[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: 42CFR436.301]



[Page 187]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 436_ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS--

 

           Subpart D_Optional Coverage of the Medically Needy

 

Sec.  436.301  General rules.



    (a) A Medicaid agency may provide Medicaid to individuals specified 

in this subpart who:

    (1) Either:

    (i) Have income that meets the standard in Sec.  436.811; 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 standards; and

    (2) Have resources that meet the standard in Sec. Sec.  436.840 and 

436.843.

    (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 and 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 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 ne 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.  436.124. 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 needed 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 begins on the last day of the pregnancy and extends through 

the end of the month in which a 60-day period following termination of 

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

the women'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 or all of the following 

groups of individuals:

    (i) Individuals under age 21 (Sec.  436.308).

    (ii) Specified relatives (Sec.  436.310).

    (iii) Aged (Sec.  436.320).

    (iv) Blind (Sec.  436.321).

    (v) Disabled (Sec.  436.322).

    (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 47990, Sept. 30, 1981; 46 FR 54743, Nov. 4, 1981, as amended at 

52 FR 43073, Nov. 9, 1987; 55 FR 48610, Nov. 21, 1990; 58 FR 4935, Jan. 

19, 1993]