---
kind: "section"
citation: "42 C.F.R. § 435.551"
title: "42"
number: "435.551"
heading: "Applicable individual."
url: "https://uscodex.org/cfr/42/435.551"
---

# §435.551. Applicable individual.


An applicable individual is an individual who is not a specified excluded individual as defined at [§ 435.554](/cfr/42/435.554.md) and who is—

- (a) Eligible to enroll or is enrolled under the State plan under [§ 435.119](/cfr/42/435.119.md); or
- (b) 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](/cfr/42/435.4.md), and who is:
  - (1) At least 19 and under 65 years of age;
  - (2) Not pregnant;
  - (3) Not entitled to or enrolled for benefits under part A of title XVIII or enrolled for benefits under part B of title XVIII; and
  - (4) **Not otherwise eligible to enroll under the State plan.**

## Notes

### 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.