42 CFR 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
- Chapter IV—Centers for Medicare & Medicaid Services, Department of Health and Human Services › Subchapter C—Medical Assistance Programs
- Subpart A—General Provisions and Definitions
- § 435.2 Purpose and applicability.
- § 435.3 Basis.
- § 435.4 Definitions and use of terms.
- § 435.10 State plan requirements.
- Subpart B—Mandatory Coverage
- § 435.100 Scope.
- Mandatory Coverage of Families and Children
- § 435.110 Parents and other caretaker relatives.
- § 435.112 Families terminated from AFDC because of increased earnings or hours of employment.
- § 435.115 Families with Medicaid eligibility extended because of increased collection of spousal support.
- Mandatory Coverage of Pregnant Women, Children Under 19, and Newborn Children
- § 435.116 Pregnant women.
- § 435.117 Deemed newborn children.
- Mandatory Coverage of Qualified Family Members
- § 435.118 Infants and children under age 19.
- Mandatory Coverage for Individuals Age 19 Through 64
- § 435.119 Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.
- Mandatory Coverage of the Aged, Blind, and Disabled
- § 435.120 Individuals receiving SSI.
- § 435.121 Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.
- § 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.
- § 435.123 Individuals eligible as qualified Medicare beneficiaries.
- § 435.124 Individuals eligible as specified low-income Medicare beneficiaries.
- § 435.125 Individuals eligible as qualifying individuals.
- § 435.126 Individuals eligible as qualified disabled and working individuals.
- § 435.130 Individuals receiving mandatory State supplements.
- § 435.131 Individuals eligible as essential spouses in December 1973.
- § 435.132 Institutionalized individuals who were eligible in December 1973.
- § 435.133 Blind and disabled individuals eligible in December 1973.
- § 435.134 Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).
- § 435.135 Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.
- § 435.136 State agency implementation requirements for one-time notice and annual review system.
- § 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.
- § 435.138 Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.
- Mandatory Coverage of Certain Aliens
- § 435.139 Coverage for certain aliens.
- Mandatory Coverage of Adoption Assistance and Foster Care Children
- § 435.145 Children with adoption assistance, foster care, or guardianship care under title IV-E.
- § 435.150 Former foster care children.
- Mandatory Coverage of Special Groups
- § 435.170 Pregnant women eligible for extended or continuous eligibility.
- § 435.172 Continuous eligibility for hospitalized children.
- Subpart C—Options for Coverage
- § 435.200 Scope.
- § 435.201 Individuals included in optional groups.
- Options for Coverage of Families and Children and the Aged, Blind, and Disabled
- § 435.210 Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs.
- § 435.211 Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions.
- § 435.212 Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
- § 435.213 Optional eligibility for individuals needing treatment for breast or cervical cancer.
- § 435.214 Eligibility for Medicaid limited to family planning and related services.
- § 435.215 Individuals infected with tuberculosis.
- § 435.217 Individuals receiving home and community-based services.
- § 435.218 Individuals with MAGI-based income above 133 percent FPL.
- § 435.219 Individuals receiving State plan home and community-based services.
- Options for Coverage of Families and Children
- § 435.220 Optional eligibility for parents and other caretaker relatives.
- § 435.221 [Reserved]
- § 435.222 Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories.
- § 435.223 Other optional eligibility for reasonable classifications of individuals under age 21.
- § 435.225 Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
- § 435.226 Optional eligibility for independent foster care adolescents.
- § 435.227 Optional eligibility for individuals under age 21 who are under State adoption assistance agreements.
- § 435.229 Optional targeted low-income children.
- Options for Coverage of the Aged, Blind, and Disabled
- § 435.230 Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.
- § 435.232 Individuals receiving only optional State supplements.
- § 435.234 Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.
- § 435.236 Individuals in institutions who are eligible under a special income level.
- Subpart D—Optional Coverage of the Medically Needy
- § 435.300 Scope.
- § 435.301 General rules.
- § 435.308 Medically needy coverage of individuals under age 21.
- § 435.310 Medically needy coverage of parents and other caretaker relatives.
- § 435.320 Medically needy coverage of the aged in States that cover individuals receiving SSI.
- § 435.322 Medically needy coverage of the blind in States that cover individuals receiving SSI.
- § 435.324 Medically needy coverage of the disabled in States that cover individuals receiving SSI.
- § 435.326 Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
- § 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.
- § 435.340 Protected medically needy coverage for blind and disabled individuals eligible in December 1973.
- § 435.350 Coverage for certain aliens.
- Subpart E—General Eligibility Requirements
- § 435.400 Scope.
- § 435.401 General rules.
- § 435.402 [Reserved]
- § 435.403 State residence.
- § 435.404 Applicant's choice of category.
- § 435.406 Citizenship and noncitizen eligibility.
- § 435.407 Types of acceptable documentary evidence of citizenship.
- Subpart F—Categorical Requirements for Eligibility
- § 435.500 Scope.
- Age
- § 435.520 Age requirements for the aged.
- Blindness
- § 435.530 Definition of blindness.
- § 435.531 Determinations of blindness.
- Disability
- § 435.540 Definition of disability.
- § 435.541 Determinations of disability.
- Community Engagement Requirement
- § 435.550 Basis and scope.
- § 435.551 Applicable individual.
- § 435.552 Demonstrating community engagement.
- § 435.553 Mandatory exceptions for certain applicable individuals.
- § 435.554 Specified excluded individuals.
- § 435.555 Optional exception for short-term hardship events.
