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Notes

42 C.F.R. §§ 435.110–435.118

6 sections in range

§435.110. Parents and other caretaker relatives.

42 C.F.R. § 435.110

(a)
Basis. This section implements sections 1931(b) and (d) of the Act.
(b)
Scope. The agency must provide Medicaid to parents and other caretaker relatives, as defined in § 435.4, and, if living with such parent or other caretaker relative, his or her spouse, whose household income is at or below the income standard established by the agency in the State plan, in accordance with paragraph (c) of this section.
(c)
Income standard. The agency must establish in its State plan the income standard as follows:
(1)
The minimum income standard is a State's AFDC income standard in effect as of May 1, 1988 for the applicable family size converted to a MAGI-equivalent standard in accordance with guidance issued by the Secretary under section 1902(e)(14)(A) and (E) of the Act.
(2)
The maximum income standard is the higher of—
(i)
The effective income level in effect for section 1931 low-income families under the Medicaid State plan or waiver of the State plan as of March 23, 2010 or December 31, 2013, if higher, converted to a MAGI-equivalent standard in accordance with guidance issued by the Secretary under section 1902(e)(14)(A) and (E) of the Act; or
(ii)
A State's AFDC income standard in effect as of July 16, 1996 for the applicable family size, increased by no more than the percentage increase in the Consumer Price Index for all urban consumers between July 16, 1996 and the effective date of such increase.
Notes, amendments, and revision history

Amendments

[77 FR 17204, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[77 FR 17204, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]

§435.112. Families terminated from AFDC because of increased earnings or hours of employment.

42 C.F.R. § 435.112

(a)
If a family loses AFDC solely because of increased income from employment or increased hours of employment, the agency must continue to provide Medicaid for 4 months to all members of the family if—
(1)
The family received AFDC in any 3 or more months during the 6-month period immediately before the month in which it became ineligible for AFDC; and
(2)
At least one member of the family is employed throughout the 4-month period, although this need not be the same member for the whole period.
(b)
The 4 calendar month period begins on the date AFDC is terminated. If AFDC benefits are terminated retroactively, the 4 calendar month period also begins retroactively with the first month in which AFDC was erroneously paid.
Notes, amendments, and revision history

Amendments

[43 FR 45204, Sept. 29, 1978, as amended at 45 FR 24883, Apr. 11, 1980]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[43 FR 45204, Sept. 29, 1978, as amended at 45 FR 24883, Apr. 11, 1980]

§435.115. Families with Medicaid eligibility extended because of increased collection of spousal support.

42 C.F.R. § 435.115

(a)
Basis. This section implements sections 408(a)(11)(B) and 1931(c)(1) of the Act.
(b)
Eligibility.
(1)
The extended eligibility period is for 4 months.
(2)
The agency must provide coverage during an extended eligibility period to a parent or other caretaker relative who was eligible and enrolled for Medicaid under § 435.110, and any dependent child of such parent or other caretaker relative who was eligible and enrolled under § 435.118, in at least 3 out of the 6 months immediately preceding the month that eligibility for the parent or other caretaker relative under § 435.110 is lost due to increased collection of spousal support under title IV-D of the Act.
Notes, amendments, and revision history

Amendments

[81 FR 86451, Nov. 30, 2016]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[81 FR 86451, Nov. 30, 2016]

§435.116. Pregnant women.

42 C.F.R. § 435.116

(a)
Basis. This section implements sections 1902(a)(10)(A)(i)(III) and (IV); 1902(a)(10)(A)(ii)(I), (IV), and (IX); and 1931(b) and (d) of the Act.
(b)
Scope. The agency must provide Medicaid to pregnant women whose household income is at or below the income standard established by the agency in its State plan, in accordance with paragraph (c) of this section.
(c)
Income standard. The agency must establish in its State plan the income standard as follows:
(1)
The minimum income standard is the higher of—
(i)
133 percent FPL for the applicable family size; or
(ii)
Such higher income standard up to 185 percent FPL, if any, as the State had established as of December 19, 1989 for determining eligibility for pregnant women, or, as of July 1, 1989, had authorizing legislation to do so.
(2)
The maximum income standard is the higher of—
(i)
The highest effective income level in effect under the Medicaid State plan for coverage under the sections specified at paragraph (a) of this section, or waiver of the State plan covering pregnant women, as of March 23, 2010 or December 31, 2013, if higher, converted to a MAGI-equivalent standard in accordance with guidance issued by the Secretary under section 1902(e)(14)(A) and (E) of the Act; or
(ii)
185 percent FPL.
(d)
Covered services.
(1)
Pregnant women are covered under this section for the full Medicaid coverage described in paragraph (d)(2) of this section, except that the agency may provide only pregnancy-related services described in paragraph (d)(3) of this section for pregnant women whose income exceeds the applicable income limit established by the agency in its State plan, in accordance with paragraph (d)(4) of this section.
(2)
Full Medicaid coverage consists of all services which the State is required to cover under § 440.210(a)(1) of this subchapter and all services which it has opted to cover under § 440.225 and § 440.250(p) of this subchapter.
(3)
Pregnancy-related services consists of services covered under the State plan consistent with § 440.210(a)(2) and § 440.250(p) of this subchapter.
(4)
Applicable income limit for full Medicaid coverage of pregnant women. For purposes of paragraph (d)(1) of this section—
(i)
The minimum applicable income limit is the State's AFDC income standard in effect as of May 1, 1988 for the applicable family size converted to a MAGI-equivalent standard in accordance with guidance issued by the Secretary under section 1902(e)(14)(A) and (E) of the Act.
(ii)
The maximum applicable income limit is the highest effective income level for coverage under section 1902(a)(10)(A)(i)(III) of the Act or under section 1931(b) and (d) of the Act in effect under the Medicaid State plan or waiver of the State plan as of March 23, 2010 or December 31, 2013, if higher, converted to a MAGI-equivalent standard.
Notes, amendments, and revision history

