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FEDERAL · 42 CFR

Part 435 — Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa

159 sections · Title 42: Public Health

§ 435.2Purpose and applicability.
§ 435.3Basis.
§ 435.4Definitions and use of terms.
§ 435.10State plan requirements.
§ 435.100Scope.
§ 435.110Parents and other caretaker relatives.
§ 435.112Families terminated from AFDC because of increased earnings or hours of employment.
§ 435.115Families with Medicaid eligibility extended because of increased collection of spousal support.
§ 435.116Pregnant women.
§ 435.117Deemed newborn children.
§ 435.118Infants and children under age 19.
§ 435.119Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.
§ 435.120Individuals receiving SSI.
§ 435.121Individuals in States using more restrictive requirements for Medicaid than the SSI requirements.
§ 435.122Individuals who are ineligible for SSI or optional State supplements because of requirements that do not apply under title XIX of the Act.
§ 435.123Individuals eligible as qualified Medicare beneficiaries.
§ 435.124Individuals eligible as specified low-income Medicare beneficiaries.
§ 435.125Individuals eligible as qualifying individuals.
§ 435.126Individuals eligible as qualified disabled and working individuals.
§ 435.130Individuals receiving mandatory State supplements.
§ 435.131Individuals eligible as essential spouses in December 1973.
§ 435.132Institutionalized individuals who were eligible in December 1973.
§ 435.133Blind and disabled individuals eligible in December 1973.
§ 435.134Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336 (July 1, 1972).
§ 435.135Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977.
§ 435.136State agency implementation requirements for one-time notice and annual review system.
§ 435.137Disabled 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.
§ 435.138Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits.
§ 435.139Coverage for certain aliens.
§ 435.145Children with adoption assistance, foster care, or guardianship care under title IV-E.
§ 435.150Former foster care children.
§ 435.170Pregnant women eligible for extended or continuous eligibility.
§ 435.172Continuous eligibility for hospitalized children.
§ 435.200Scope.
§ 435.201Individuals included in optional groups.
§ 435.210Optional eligibility for individuals who meet the income and resource requirements of the cash assistance programs.
§ 435.211Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions.
§ 435.212Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
§ 435.213Optional eligibility for individuals needing treatment for breast or cervical cancer.
§ 435.214Eligibility for Medicaid limited to family planning and related services.
§ 435.215Individuals infected with tuberculosis.
§ 435.217Individuals receiving home and community-based services.
§ 435.218Individuals with MAGI-based income above 133 percent FPL.
§ 435.219Individuals receiving State plan home and community-based services.
§ 435.220Optional eligibility for parents and other caretaker relatives.
§ 435.221§ 435.221 [Reserved]
§ 435.222Optional eligibility for reasonable classifications of individuals under age 21 with income below a MAGI-equivalent standard in specified eligibility categories.
§ 435.223Other optional eligibility for reasonable classifications of individuals under age 21.
§ 435.225Individuals under age 19 who would be eligible for Medicaid if they were in a medical institution.
§ 435.226Optional eligibility for independent foster care adolescents.
§ 435.227Optional eligibility for individuals under age 21 who are under State adoption assistance agreements.
§ 435.229Optional targeted low-income children.
§ 435.230Aged, blind, and disabled individuals in States that use more restrictive requirements for Medicaid than SSI requirements: Optional coverage.
§ 435.232Individuals receiving only optional State supplements.
§ 435.234Individuals receiving only optional State supplements in States using more restrictive eligibility requirements than SSI and certain States using SSI criteria.
§ 435.236Individuals in institutions who are eligible under a special income level.
§ 435.300Scope.
§ 435.301General rules.
§ 435.308Medically needy coverage of individuals under age 21.
§ 435.310Medically needy coverage of parents and other caretaker relatives.
§ 435.320Medically needy coverage of the aged in States that cover individuals receiving SSI.
§ 435.322Medically needy coverage of the blind in States that cover individuals receiving SSI.
§ 435.324Medically needy coverage of the disabled in States that cover individuals receiving SSI.
§ 435.326Individuals who would be ineligible if they were not enrolled in an MCO or PCCM.
§ 435.330Medically needy coverage of the aged, blind, and disabled in States using more restrictive eligibility requirements for Medicaid than those used under SSI.
§ 435.340Protected medically needy coverage for blind and disabled individuals eligible in December 1973.
§ 435.350Coverage for certain aliens.
§ 435.400Scope.
§ 435.401General rules.
§ 435.402§ 435.402 [Reserved]