- § 435.556 Assessing compliance with the community engagement requirement.
- § 435.557 Verifying compliance with or exception or exclusion from the community engagement requirement.
- § 435.558 Noncompliance procedures.
- § 435.559 Implementation timing for the community engagement requirement.
- § 435.560 Good faith effort exemption.
- § 435.561 State requirements for outreach.
- § 435.562 Requirements for States to submit data for monitoring community engagement.
- § 435.563 Prohibition of waivers of the community engagement requirement.
- Subpart G—General Financial Eligibility Requirements and Options
- § 435.600 Scope.
- § 435.601 Application of financial eligibility methodologies.
- § 435.602 Financial responsibility of relatives and other individuals.
- § 435.603 Application of modified adjusted gross income (MAGI).
- § 435.604 [Reserved]
- § 435.606 [Reserved]
- § 435.608 [Reserved]
- § 435.610 Assignment of rights to benefits.
- § 435.622 Individuals in institutions who are eligible under a special income level.
- § 435.631 General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.
- § 435.640 Protected Medicaid eligibility for individuals eligible in December 1973.
- Subpart H—Specific Post-Eligibility Financial Requirements for the Categorically Needy
- § 435.700 Scope.
- § 435.725 Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.
- § 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.
- § 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.
- § 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.
- Subpart I—Specific Eligibility and Post-Eligibility Financial Requirements for the Medically Needy
- § 435.800 Scope.
- Medically Needy Income Standard
- § 435.811 Medically needy income standard: General requirements.
- § 435.814 Medically needy income standard: State plan requirements.
- Medically Needy Income Eligibility
- § 435.831 Income eligibility.
- § 435.832 Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.
- Medically Needy Resource Standard
- § 435.840 Medically needy resource standard: General requirements.
- § 435.843 Medically needy resource standard: State plan requirements.
- Determining Eligibility on the Basis of Resources
- § 435.845 Medically needy resource eligibility.
- §§ 435.850-435.852 [Reserved]
- Subpart J—Eligibility in the States and District of Columbia
- § 435.900 Scope.
- General Methods of Administration
- § 435.901 Consistency with objectives and statutes.
- § 435.902 Simplicity of administration.
- § 435.903 Adherence of local agencies to State plan requirements.
- § 435.904 Establishment of outstation locations to process applications for certain low-income eligibility groups.
- Applications
- § 435.905 Availability and accessibility of program information.
- § 435.906 Opportunity to apply.
- § 435.907 Application.
- § 435.908 Assistance with application and renewal.
- § 435.909 Automatic entitlement to Medicaid following a determination of eligibility under other programs.
- § 435.910 Use of social security number.
- Determination of Medicaid Eligibility
- § 435.911 Determination of eligibility.
- § 435.912 Timely determination of eligibility.
- § 435.914 Case documentation.
- § 435.915 Effective date.
- Redeterminations of Medicaid Eligibility
- § 435.916 Periodic renewal of Medicaid eligibility.
- § 435.917 Notice of agency's decision concerning eligibility, benefits, or services.
- § 435.918 Use of electronic notices.
- § 435.919 [Reserved]
- § 435.920 Verification of SSNs.
- § 435.923 Authorized representatives.
- § 435.926 Continuous eligibility for children.
- § 435.927 Requirements for States to submit certain data on redeterminations.
- § 435.928 Reduction in FMAP for failure to submit certain data.
- Furnishing Medicaid
- § 435.930 Furnishing Medicaid.
- Income and Eligibility Verification Requirements
- § 435.940 Basis and scope.
- § 435.945 General requirements.
- § 435.948 Verifying financial information.
- § 435.949 Verification of information through an electronic service.
- § 435.952 Use of information and requests of additional information from individuals.
- § 435.956 Verification of other non-financial information.
- § 435.960 Standardized formats for furnishing and obtaining information to verifying income and eligibility.
- § 435.965 Delay of effective date.
- Subpart K—Federal Financial Participation
- § 435.1000 Scope.
- FFP in Expenditures for Determining Eligibility and Providing Services
- § 435.1001 FFP for administration.
- § 435.1002 FFP for services.
- § 435.1003 FFP for redeterminations.
- § 435.1004 Beneficiaries overcoming certain conditions of eligibility.
- Limitations on FFP
- § 435.1005 Beneficiaries in institutions eligible under a special income standard.
- § 435.1006 Beneficiaries of optional State supplements only.
- § 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries.
- § 435.1008 FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status.
- § 435.1009 Institutionalized individuals.
- § 435.1010 Definitions relating to institutional status.
- Requirements for State Supplements
- § 435.1011 Requirement for mandatory State supplements.
- § 435.1012 Requirement for maintenance of optional State supplement expenditures.
- FFP for Premium Assistance
- § 435.1015 FFP for premium assistance for plans in the individual market.
- Subpart L—Options for Coverage of Special Groups under Presumptive Eligibility
- § 435.1100 Basis for presumptive eligibility.
- § 435.1101 Definitions related to presumptive eligibility.
- § 435.1102 Children covered under presumptive eligibility.
- § 435.1103 Presumptive eligibility for other individuals.
- § 435.1110 Presumptive eligibility determined by hospitals.
- Subpart M—Coordination of Eligibility and Enrollment Between Medicaid, CHIP, Exchanges and Other Insurance Affordability Programs
- § 435.1200 Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs.
- § 435.1205 Alignment with exchange initial open enrollment period.
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