of this section.