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Notes

42 C.F.R. §§ 435.905–435.908

4 sections in range

§435.905. Availability and accessibility of program information.

42 C.F.R. § 435.905

(a)
The agency must furnish the following information in electronic and paper formats (including through the Internet Web site described in § 435.1200(f) of this part), and orally as appropriate, to all applicants and other individuals who request it:
(1)
The eligibility requirements;
(2)
Available Medicaid services; and
(3)
The rights and responsibilities of applicants and beneficiaries.
(b)
Such information must be provided to applicants and beneficiaries in plain language and in a manner that is accessible and timely to—
(1)
Individuals who are limited English proficient through the provision of language services at no cost to the individual including, oral interpretation and written translations;
(2)
Individuals living with disabilities through the provision of auxiliary aids and services at no cost to the individual in accordance with the Americans with Disabilities Act and section 504 of the Rehabilitation Act; and
(3)
Individuals must be informed of the availability of the accessible information and language services described in this paragraph and how to access such information and services, at a minimum through providing taglines in non-English languages indicating the availability of language services.
Notes, amendments, and revision history

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 81 FR 86457, Nov. 30, 2016]

Source

Source: 44 FR 17937, Mar. 23, 1979, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

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

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 81 FR 86457, Nov. 30, 2016]

§435.906. Opportunity to apply.

42 C.F.R. § 435.906

The agency must afford an individual wishing to do so the opportunity to apply for Medicaid without delay.
Notes, amendments, and revision history

Source

Source: 44 FR 17937, Mar. 23, 1979, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

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

§435.907. Application.

42 C.F.R. § 435.907

(a)
Basis and implementation. In accordance with section 1413(b)(1)(A) of the Affordable Care Act, the agency must accept an application from the applicant, an adult who is in the applicant's household, as defined in § 435.603(f), or family, as defined in section 36B(d)(1) of the Code, an authorized representative, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant, and any documentation required to establish eligibility—
(1)
Via the internet Web site described in § 435.1200(f) of this part;
(2)
By telephone;
(3)
Via mail;
(4)
In person; and
(5)
Through other commonly available electronic means.
(b)
The application must be—
(1)
The single, streamlined application for all insurance affordability programs developed by the Secretary; or
(2)
An alternative single, streamlined application for all insurance affordability programs, which may be no more burdensome on the applicant than the application described in paragraph (b)(1) of this section, approved by the Secretary.
(c)
For individuals applying, or who may be eligible, for assistance on a basis other than the applicable MAGI standard in accordance with § 435.911(c)(2) of this part, the agency may use either—
(1)
An application described in paragraph (b) of this section and supplemental forms to collect additional information needed to determine eligibility on such other basis; or
(2)
An application designed specifically to determine eligibility on a basis other than the applicable MAGI standard. Such application must minimize burden on applicants.
(3)
Any MAGI-exempt applications and supplemental forms in use by the agency must be submitted to the Secretary.
(d)
Prohibition on requiring in-person interviews. The agency may not require an in-person interview as part of the application process for a determination of eligibility using MAGI-based income. This paragraph (d) sunsets on October 1, 2034. CMS will follow applicable rulemaking procedures to ensure that policy governing in-person interviews are implemented and effective on October 1, 2034, replacing the policy scheduled to sunset on that date for the period until October 1, 2034.
(e)
Limits on information.
(1)
The agency may only require an applicant to provide the information necessary to make an eligibility determination or for a purpose directly connected to the administration of the State plan.
(2)
The agency may request information necessary to determine eligibility for other insurance affordability or benefit programs.
(3)
The agency may request a non-applicant's SSN provided that—
(i)
Provision of such SSN is voluntary;
(ii)
Such SSN is used only to determine an applicant's or beneficiary's eligibility for Medicaid or other insurance affordability program or for a purpose directly connected to the administration of the State plan; and
(iii)
At the time such SSN is requested, the agency provides clear notice to the individual seeking assistance, or person acting on such individual's behalf, that provision of the non-applicant's SSN is voluntary and information regarding how the SSN will be used.
(f)
The agency must require that all initial applications are signed under penalty of perjury. Electronic, including telephonically recorded, signatures and handwritten signatures transmitted via any other electronic transmission must be accepted.
(g)
Any application or supplemental form must be accessible to persons who are limited English proficient and persons who have disabilities, consistent with § 435.905(b) of this subpart.
(h)
Reinstatement of withdrawn applications.
(1)
In the case of individuals described in paragraph (h)(2) of this section, the agency must reinstate the application submitted by the individual, effective as of the date the application was first received by the Exchange.
(2)
Individuals described in this paragraph are individuals who—
(i)
Submitted an application described in paragraph (b) of this section to the Exchange;
(ii)
Withdrew their application for Medicaid in accordance with 45 CFR 155.302(b)(4)(A);
(iii)
Are assessed as potentially eligible for Medicaid by the Exchange appeals entity.
Notes, amendments, and revision history

