[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR435.115]



[Page 113-115]

 

                         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 B_Mandatory Coverage of the Categorically Needy

 

Sec. 435.115  Individuals deemed to be receiving AFDC.



    (a) The Medicaid agency must provide Medicaid to individuals deemed 

to be receiving AFDC, as specified in this section.

    (b) The State must deem individuals to be receiving AFDC who are 

denied a cash payment from the title IV-A State agency solely because 

the amount of the AFDC payment would be less than $10.

    (c) The State may deem participants in a work supplementation 

program to be receiving AFDC under section 414(g) of the Act. This 

section permits States, for purposes of title XIX, to deem an individual 

and any child or relative of the individual (or other individual living 

in the same household) to be receiving AFDC, if the individual--

    (1) Participates in a State-operated work supplementation program 

under section 414 of the Act; and



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    (2) Would be eligible for an AFDC cash payment if the individual 

were not participating in the work supplementation program.

    (d) The State must deem to be receiving AFDC those individuals who 

are denied AFDC payments from the title IV-A State agency solely because 

that agency is recovering an overpayment.

    (e) The State must deem to be receiving AFDC individuals described 

in section 473(a)(1) of the Act--

    (1) For whom an adoption assistance agreement is in effect under 

title IV-E of the Act, whether or not adoption assistance is being 

provided or an interlocutory or other judicial decree of adoption has 

been issued; or

    (2) For whom foster care maintenance payments are made under title 

IV-E of the Act.

    (f) The State must deem an individual to be receiving AFDC if a new 

collection or increased collection of child or spousal support under 

title IV-D of the Social Security Act results in the termination of AFDC 

eligibility in accordance with section 406(h) of the Social Security 

Act. States must continue to provide Medicaid for four consecutive 

calendar months, beginning with the first month of AFDC ineligibility, 

to each dependent child and each relative with whom such a child is 

living (including the eligible spouse of such relative as described in 

section 406(b) of the Social Security Act) who:

    (1) Becomes ineligible for AFDC on or after August 16, 1984; and

    (2) Has received AFDC for at least three of the six months 

immediately preceding the month in which the individual becomes 

ineligible for AFDC; and

    (3) Becomes ineligible for AFDC wholly or partly as a result of the 

initiation of or an increase in the amount of the child or spousal 

support collection under title IV-D.

    (g)(1) Except as provided in paragraph (g)(2) of this section, 

individuals who are eligible for extended Medicaid lose this coverage if 

they move to another State during the 4-month period. However, if they 

move back to and reestablish residence in the State in which they have 

extended coverage, they are eligible for any of the months remaining in 

the 4-month period in which they are residents of the State.

    (2) If a State has chosen in its State plan to provide Medicaid to 

non-residents, the State may continue to provide the 4-month extended 

benefits to individuals who have moved to another State.

    (h) For purposes of paragraph (f) of this section:

    (1) The new collection or increased collection of child or spousal 

support results in the termination of AFDC eligibility when it actively 

causes or contributes to the termination. This occurs when:

    (i) The change in support collection in and of itself is sufficient 

to cause ineligibility. This rule applies even if the support collection 

must be added to other, stable income. It also applies even if other 

independent factors, alone or in combination with each other, might 

simultaneously cause ineligibility; or

    (ii) The change in support contributes to ineligibility but does not 

by itself cause ineligibility. Ineligibility must result when the change 

in support is combined with other changes in income or changes in other 

circumstances and the other changes in income or circumstances cannot 

alone or in combination result in termination without the change in 

support.

    (2) In cases of increases in the amounts of both support collections 

and earned income, eligibility under this section does not preclude 

eligibility under 45 CFR 233.20(a)(14) or section 1925 of the Social 

Security Act (which was added by section 303(a) of the Family Support 

Act of 1988 (42 U.S.C. 1396r-6)). Extended periods resulting from both 

an increase in the amount of the support collection and from an increase 

in earned income must run concurrently.



[46 FR 47985, Sept. 30, 1981, as amended at 52 FR 43071, Nov. 9, 1987; 

55 FR 48607, Nov. 21, 1990; 59 FR 59376, Nov. 17, 1994]



[[Page 115]]



  Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn 

                                Children