§435.551. Applicable individual.
42 C.F.R. § 435.551
An applicable individual is an individual who is not a specified excluded individual as defined at § 435.554 and who is—
Eligible to enroll or is enrolled under the State plan under § 435.119; or
Otherwise eligible to enroll or is enrolled in a demonstration project under section 1115(a)(2) of the Act that provides coverage that meets minimum essential coverage requirements as defined under § 435.4, and who is:
At least 19 and under 65 years of age;
Not pregnant;
Not entitled to or enrolled for benefits under part A of title XVIII or enrolled for benefits under part B of title XVIII; and
Not otherwise eligible to enroll under the State plan.
Notes, amendments, and revision history
Source
Source: 91 FR 33469, June 3, 2026, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302.
Source
Source: 43 FR 45204, Sept. 29, 1978, unless otherwise noted.