[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: 42CFR435.225]



[Page 130]

 

                         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 

 

          Subpart C_Options for Coverage as Categorically Needy

 

Sec.  435.225  Individuals under age 19 who would be eligible for 



Medicaid if they were in a medical institution.



    (a) The agency may provide Medicaid to children 18 years of age or 

younger who qualify under section 1614(a) of the Act, who would be 

eligible for Medicaid if they were in a medical institution, and who are 

receiving, while living at home, medical care that would be provided in 

a medical institution.

    (b) If the agency elects the option provided by paragraph (a) of 

this section, it must determine, in each case, that the following 

conditions are met:

    (1) The child requires the level of care provided in a hospital, 

SNF, or ICF.

    (2) It is appropriate to provide that level of care outside such an 

institution.

    (3) The estimated Medicaid cost of care outside an institution is no 

higher than the estimated Medicaid cost of appropriate institutional 

care.

    (c) The agency must specify in its State plan the method by which it 

determines the cost-effectiveness of caring for disabled children at 

home.



[55 FR 48608, Nov. 21, 1990]