§ 435.403State residence.
§ 435.404Applicant's choice of category.
§ 435.406Citizenship and noncitizen eligibility.
§ 435.407Types of acceptable documentary evidence of citizenship.
§ 435.500Scope.
§ 435.520Age requirements for the aged.
§ 435.530Definition of blindness.
§ 435.531Determinations of blindness.
§ 435.540Definition of disability.
§ 435.541Determinations of disability.
§ 435.600Scope.
§ 435.601Application of financial eligibility methodologies.
§ 435.602Financial responsibility of relatives and other individuals.
§ 435.603Application of modified adjusted gross income (MAGI).
§ 435.604§ 435.604 [Reserved]
§ 435.606§ 435.606 [Reserved]
§ 435.608§ 435.608 [Reserved]
§ 435.610Assignment of rights to benefits.
§ 435.622Individuals in institutions who are eligible under a special income level.
§ 435.631General requirements for determining income eligibility in States using more restrictive requirements for Medicaid than SSI.
§ 435.640Protected Medicaid eligibility for individuals eligible in December 1973.
§ 435.700Scope.
§ 435.725Post-eligibility treatment of income of institutionalized individuals in SSI States: Application of patient income to the cost of care.
§ 435.726Post-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.
§ 435.733Post-eligibility treatment of income of institutionalized individuals in States using more restrictive requirements than SSI: Application of patient income to the cost of care.
§ 435.735Post-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.
§ 435.800Scope.
§ 435.811Medically needy income standard: General requirements.
§ 435.814Medically needy income standard: State plan requirements.
§ 435.831Income eligibility.
§ 435.832Post-eligibility treatment of income of institutionalized individuals: Application of patient income to the cost of care.
§ 435.840Medically needy resource standard: General requirements.
§ 435.843Medically needy resource standard: State plan requirements.
§ 435.845Medically needy resource eligibility.
§ 435.850-435.852§§ 435.850-435.852 [Reserved]
§ 435.900Scope.
§ 435.901Consistency with objectives and statutes.
§ 435.902Simplicity of administration.
§ 435.903Adherence of local agencies to State plan requirements.
§ 435.904Establishment of outstation locations to process applications for certain low-income eligibility groups.
§ 435.905Availability and accessibility of program information.
§ 435.906Opportunity to apply.
§ 435.907Application.
§ 435.908Assistance with application and renewal.
§ 435.909Automatic entitlement to Medicaid following a determination of eligibility under other programs.
§ 435.910Use of social security number.
§ 435.911Determination of eligibility.
§ 435.912Timely determination and redetermination of eligibility.
§ 435.914Case documentation.
§ 435.915Effective date.
§ 435.916Regularly scheduled renewals of Medicaid eligibility.
§ 435.917Notice of agency's decision concerning eligibility, benefits, or services.
§ 435.918Use of electronic notices.
§ 435.919Changes in circumstances.
§ 435.920Verification of SSNs.
§ 435.923Authorized representatives.
§ 435.926Continuous eligibility for children.
§ 435.927Requirements for States to submit certain data on redeterminations.
§ 435.928Reduction in FMAP for failure to submit certain data.
§ 435.930Furnishing Medicaid.
§ 435.940Basis and scope.
§ 435.945General requirements.
§ 435.948Verifying financial information.
§ 435.949Verification of information through an electronic service.
§ 435.952Use of information and requests of additional information from individuals.
§ 435.956Verification of other non-financial information.
§ 435.960Standardized formats for furnishing and obtaining information to verifying income and eligibility.
§ 435.965Delay of effective date.
§ 435.1000Scope.
§ 435.1001FFP for administration.
§ 435.1002FFP for services.
§ 435.1003FFP for redeterminations.
§ 435.1004Beneficiaries overcoming certain conditions of eligibility.
§ 435.1005Beneficiaries in institutions eligible under a special income standard.
§ 435.1006Beneficiaries of optional State supplements only.
§ 435.1007Categorically needy, medically needy, and qualified Medicare beneficiaries.
§ 435.1008FFP in expenditures for medical assistance for individuals who have declared citizenship or nationality or satisfactory immigration status.
§ 435.1009Institutionalized individuals.
§ 435.1010Definitions relating to institutional status.
§ 435.1011Requirement for mandatory State supplements.
§ 435.1012Requirement for maintenance of optional State supplement expenditures.
§ 435.1015FFP for premium assistance for plans in the individual market.
§ 435.1100Basis for presumptive eligibility.
§ 435.1101Definitions related to presumptive eligibility.
§ 435.1102Children covered under presumptive eligibility.
§ 435.1103Presumptive eligibility for other individuals.
§ 435.1110Presumptive eligibility determined by hospitals.
§ 435.1200Medicaid agency responsibilities for a coordinated eligibility and enrollment process with other insurance affordability programs.
§ 435.1205Alignment with exchange initial open enrollment period.