[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: 42CFR435.301]



[Page 126-127]

 

                         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 D_Optional Coverage of the Medically Needy

 

Sec. 435.301  General rules.



    (a) An agency may provide Medicaid to individuals specified in this 

subpart who:



[[Page 127]]



    (1) Either:

    (i) Have income that meets the applicable standards in Sec. Sec. 

435.811 and 435.814; or

    (ii) If their income is more than allowed under the standard, have 

incurred medical expenses at least equal to the difference between their 

income and the applicable income standard; and

    (2) Have resources that meet the applicable standards in Sec. Sec. 

435.840 and 435.843.

    (b) If the agency chooses this option, the following provisions 

apply:

    (1) The agency must provide Medicaid to the following individuals 

who meet the requirements of paragraph (a) of this section:

    (i) All pregnant women during the course of their pregnancy who, 

except for income and resources, would be eligible for Medicaid as 

mandatory or optional categorically needy under subparts B or C of this 

part;

    (ii) All individuals under 18 years of age who, except for income 

and resources, would be eligible for Medicaid as mandatory categorically 

needy under subpart B of this part;

    (iii) All newborn children born on or after October 1, 1984, to a 

woman who is eligible as medically needy and is receiving Medicaid on 

the date of the child's birth. The child is deemed to have applied and 

been found eligible for Medicaid on the date of birth and remains 

eligible as medically needy for one year so long as the woman remains 

eligible and the child is a member of the woman's household. If the 

woman's basis of eligibility changes to categorically needy, the child 

is eligible as categorically needy under Sec. 435.117. The woman is 

considered to remain eligible if she meets the spend-down requirements 

in any consecutive budget period following the birth of the child.

    (iv) Women who, while pregnant, applied for, were eligible for, and 

received Medicaid services as medically needy on the day that their 

pregnancy ends. The agency must provide medically needy eligibility to 

these women for an extended period following termination of pregnancy. 

This period extends from the last day of the pregnancy through the end 

of the month in which a 60-day period, beginning on the last day of 

pregnancy, ends. Eligibility must be provided, regardless of changes in 

the woman's financial circumstances that may occur within this extended 

period. These women are eligible for the extended period for all 

services under the plan that are pregnancy-related (as defined in Sec. 

440.210(c)(1) of this subchapter).

    (2) The agency may provide Medicaid to any of the following groups 

of individuals;

    (i) Individuals under age 21 (Sec. 435.308).

    (ii) Specified relatives (Sec. 435.310).

    (iii) Aged (Sec. 435.330.320 and 435.330).

    (iv) Blind (Sec. Sec. 435.322, 435.330 and 435.340).

    (v) Disabled (Sec. Sec. 435.324, 435.330, and 435.340).

    (3) If the agency provides Medicaid to any individual in a group 

specified in paragraph (b)(2) of this section, the agency must provide 

Medicaid to all individuals eligible to be members of that group.



[46 FR 47986, Sept. 30, 1981, as amended at 52 FR 43072, Nov. 9, 1987; 

52 FR 48438, Dec. 22, 1987; 55 FR 48609, Nov. 21, 1990; 58 FR 4929, Jan. 

19, 1993]