Part 435 — Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa
Subpart A — General Provisions and Definitions
Subpart B — Mandatory Coverage
- § 435.100— Scope.
- § 435.110— Parents and other caretaker relatives.
- § 435.112— Families terminated from AFDC because of increased earnings or hours of employment.
- § 435.115— Families with Medicaid eligibility extended because of increased collection of spousal support.
- § 435.116— Pregnant women.
- § 435.117— Deemed newborn children.
- § 435.118— Infants and children under age 19.
- § 435.119— Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.
- § 435.120— Individuals receiving SSI.
- § 435.121— Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.
- § 435.122— Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act.
- § 435.123— Individuals eligible as qualified Medicare beneficiaries.
- § 435.124— Individuals eligible as specified low-income Medicare beneficiaries.
- § 435.125— Individuals eligible as qualifying individuals.
- § 435.126— Individuals eligible as qualified disabled and working individuals.
- § 435.130— Individuals receiving mandatory State supplements.
- § 435.131— Individuals eligible as essential spouses in December 1973.
- § 435.132— Institutionalized individuals who were eligible in December 1973.
- § 435.133— Blind and disabled individuals eligible in December 1973.
- § 435.134— Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).
- § 435.135— Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.
- § 435.136— State agency implementation requirements for one-time notice and annual review system.
- § 435.137— 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.
- § 435.138— Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.
- § 435.139— Coverage for certain aliens.
- § 435.145— Children with adoption assistance, foster care, or guardianship care under title IV-E.
- § 435.150— Former foster care children.
- § 435.170— Pregnant women eligible for extended or continuous eligibility.
- § 435.172— Continuous eligibility for hospitalized children.
Subpart C — Options for Coverage
- § 435.200— Scope.
- § 435.201— Individuals included in optional groups.
- § 435.210— Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs.
- § 435.211— Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions.
- § 435.212— Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
- § 435.213— Optional eligibility for individuals needing treatment for breast or cervical cancer.
- § 435.214— Eligibility for Medicaid limited to family planning and related services.
- § 435.215— Individuals infected with tuberculosis.
- § 435.217— Individuals receiving home and community-based services.
- § 435.218— Individuals with MAGI-based income above 133 percent FPL.
- § 435.219— Individuals receiving State plan home and community-based services.
- § 435.220— Optional eligibility for parents and other caretaker relatives.
- § 435.222— Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories.
- § 435.223— Other optional eligibility for reasonable classifications of individuals under age 21.
- § 435.225— Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
- § 435.226— Optional eligibility for independent foster care adolescents.
- § 435.227— Optional eligibility for individuals under age 21 who are under State adoption assistance agreements.
- § 435.229— Optional targeted low-income children.
- § 435.230— Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.
- § 435.232— Individuals receiving only optional State supplements.
- § 435.234— Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.
- § 435.236— Individuals in institutions who are eligible under a special income level.
Subpart D — Optional Coverage of the Medically Needy
- § 435.300— Scope.
- § 435.301— General rules.
- § 435.308— Medically needy coverage of individuals under age 21.
- § 435.310— Medically needy coverage of parents and other caretaker relatives.
- § 435.320— Medically needy coverage of the aged in States that cover individuals receiving SSI.
- § 435.322— Medically needy coverage of the blind in States that cover individuals receiving SSI.
- § 435.324— Medically needy coverage of the disabled in States that cover individuals receiving SSI.
- § 435.326— Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
- § 435.330— Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI.
- § 435.340— Protected medically needy coverage for blind and disabled individuals eligible in December 1973.
- § 435.350— Coverage for certain aliens.
Subpart E — General Eligibility Requirements
Subpart F — Categorical Requirements for Eligibility
Subpart G — General Financial Eligibility Requirements and Options
- § 435.600— Scope.
- § 435.601— Application of financial eligibility methodologies.
- § 435.602— Financial responsibility of relatives and other individuals.
- § 435.603— Application of modified adjusted gross income (MAGI).
- § 435.610— Assignment of rights to benefits.
- § 435.622— Individuals in institutions who are eligible under a special income level.
- § 435.631— General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.
- § 435.640— Protected Medicaid eligibility for individuals eligible in December 1973.
Subpart H — Specific Post-Eligibility Financial Requirements for the Categorically Needy
- § 435.700— Scope.
- § 435.725— Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.
- § 435.726— 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.
- § 435.733— 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.
- § 435.735— 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.
Subpart I — Specific Eligibility and Post-Eligibility Financial Requirements for the Medically Needy
- § 435.800— Scope.
- § 435.811— Medically needy income standard: General requirements.
- § 435.814— Medically needy income standard: State plan requirements.
- § 435.831— Income eligibility.
- § 435.832— Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.
- § 435.840— Medically needy resource standard: General requirements.
- § 435.843— Medically needy resource standard: State plan requirements.
- § 435.845— Medically needy resource eligibility.
Subpart J — Eligibility in the States and District of Columbia
- § 435.900— Scope.
- § 435.901— Consistency with objectives and statutes.
- § 435.902— Simplicity of administration.
- § 435.903— Adherence of local agencies to State plan requirements.
- § 435.904— Establishment of outstation locations to process applications for certain low-income eligibility groups.
- § 435.905— Availability and accessibility of program information.
- § 435.906— Opportunity to apply.
- § 435.907— Application.
- § 435.908— Assistance with application and renewal.
- § 435.909— Automatic entitlement to Medicaid following a determination of eligibility under other programs.
- § 435.910— Use of social security number.
- § 435.911— Determination of eligibility.
- § 435.912— Timely determination and redetermination of eligibility.
- § 435.914— Case documentation.
- § 435.915— Effective date.
- § 435.916— Regularly scheduled renewals of Medicaid eligibility.
- § 435.917— Notice of agency's decision concerning eligibility, benefits, or services.
- § 435.918— Use of electronic notices.
- § 435.919— Changes in circumstances.
- § 435.920— Verification of SSNs.
- § 435.923— Authorized representatives.
- § 435.926— Continuous eligibility for children.
- § 435.927— Requirements for States to submit certain data on redeterminations.
- § 435.928— Reduction in FMAP for failure to submit certain data.
- § 435.930— Furnishing Medicaid.
- § 435.940— Basis and scope.
- § 435.945— General requirements.
- § 435.948— Verifying financial information.
- § 435.949— Verification of information through an electronic service.
- § 435.952— Use of information and requests of additional information from individuals.
- § 435.956— Verification of other non-financial information.
- § 435.960— Standardized formats for furnishing and obtaining information to verifying income and eligibility.
- § 435.965— Delay of effective date.
Subpart K — Federal Financial Participation
- § 435.1000— Scope.
- § 435.1001— FFP for administration.
- § 435.1002— FFP for services.
- § 435.1003— FFP for redeterminations.
- § 435.1004— Beneficiaries overcoming certain conditions of eligibility.
- § 435.1005— Beneficiaries in institutions eligible under a special income standard.
- § 435.1006— Beneficiaries of optional State supplements only.
- § 435.1007— Categorically needy, medically needy, and qualified Medicare beneficiaries.
- § 435.1008— FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status.
- § 435.1009— Institutionalized individuals.
- § 435.1010— Definitions relating to institutional status.
- § 435.1011— Requirement for mandatory State supplements.
- § 435.1012— Requirement for maintenance of optional State supplement expenditures.
- § 435.1015— FFP for premium assistance for plans in the individual market.