---
kind: "section"
citation: "42 C.F.R. § 423.904"
title: "42"
number: "423.904"
heading: "Eligibility determinations for low-income subsidies."
url: "https://uscodex.org/cfr/42/423.904"
---

# §423.904. Eligibility determinations for low-income subsidies.

- (a) **General rule.** The State agency must make eligibility determinations and redeterminations for low-income premium and cost-sharing subsidies in accordance with [subpart P of part 423](/cfr/42/part423-subpartP.md).
- (b) **Notification to CMS.** The State agency must inform CMS of cases where eligibility is established or redetermined, in a manner determined by CMS.
- (c) **Screening for eligibility for Medicare cost-sharing and enrollment under the State plan.** States must—
  - (1) Screen individuals who apply for subsidies under this part for eligibility for Medicaid programs that provide assistance with Medicare cost-sharing specified in [section 1905(p)(3)](/cfr/42/1905.md?p=p-3) of the Act.
  - (2) Offer enrollment for the programs under the State plan (or under a waiver of the plan) for those meeting the eligibility requirements.
- (d) **Application form and process—**
  - (1) **Assistance with application.** No later than July 1, 2005, States must make available—
    - (i) Low-income subsidy application forms;
    - (ii) Information on the nature of, and eligibility requirements for, the subsidies under this section; and
    - (iii) **Assistance with completion of low-income subsidy application forms.**
  - (2) **Completion of application.** The State must require an individual or personal representative applying for the low-income subsidy to—
    - (i) Complete all required elements of the application and provide documents, as necessary, consistent with [paragraph (d)(3)](#d-3) of this section; and
    - (ii) Certify, under penalty of perjury or similar sanction for false statements, as to the accuracy of the information provided on the application form.
  - (3) **The application process and States.**
    - (i) States may require submission of statements from financial institutions for an application for low-income subsidies to be considered complete; and
    - (ii) May require that information submitted on the application be subject to verification in a manner the State determines to be most cost-effective and efficient.
  - (4) **Other information.** States must provide CMS with other information as specified by CMS that may be needed to carry out the requirements of the Part D prescription drug benefit.

## Notes

### Authority

Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152, and 1395hh.

### Source

Source: 70 FR 4525, Jan. 28, 2005, unless otherwise noted.