[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: 42CFR457.320]



[Page 393-394]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 457_ALLOTMENTS AND GRANTS TO STATES--Table of Contents

 

Subpart C_State Plan Requirements: Eligibility, Screening, Applications, 

                             and Enrollment

 

Sec.  457.320  Other eligibility standards.



    (a) Eligibility standards. To the extent consistent with title XXI 

of the Act and except as provided in paragraph (b) of this section, the 

State plan may adopt eligibility standards for one or more groups of 

children related to--

    (1) Geographic area(s) served by the plan;

    (2) Age (up to, but not including, age 19);

    (3) Income;

    (4) Resources;

    (5) Spenddowns;

    (6) Disposition of resources;

    (7) Residency, in accordance with paragraph (d) of this section;

    (8) Disability status, provided that such standards do not restrict 

eligibility;

    (9) Access to, or coverage under, other health coverage; and

    (10) Duration of eligibility, in accordance with paragraph (e) of 

this section.

    (b) Prohibited eligibility standards. In establishing eligibility 

standards and methodologies, a State may not--

    (1) Cover children with a higher family income without covering 

children with a lower family income within any defined group of covered 

targeted low-income children;

    (2) Deny eligibility based on a preexisting medical condition;

    (3) Discriminate on the basis of diagnosis;

    (4) Require any family member who is not requesting services to 

provide a social security number (including those family members whose 

income or resources might be used in making the child's eligibility 

determination);

    (5) Exclude American Indian or Alaska Native children based on 

eligibility for, or access to, medical care funded by the Indian Health 

Service;

    (6) Exclude individuals based on citizenship or nationality, to the 

extent that the children are U.S. citizens, U.S. nationals or qualified 

aliens, (as defined at section 431 of the Personal Responsibility and 

Work Opportunity Reconciliation Act (PRWORA) of 1996, as amended by the 

BBA of 1997, except to the extent that section 403 of PRWORA precludes 

them from receiving Federal means-tested public benefits); or

    (7) Violate any other Federal laws or regulations pertaining to 

eligibility for a separate child health program under title XXI.

    (c) Self-declaration of citizenship. In establishing eligibility for 

coverage under a separate child health plan, a State may accept self-

declaration of citizenship (including nationals of the U.S.), provided 

that the State has implemented effective, fair, and nondiscriminatory 

procedures for ensuring the integrity of its application process.

    (d) Residency. The State may establish residency requirements, 

except that a State may not--

    (1) Impose a durational residency requirement;

    (2) Preclude the following individuals from declaring residence in a 

State--

    (i) A non-institutionalized child who is not a ward of the State, if 

the child is physically located in that State, including as a result of 

the parent's or caretaker's employment in that State;

    (ii) An institutionalized child who is not a ward of a State, if the 

State is the State of residence of the child's custodial parent's or 

caretaker at the time of placement;

    (iii) A child who is a ward of a State, regardless of the child's 

physical location; or

    (iv) A child whose custodial parent or caretaker is involved in work 

of a transient nature, if the State is the parent's or caretaker's home 

State.



[[Page 394]]



    (e) Duration of eligibility. (1) The State may not impose a lifetime 

cap or other time limit on the eligibility of an individual applicant or 

enrollee, based on the length of time such applicant or enrollee has 

received benefits under the State's separate child health program.

    (2) Eligibility must be redetermined at least every 12 months.



[66 FR 2675, Jan. 11, 2001, as amended at 66 FR 33823, June 25, 2001]