[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: 42CFR435.230]



[Page 124-125]

 

                         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 C_Options for Coverage as Categorically Needy

 

Sec. 435.230  Aged, blind, and disabled individuals in States that 

use more restrictive requirements for Medicaid than SSI requirements: 

Optional coverage.



    (a) Basic optional coverage rule. If the agency elects the option 

under Sec. 435.121 to provide mandatory eligibility for aged, blind, 

and disabled SSI recipients using more restrictive requirements than 

those used under SSI, the agency may provide eligibility as optional 

categorically needy to additional individuals who meet the requirements 

of this section.

    (b) Group composition. Subject to the conditions specified in 

paragraphs (d) and (e) of this section, the agency may provide Medicaid 

to individuals who:

    (1) Meet the nonfinancial criteria that the State has elected to 

apply under Sec. 435.121;



[[Page 125]]



    (2) Meet the resource requirements that the State has elected to 

apply under Sec. 435.121; and

    (3) Meet the income eligibility standards specified in paragraph (c) 

of this section.

    (c) Criteria for income standards. The agency may provide Medicaid 

to the following individuals who meet the requirements of paragraphs 

(b)(1) and (b)(2) of this section:

    (1) Individuals who are financially eligible for but not receiving 

SSI benefits and who, before deduction of incurred medical and remedial 

expenses, meet the State's more restrictive eligibility requirements 

described in Sec. 435.121;

    (2) Individuals who meet the income standards of the following 

eligibility groups:

    (i) Individuals who would be eligible for cash assistance except for 

institutional status described in Sec. 435.211;

    (ii) Individuals who are enrolled in an HMO or other entity and who 

are deemed to continue to be Medicaid eligible for a period specified by 

the agency up to 6 months from the date of enrollment and who became 

ineligible during the specified enrollment period, as described in Sec. 

435.212;

    (iii) Individuals receiving home and community-based waiver services 

described in Sec. 435.217;

    (iv) Individuals receiving only optional State supplements described 

in Sec. 435.234;

    (v) Institutionalized individuals with income below a special income 

level described in Sec. 435.236;

    (vi) Aged and disabled individuals who have income below 100 percent 

of the Federal poverty level described in section 1905(m) of the Act.

    (3) Individuals who qualify for special status under Sec. Sec. 

435.135 and 435.138, and with respect to whom the State elects to 

disregard some or the maximum amount of title II payments permitted to 

be disregarded under those sections.

    (d) Use of more liberal methods. The agency may elect to apply more 

liberal methods of counting income and resources that are approved for 

this eligibility group under the provisions of Sec. 435.601.



[58 FR 4928, Jan. 19, 1993]