---
kind: "section"
citation: "42 C.F.R. § 435.119"
title: "42"
number: "435.119"
heading: "Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL."
url: "https://uscodex.org/cfr/42/435.119"
---

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

- (a) **Basis.** This section implements [section 1902(a)(10)(A)(i)(VIII)](/cfr/42/1902.md?p=a-10-A-i-VIII) of the Act.
- (b) **Eligibility.** Effective January 1, 2014, the agency must provide Medicaid to individuals who:
  - (1) Are age 19 or older and under age 65;
  - (2) Are not pregnant;
  - (3) Are not entitled to or enrolled for Medicare benefits under part A or B of title XVIII of the Act;
  - (4) Are not otherwise eligible for and enrolled for mandatory coverage under a State's Medicaid State plan in accordance with subpart B of this part; and
  - (5) **Have household income that is at or below 133 percent FPL for the applicable family size.**
- (c) **Coverage for dependent children.**
  - (1) A State may not provide Medicaid under this section to a parent or other caretaker relative living with a dependent child if the child is under the age specified in [paragraph (c)(2)](#c-2) of this section, unless such child is receiving benefits under Medicaid, the Children's Health Insurance Program under subchapter D of this chapter, or otherwise is enrolled in minimum essential coverage as defined in [§ 435.4](/cfr/42/435.4.md) of this part.
  - (2) For the purpose of [paragraph (c)(1)](#c-1) of this section, the age specified is under age 19, unless the State had elected as of March 23, 2010 to provide Medicaid to individuals under age 20 or 21 under [§ 435.222](/cfr/42/435.222.md) of this part, in which case the age specified is such higher age.
- (d) **Community engagement.** As of the implementation date in accordance with [§ 435.559](/cfr/42/435.559.md), the 50 States and the District of Columbia must provide that eligibility under this section is subject to the community engagement requirement described at [§§ 435.550 through 435.563](/cfr/42/435.550..435.563.md).

## Notes

### Amendments

[58 FR 48614, Sept. 17, 1993, as amended at 77 FR 17205, Mar. 23, 2012; 78 FR 42302, July 15, 2013; 91 FR 33469, June 3, 2026]

### Authority

Authority: 42 U.S.C. 1302.

### Source

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

### Amendments

[58 FR 48614, Sept. 17, 1993, as amended at 77 FR 17205, Mar. 23, 2012; 78 FR 42302, July 15, 2013; 91 FR 33469, June 3, 2026]