[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR431.10]



[Page 21-22]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 431_STATE ORGANIZATION AND GENERAL ADMINISTRATION--Table of Contents

 

                      Subpart A_Single State Agency

 

Sec.  431.10  Single State agency.





    (a) Basis and purpose. This section implements section 1902(a)(5) of 

the Act, which provides for designation of a single State agency for the 

Medicaid program.

    (b) Designation and certification. A State plan must--

    (1) Specify a single State agency established or designated to 

administer or supervise the administration of the plan; and

    (2) Include a certification by the State Attorney General, citing 

the legal authority for the single State agency to--

    (i) Administer or supervise the administration of the plan; and

    (ii) Make rules and regulations that it follows in administering the 

plan or that are binding upon local agencies that administer the plan.

    (c) Determination of eligibility. (1) The plan must specify whether 

the agency that determines eligibility for families and for individuals 

under 21 is--

    (i) The Medicaid agency; or

    (ii) The single State agency for the financial assistance program 

under title IV-A (in the 50 States or the District of Columbia), or 

under title I or XVI (AABD), in Guam, Puerto Rico, or the Virgin 

Islands.

    (2) The plan must specify whether the agency that determines 

eligibility for the aged, blind, or disabled is--

    (i) The Medicaid agency;

    (ii) The single State agency for the financial assistance program 

under title IV-A (in the 50 States or the District of Columbia) or under 

title I or XVI (AABD), in Guam, Puerto Rico, or the Virgin Islands; or

    (iii) The Federal agency administering the supplemental security 

income program under title XVI (SSI). In this case, the plan must also 

specify whether the Medicaid agency or the title IV-A agency determines 

eligibility for any groups whose eligibility is not determined by the 

Federal agency.

    (d) Agreement with Federal or State agencies. The plan must provide 

for written agreements between the Medicaid agency and the Federal or 

other State agencies that determine eligibility for Medicaid, stating 

the relationships and respective responsibilities of the agencies.

    (e) Authority of the single State agency. In order for an agency to 

qualify as the Medicaid agency--

    (1) The agency must not delegate, to other than its own officials, 

authority to--



[[Page 22]]



    (i) Exercise administrative discretion in the administration or 

supervision of the plan, or

    (ii) Issue policies, rules, and regulations on program matters.

    (2) The authority of the agency must not be impaired if any of its 

rules, regulations, or decisions are subject to review, clearance, or 

similar action by other offices or agencies of the State.

    (3) If other State or local agencies or offices perform services for 

the Medicaid agency, they must not have the authority to change or 

disapprove any administrative decision of that agency, or otherwise 

substitute their judgment for that of the Medicaid agency with respect 

to the application of policies, rules, and regulations issued by the 

Medicaid agency.



[44 FR 17930, Mar. 23, 1979]