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013; 89 FR 22867, Apr. 2, 2024; 91 FR 33480, June 3, 2026]

Source

Source: 44 FR 17937, Mar. 23, 1979, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

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

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013; 89 FR 22867, Apr. 2, 2024; 91 FR 33480, June 3, 2026]

§435.908. Assistance with application and renewal.

42 C.F.R. § 435.908

(a)
The agency must provide assistance to any individual seeking help with the application or renewal process in person, over the telephone, and online, and in a manner that is accessible to individuals with disabilities and those who are limited English proficient, consistent with § 435.905(b) of this subpart.
(b)
The agency must allow individual(s) of the applicant or beneficiary's choice to assist in the application process or during a renewal of eligibility.
(c)
Certified Application Counselors.
(1)
At State option, the agency may certify staff and volunteers of State-designated organizations to act as application assisters, authorized to provide assistance to applicants and beneficiaries with the application process and during renewal of eligibility. To be certified, application assisters must be—
(i)
Authorized and registered by the agency to provide assistance at application and renewal;
(ii)
Effectively trained in the eligibility and benefits rules and regulations governing enrollment in a QHP through the Exchange and all insurance affordability programs operated in the State, as implemented in the State; and
(iii)
Trained in and adhere to all rules regulations relating to the safeguarding and confidentiality of information and prohibiting conflict of interest, including regulations set forth at part 431, subpart F of this chapter, and at 45 CFR 155.260(f), regulations relating to the prohibition against reassignment of provider claims specified in § 447.10 of this chapter, and all other State and Federal laws concerning conflicts of interest and confidentiality of information.
(2)
For purposes of this section, assistance includes providing information on insurance affordability programs and coverage options, helping individuals complete an application or renewal, working with the individual to provide required documentation, submitting applications and renewals to the agency, interacting with the agency on the status of such applications and renewals, assisting individuals with responding to any requests from the agency, and managing their case between the eligibility determination and regularly scheduled renewals. Application assisters may be certified by the agency to act on behalf of applicants and beneficiaries for one, some or all of the permitted assistance activities.
(3)
If the agency elects to certify application assisters, it must establish procedures to ensure that—
(i)
Applicants and beneficiaries are informed of the functions and responsibilities of certified application assisters;
(ii)
Individuals are able to authorize application assisters to receive confidential information about the individual related to the individual's application for or renewal of Medicaid; and
(iii)
The agency does not disclose confidential applicant or beneficiary information to an application assister unless the applicant or beneficiary has authorized the application assister to receive such information.
(4)
Application assisters may not impose, accept or receive payment or compensation in any form from applicants or beneficiaries for application assistance.
Notes, amendments, and revision history

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]

Source

Source: 44 FR 17937, Mar. 23, 1979, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

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

Amendments

[77 FR 17208, Mar. 23, 2012, as amended at 78 FR 42302, July 15, 2013]