Amendments

[77 FR 17204, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[77 FR 17204, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]

§435.117. Deemed newborn children.

42 C.F.R. § 435.117

(a)
Basis. This section implements sections 1902(e)(4) and 2112(e) of the Act.
(b)
Eligibility.
(1)
The agency must provide Medicaid to children from birth until the child's first birthday without application if, for the date of the child's birth, the child's mother was eligible for and received covered services under—
(i)
The Medicaid State plan (including during a period of retroactive eligibility under § 435.915) regardless of whether payment for services for the mother is limited to services necessary to treat an emergency medical condition, as defined in section 1903(v)(3) of the Act; or
(ii)
The CHIP State plan as a targeted low-income pregnant woman in accordance with section 2112 of the Act, with household income at or below the income standard established by the agency under § 435.118 for infants under age 1.
(2)
The agency may provide coverage under this section to children from birth until the child's first birthday without application who are not described in (b)(1) of this section if, for the date of the child's birth, the child's mother was eligible for and received covered services under—
(i)
The Medicaid State plan of any State (including during a period of retroactive eligibility under § 435.915); or
(ii)
Any of the following, provided that household income of the child's mother at the time of the child's birth is at or below the income standard established by the agency under § 435.118 for infants under age 1:
(A)
The State's separate CHIP State plan as a targeted low-income child;
(B)
The CHIP State plan of any State as a targeted low-income pregnant woman or child; or
(C)
A Medicaid or CHIP demonstration project authorized under section 1115 of the Act.
(3)
The child is deemed to have applied and been determined eligible under the Medicaid State plan effective as of the date of birth, and remains eligible regardless of changes in circumstances until the child's first birthday, unless the child dies or ceases to be a resident of the State or the child's representative requests a voluntary termination of eligibility.
(c)
Medicaid identification number.
(1)
The Medicaid identification number of the mother serves as the child's identification number, and all claims for covered services provided to the child may be submitted and paid under such number, unless and until the State issues the child a separate identification number.
(2)
The State must issue a separate Medicaid identification number for the child prior to the effective date of any termination of the mother's eligibility or prior to the date of the child's first birthday, whichever is sooner, except that the State must issue a separate Medicaid identification number in the case of a child born to a mother:
(i)
Whose coverage is limited to services necessary for the treatment of an emergency medical condition, consistent with § 435.139 or § 435.350;
(ii)
Covered under the State's separate CHIP; or
(iii)
Who received Medicaid in another State on the date of birth.
(d)
Renewal of eligibility. A redetermination of eligibility must be completed on behalf of the children described in this provision in accordance with the procedures at § 435.916. At that time, the State must collect documentary evidence of citizenship and identity as required under § 435.406.
Notes, amendments, and revision history

Amendments

[72 FR 38690, July 13, 2007, as amended at 81 FR 86451, Nov. 30, 2016]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[72 FR 38690, July 13, 2007, as amended at 81 FR 86451, Nov. 30, 2016]

§435.118. Infants and children under age 19.

42 C.F.R. § 435.118

(a)
Basis. This section implements sections 1902(a)(10)(A)(i)(III), (IV), (VI), and (VII); 1902(a)(10)(A)(ii)(IV) and (IX); and 1931(b) and (d) of the Act.
(b)
Scope. The agency must provide Medicaid to children under age 19 whose household income is at or below the income standard established by the agency in its State plan, in accordance with paragraph (c) of this section.
(c)
Income standard.
(1)
The minimum income standard is the higher of—
(i)
133 percent FPL for the applicable family size; or
(ii)
For infants under age 1, such higher income standard up to 185 percent FPL, if any, as the State had established as of December 19, 1989 for determining eligibility for infants, or, as of July 1, 1989 had authorizing legislation to do so.
(2)
The maximum income standard for each of the age groups of infants under age 1, children age 1 through age 5, and children age 6 through age 18 is the higher of—
(i)
133 percent FPL;
(ii)
The highest effective income level for each age group in effect under the Medicaid State plan for coverage under the applicable sections of the Act listed at paragraph (a) of this section or waiver of the State plan covering such age group as of March 23, 2010 or December 31, 2013, if higher, converted to a MAGI-equivalent standard in accordance with guidance issued by the Secretary under section 1902(e)(14)(A) and (E) of the Act; or
(iii)
For infants under age 1, 185 percent FPL.
Notes, amendments, and revision history

Amendments

[77 FR 17205, Mar. 23, 2012]

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.

Amendments

[77 FR 17205, Mar. 23, 2012]