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Electronic Code of Federal Regulations

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e-CFR Data is current as of July 22, 2014

TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS

PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA

rule

Subpart A—GENERAL PROVISIONS AND DEFINITIONS

§435.2
Purpose and applicability.
§435.3
Basis.
§435.4
Definitions and use of terms.
§435.10
State plan requirements.
rule

Subpart B—MANDATORY COVERAGE

§435.100
Scope.

Mandatory Coverage of Families and Children

§435.110
Parents and other caretaker relatives.
§435.112
Families terminated from AFDC because of increased earnings or hours of employment.
§435.113
Individuals who are ineligible for AFDC because of requirements that do not apply under title XIX of the Act.
§435.114
Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336 (July 1, 1972).
§435.115
Individuals deemed to be receiving AFDC.

Mandatory Coverage of Pregnant Women, Children Under 19, and Newborn Children

§435.116
Pregnant women.
§435.117
Newborn children.
§435.118
Infants and children under age 19.

Mandatory Coverage for Individuals Age 19 Through 64

§435.119
Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.

Mandatory Coverage of the Aged, Blind, and Disabled

§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.
§435.130
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.

Mandatory Coverage of Certain Aliens

§435.139
Coverage for certain aliens.

Mandatory Coverage of Adoption Assistance and Foster Care Children

§435.145
Children for whom adoption assistance or foster care maintenance payments are made.

Mandatory Coverage of Special Groups

§435.170
Pregnant women eligible for extended coverage.
rule

Subpart C—OPTIONS FOR COVERAGE

§435.200
Scope.
§435.201
Individuals included in optional groups.

Options for Coverage of Families and Children and the Aged, Blind, and Disabled

§435.210
Individuals who meet the income and resource requirements of the cash assistance programs.
§435.211
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.
§435.217
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.

Options for Coverage of Families and Children

§435.220
Individuals who would meet the income and resource requirements under AFDC if child care costs were paid from earnings.
§435.221
[Reserved]
§435.222
Individuals under age 21 who meet the income and resource requirements of AFDC.
§435.223
Individuals who would be eligible for AFDC if coverage under the State's AFDC plan were as broad as allowed under title IV-A.
§435.225
Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
§435.227
Individuals under age 21 who are under State adoption assistance agreements.
§435.229
Optional targeted low-income children.

Options for Coverage of the Aged, Blind, and Disabled

§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.
rule

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 specified 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.
rule

Subpart E—GENERAL ELIGIBILITY REQUIREMENTS

§435.400
Scope.
§435.401
General rules.
§435.402
[Reserved]
§435.403
State residence.
§435.404
Applicant's choice of category.
§435.406
Citizenship and alienage.
§435.407
Types of acceptable documentary evidence of citizenship.
rule

Subpart F—CATEGORICAL REQUIREMENTS FOR ELIGIBILITY

§435.500
Scope.

Dependency

§435.510
Determination of dependency.

Age

§435.520
Age requirements for the aged.
§435.522
Determination of age.

Blindness

§435.530
Definition of blindness.
§435.531
Determinations of blindness.

Disability

§435.540
Definition of disability.
§435.541
Determinations of disability.
rule

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).
§435.604
[Reserved]
§435.606
[Reserved]
§435.608
Applications for other benefits.
§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.
rule

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.
rule

Subpart I—SPECIFIC ELIGIBILITY AND POST-ELIGIBILITY FINANCIAL REQUIREMENTS FOR THE MEDICALLY NEEDY

§435.800
Scope.

Medically Needy Income Standard

§435.811
Medically needy income standard: General requirements.
§435.814
Medically needy income standard: State plan requirements.

Medically Needy Income Eligibility

§435.831
Income eligibility.
§435.832
Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.

Medically Needy Resource Standard

§435.840
Medically needy resource standard: General requirements.
§435.843
Medically needy resource standard: State plan requirements.

Determining Eligibility on the Basis of Resources

§435.845
Medically needy resource eligibility.
§§435.850-435.852
[Reserved]
rule

Subpart J—ELIGIBILITY IN THE STATES AND DISTRICT OF COLUMBIA

§435.900
Scope.

General Methods of Administration

§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.

Applications

§435.905
Availability 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.

Determination of Medicaid Eligibility

§435.911
Determination of eligibility.
§435.912
Timely determination of eligibility.
§435.913
Notice of agency's decision concerning eligibility.
§435.914
Case documentation.
§435.915
Effective date.

Redeterminations of Medicaid Eligibility

§435.916
Periodic renewal of Medicaid eligibility.
§435.918
Use of electronic notices.
§435.919
Timely and adequate notice concerning adverse actions.
§435.920
Verification of SSNs.
§435.923
Authorized Representatives.

Furnishing Medicaid

§435.930
Furnishing Medicaid.

Income and Eligibility Verification Requirements

§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.
rule

Subpart K—FEDERAL FINANCIAL PARTICIPATION

§435.1000
Scope.

FFP in Expenditures for Determining Eligibility and Providing Services

§435.1001
FFP for administration.
§435.1002
FFP for services.
§435.1003
FFP for redeterminations.
§435.1004
Beneficiaries overcoming certain conditions of eligibility.

Limitations on FFP

§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 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.
§435.1009
Institutionalized individuals.
§435.1010
Definitions relating to institutional status.

Requirements for State Supplements

§435.1011
Requirement for mandatory State supplements.
§435.1012
Requirement for maintenance of optional State supplement expenditures.

FFP for Premium Assistance

§435.1015
FFP for premium assistance for plans in the individual market.
rule

Subpart L—OPTIONS FOR COVERAGE OF SPECIAL GROUPS UNDER PRESUMPTIVE ELIGIBILITY

§435.1100
Basis and scope.

Presumptive Eligibility for Children

§435.1101
Definitions related to presumptive eligibility for children.
§435.1102
Children covered under presumptive eligibility.
§435.1103
Presumptive eligibility for other individuals.
§435.1110
Presumptive eligibility determined by hospitals.
rule

Subpart M—COORDINATION OF ELIGIBILITY AND ENROLLMENT BETWEEN MEDICAID, CHIP, EXCHANGES AND OTHER INSURANCE AFFORDABILITY PROGRAMS

§435.1200
Medicaid agency responsibilities.
§435.1205
Alignment with exchange initial open enrollment period.


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