[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR435.2] [Page 106-109] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 435_ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA--Table of Contents Subpart A_General Provisions and Definitions Sec. 435.2 Purpose and applicability. Subpart A_General Provisions and Definitions Sec. 435.2 Purpose and applicability. 435.3 Basis. 435.4 Definitions and use of terms. 435.10 State plan requirements. Subpart B_Mandatory Coverage of the Categorically Needy 435.100 Scope. Mandatory Coverage of Families and Children 435.110 Individuals receiving aid to families with dependent children. 435.112 Families terminated from AFDC because of increased earnings or hours of employment. 435.113 Individuals who are ineligible for AFDC because of requirements that do not apply under title XIX of the Act. 435.114 Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336 (July 1, 1972). 435.115 Individuals deemed to be receiving AFDC. Mandatory Coverage of Pregnant Women, Children under 8, and Newborn Children 435.116 Qualified pregnant women and children who are not qualified family members. 435.117 Newborn children. Mandatory Coverage of Qualified Family Members 435.119 Qualified family members. 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. 435.130 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 under Pub. L. 98-31. 435.138 Disabled widows and widowers aged 60 through 64 who would be eligible for SSI benefits except for receipt of early 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 for whom adoption assistance or foster care maintenance payments are made. Mandatory Coverage of Special Groups 435.170 Pregnant women eligible for extended coverage. Subpart C_Options for Coverage as Categorically Needy 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 Individuals who meet the income and resource requirements of the cash assistance programs. 435.211 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. 435.217 Individuals receiving home and community-based services. [[Page 107]] Options for Coverage of Families and Children 435.220 Individuals who would meet the income and resource requirements under AFDC if child care costs were paid from earnings. 435.221 [Reserved] 435.222 Individuals under age 21 who meet the income and resource requirements of AFDC. 435.223 Individuals who would be eligible for AFDC if coverage under the State's AFDC plan were as broad as allowed under title IV-A. 435.225 Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution. 435.227 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 specified 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 alienage. 435.408 Categories of aliens who are permanently residing in the United States under color of law. Subpart F_Categorical Requirements for Eligibility 435.500 Scope. Dependency 435.510 Determination of dependency. Age 435.520 Age requirements for the aged. 435.522 Determination of age. Blindness 435.530 Definition of blindness. 435.531 Determinations of blindness. Disability 435.540 Definition of disability. 435.541 Determinations of disability. 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. 435.604 [Reserved] 435.606 [Reserved] 435.608 Applications for other benefits. 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 [[Page 108]] 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 of program information. 435.906 Opportunity to apply. 435.907 Written application. 435.908 Assistance with application. 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 Timely determination of eligibility. 435.912 Notice of agency's decision concerning eligibility. 435.913 Case documentation. 435.914 Effective date. Redeterminations of Medicaid Eligibility 435.916 Periodic redeterminations of Medicaid eligibility. 435.919 Timely and adequate notice concerning adverse actions. 435.920 Verification of SSNs. Furnishing Medicaid 435.930 Furnishing Medicaid. Income and Eligibility Verification Requirements 435.940 Basis and scope. 435.945 General requirements. 435.948 Requesting information. 435.952 Use of information. 435.953 Identifying items of information to use. 435.955 Additional requirements regarding information released by a Federal agency. 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 Recipients overcoming certain conditions of eligibility. Limitations on FFP 435.1005 Recipients in institutions eligible under a special income standard. 435.1006 Recipients of optional State supplements only. 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries. 435.1008 Institutionalized individuals. 435.1009 Definitions relating to institutional status. [[Page 109]] Requirements for State Supplements 435.1010 Requirement for mandatory State supplements. 435.1011 Requirement for maintenance of optional State supplement expenditures. Subpart L_Option for Coverage of Special Groups 435.1100 Basis and scope. Presumptive Eligibility for Children 435.1101 Definitions related to presumptive eligibility for children. 435.1102 General rules. Authority: Sec. 1102 of the Social Security Act (42 U.S.C. 1302). Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted. This part sets forth, for the 50 States, the District of Columbia, the Northern Mariana Islands, and American Samoa-- (a) The eligibility provisions that a State plan must contain; (b) The mandatory and optional groups of individuals to whom Medicaid is provided under a State plan; (c) The eligibility requirements and procedures that the Medicaid agency must use in determining and redetermining eligibility, and requirements it may not use; (d) The availability of FFP for providing Medicaid and for administering the eligibility provisions of the plan; and (e) Other requirements concerning eligibility determinations, such as use of an institutionalized individual's income for the cost of care. [43 FR 45204, Sept. 29, 1978, as amended at 44 FR 17937, Mar. 23, 1979; 51 FR 41350, Nov. 14, 1986]