---
kind: "section"
citation: "42 C.F.R. § 436.1102"
title: "42"
number: "436.1102"
heading: "General rules."
url: "https://uscodex.org/cfr/42/436.1102"
---

# §436.1102. General rules.

- (a) The agency may provide services to children under age 19 during one or more periods of presumptive eligibility following a determination made by a qualified entity that the child's estimated gross family income or, at the State's option, the child's estimated family income after applying simple disregards, does not exceed the applicable income standard.
- (b) If the agency elects to provide services to children during a period of presumptive eligibility, the agency must—
  - (1) Provide qualified entities with application forms for Medicaid and information on how to assist parents, caretakers and other persons in completing and filing such forms;
  - (2) **Establish procedures to ensure that qualified entities—**
    - (i) Notify the parent or caretaker of the child at the time a determination regarding presumptive eligibility is made, in writing and orally if appropriate, of such determination;
    - (ii) Provide the parent or caretaker of the child with a Medicaid application form;
    - (iii) Within 5 working days after the date that the determination is made, notify the agency that a child is presumptively eligible;
    - (iv) For children determined to be presumptively eligible, notify the child's parent or caretaker at the time the determination is made, in writing and orally if appropriate, that—
      - (A) If a Medicaid application on behalf of the child is not filed by the last day of the following month, the child's presumptive eligibility will end on that last day; and
      - (B) If a Medicaid application on behalf of the child is filed by the last day of the following month, the child's presumptive eligibility will end on the day that a decision is made on the Medicaid application; and
    - (v) For children determined not to be presumptively eligible, notify the child's parent or caretaker at the time the determination is made, in writing and orally if appropriate—
      - (A) Of the reason for the determination; and
      - (B) That he or she may file an application for Medicaid on the child's behalf with the Medicaid agency; and
  - (3) **Provide all services covered under the plan, including EPSDT.**
  - (4) **Allow determinations of presumptive eligibility to be made by qualified entities on a Statewide basis.**
- (c) The agency must adopt reasonable standards regarding the number of periods of presumptive eligibility that will be authorized for a child in a given time frame.

## Notes

### Source

Source: 66 FR 2669, Jan. 11, 2001, unless otherwise noted.

### Authority

Authority: Sec. 1102 of the Social Security Act (42 U.S.C. 1302).

### Source

Source: 43 FR 45218, Sept. 29, 1978, unless otherwise noted.