42 C.F.R. PART 435--ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
TITLE 42--Public Health
CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER C--MEDICAL ASSISTANCE PROGRAMS
PART 435--ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
Subpart A--GENERAL PROVISIONS AND DEFINITIONS
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| Purpose and applicability.
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| Definitions and use of terms.
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Subpart B--MANDATORY COVERAGE OF THE CATEGORICALLY NEEDY
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| Individuals receiving aid to families with dependent children.
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| Families terminated from AFDC because of increased earnings or hours of employment.
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| Individuals who are ineligible for AFDC because of requirements that do not apply under title XIX of the Act.
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| Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336 (July 1, 1972).
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| Individuals deemed to be receiving AFDC.
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| Qualified pregnant women and children who are not qualified family members.
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| Qualified family members.
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| Individuals receiving SSI.
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| Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.
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| Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act.
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| Individuals receiving mandatory State supplements.
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| Individuals eligible as essential spouses in December 1973.
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| Institutionalized individuals who were eligible in December 1973.
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| Blind and disabled individuals eligible in December 1973.
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| Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).
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| Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.
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| State agency implementation requirements for one-time notice and annual review system.
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| Disabled widows and widowers who would be eligible for SSI except for the increase in disability benefits resulting from elimination of the reduction factor under Pub. L. 98-21.
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| Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.
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| Coverage for certain aliens.
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| Children for whom adoption assistance or foster care maintenance payments are made.
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| Pregnant women eligible for extended coverage.
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Subpart C--OPTIONS FOR COVERAGE AS CATEGORICALLY NEEDY
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| Individuals included in optional groups.
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| Individuals who meet the income and resource requirements of the cash assistance programs.
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| Individuals who would be eligible for cash assistance if they were not in medical institutions.
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| Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
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| Individuals receiving home and community-based services.
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| Individuals who would meet the income and resource requirements under AFDC if child care costs were paid from earnings.
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| Individuals under age 21 who meet the income and resource requirements of AFDC.
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| Individuals who would be eligible for AFDC if coverage under the State's AFDC plan were as broad as allowed under title IV-A.
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| Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
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| Individuals under age 21 who are under State adoption assistance agreements.
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| Optional targeted low-income children.
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| Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.
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| Individuals receiving only optional State supplements.
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| Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.
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| Individuals in institutions who are eligible under a special income level.
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Subpart D--OPTIONAL COVERAGE OF THE MEDICALLY NEEDY
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| Medically needy coverage of individuals under age 21.
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| Medically needy coverage of specified relatives.
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| Medically needy coverage of the aged in States that cover individuals receiving SSI.
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| Medically needy coverage of the blind in States that cover individuals receiving SSI.
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| Medically needy coverage of the disabled in States that cover individuals receiving SSI.
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| Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
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| Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI.
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| Protected medically needy coverage for blind and disabled individuals eligible in December 1973.
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| Coverage for certain aliens.
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Subpart E--GENERAL ELIGIBILITY REQUIREMENTS
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| Applicant's choice of category.
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| Citizenship and alienage.
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| Types of acceptable documentary evidence of citizenship.
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Subpart F--CATEGORICAL REQUIREMENTS FOR ELIGIBILITY
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| Determination of dependency.
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| Age requirements for the aged.
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| Determinations of blindness.
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| Definition of disability.
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| Determinations of disability.
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Subpart G--GENERAL FINANCIAL ELIGIBILITY REQUIREMENTS AND OPTIONS
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| Application of financial eligibility methodologies.
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| Financial responsibility of relatives and other individuals.
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| Applications for other benefits.
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| Assignment of rights to benefits.
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| Individuals in institutions who are eligible under a special income level.
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| General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.
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| Protected Medicaid eligibility for individuals eligible in December 1973.
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Subpart H--SPECIFIC POST-ELIGIBILITY FINANCIAL REQUIREMENTS FOR THE CATEGORICALLY NEEDY
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| Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.
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| Post-eligibility treatment of income of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care.
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| Post-eligibility treatment of income of institutionalized individuals in States using more restrictive requirements than SSI: Application of patient income to the cost of care.
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| Post-eligibility treatment of income and resources of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care.
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Subpart I--SPECIFIC ELIGIBILITY AND POST-ELIGIBILITY FINANCIAL REQUIREMENTS FOR THE MEDICALLY NEEDY
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| Medically needy income standard: General requirements.
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| Medically needy income standard: State plan requirements.
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| Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.
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| Medically needy resource standard: General requirements.
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| Medically needy resource standard: State plan requirements.
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| Medically needy resource eligibility.
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Subpart J--ELIGIBILITY IN THE STATES AND DISTRICT OF COLUMBIA
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| Consistency with objectives and statutes.
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| Simplicity of administration.
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| Adherence of local agencies to State plan requirements.
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| Establishment of outstation locations to process applications for certain low-income eligibility groups.
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| Availability of program information.
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| Assistance with application.
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| Automatic entitlement to Medicaid following a determination of eligibility under other programs.
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| Use of social security number.
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| Timely determination of eligibility.
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| Notice of agency's decision concerning eligibility.
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| Periodic redeterminations of Medicaid eligibility.
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| Timely and adequate notice concerning adverse actions.
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| Identifying items of information to use.
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| Additional requirements regarding information released by a Federal agency.
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| Standardized formats for furnishing and obtaining information to verifying income and eligibility.
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Subpart K--FEDERAL FINANCIAL PARTICIPATION
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| FFP for redeterminations.
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| Recipients overcoming certain conditions of eligibility.
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| Recipients in institutions eligible under a special income standard.
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| Recipients of optional State supplements only.
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| Categorically needy, medically needy, and qualified Medicare beneficiaries.
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| FFP in expenditures for medical assistance for individuals who have declared United States citizenship or nationality under section 1137(d) of the Act and with respect to whom the State has not documented citizenship and identity.
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| Institutionalized individuals.
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| Definitions relating to institutional status.
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| Requirement for mandatory State supplements.
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| Requirement for maintenance of optional State supplement expenditures.
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Subpart L--OPTION FOR COVERAGE OF SPECIAL GROUPS
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| Definitions related to presumptive eligibility for children.
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