---
kind: "section"
citation: "42 U.S.C. § 1396u–1"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1396u–1"
heading: "Assuring coverage for certain low-income families"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1396u-1"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XIX — Grants to States for Medical Assistance Programs"
---

# §1396u–1. Assuring coverage for certain low-income families

- (a) **References to subchapter IV–A are references to pre-welfare-reform provisions—** Subject to the succeeding provisions of this section, with respect to a [State](/usc/42/619.md?p=5) any reference in this subchapter (or any other provision of law in relation to the operation of this subchapter) to a provision of part A of subchapter IV, or a [State](/usc/42/619.md?p=5) plan under such part (or a provision of such a plan), [including](/usc/42/1301.md?p=b) income and resource [standards](/usc/42/1320d.md?p=7) and income and resource methodologies under such part or plan, shall be considered a reference to such a provision or plan as in effect as of July 16, 1996, with respect to the [State](/usc/42/619.md?p=5).
- (b) **Application of pre-welfare-reform eligibility criteria—**
  - (1) **In general—** For purposes of this subchapter, subject to paragraphs [(2)](#b-2) and [(3)](#b-3), in determining eligibility for [medical assistance](/usc/42/1396d.md?p=a)—
    - (A) an individual shall be treated as receiving aid or assistance under a [State](/usc/42/619.md?p=5) plan approved under part A of subchapter IV only if the individual meets—
      - (i) the income and resource [standards](/usc/42/1320d.md?p=7) for determining eligibility under such plan, and
      - (ii) the eligibility requirements of such plan under subsections (a) through (c) of [section 606 of this title](/usc/42/606.md) and [section 607(a) of this title](/usc/42/607.md?p=a),

      as in effect as of July 16, 1996; and

    - (B) the income and resource methodologies under such plan as of such date shall be used in the determination of whether any individual meets income and resource [standards](/usc/42/1320d.md?p=7) under such plan.
  - (2) **State option—** For purposes of applying this section, a [State](/usc/42/619.md?p=5)—
    - (A) may lower its income [standards](/usc/42/1320d.md?p=7) applicable with respect to part A of subchapter IV, but not below the income [standards](/usc/42/1320d.md?p=7) applicable under its [State](/usc/42/619.md?p=5) plan under such part on May 1, 1988;
    - (B) may increase income or resource [standards](/usc/42/1320d.md?p=7) under the [State](/usc/42/619.md?p=5) plan referred to in [paragraph (1)](#b-1) over a period (beginning after July 16, 1996) by a percentage that does not exceed the percentage increase in the Consumer Price Index for all urban consumers (all items; [United States](/usc/42/1301.md?p=a-2) city average) over such period; and
    - (C) may use income and resource methodologies that are less restrictive than the methodologies used under the [State](/usc/42/619.md?p=5) plan under such part as of July 16, 1996.
  - (3) **Option to terminate medical assistance for failure to meet work requirement—**
    - (A) **Individuals receiving cash assistance under TANF—** In the case of an individual who—
      - (i) is receiving cash assistance under a [State](/usc/42/619.md?p=5) program funded under part A of subchapter IV,
      - (ii) is eligible for [medical assistance](/usc/42/1396d.md?p=a) under this subchapter on a basis not related to [section 1396a(l)](/usc/42/1396a.md?p=l) of this title, and
      - (iii) has the cash assistance under such program terminated pursuant to [section 607(e)(1)(B) of this title](/usc/42/607.md?p=e-1-B) (as in effect on or after the welfare reform effective date) because of refusing to work,

      the [State](/usc/42/619.md?p=5) may terminate such individual’s eligibility for [medical assistance](/usc/42/1396d.md?p=a) under this subchapter until such time as there no longer is a basis for the termination of such cash assistance because of such refusal.

    - (B) **Exception for children—** [Subparagraph (A)](#b-3-A) shall not be construed as permitting a [State](/usc/42/619.md?p=5) to terminate [medical assistance](/usc/42/1396d.md?p=a) for a [minor child](/usc/42/619.md?p=2) who is not the head of a household receiving assistance under a [State](/usc/42/619.md?p=5) program funded under part A of subchapter IV.
- (c) **Treatment for purposes of transitional coverage provisions—**
  - (1) **Transition in the case of child support collections—** The provisions of [section 606(h) of this title](/usc/42/606.md) (as in effect on July 16, 1996) shall apply, in relation to this subchapter, with respect to individuals (and families composed of individuals) who are described in [subsection (b)(1)(A)](#b-1-A), in the same manner as they applied before such date with respect to individuals who became ineligible for aid to families with dependent children as a result (wholly or partly) of the collection of [child](/usc/42/1382c.md?p=c) or spousal support under part D of subchapter IV.
  - (2) **Transition in the case of earnings from employment—** For continued [medical assistance](/usc/42/1396d.md?p=a) in the case of individuals (and families composed of individuals) described in [subsection (b)(1)(A)](#b-1-A) who would otherwise become ineligible because of hours or income from employment, see sections [1396r–6](/usc/42/1396r–6.md) and [1396a(e)(1)](/usc/42/1396a.md?p=e-1) of this title.
- (d) **Waivers—** In the case of a waiver of a provision of part A of subchapter IV in effect with respect to a [State](/usc/42/619.md?p=5) as of July 16, 1996, or which is submitted to the [Secretary](/usc/42/1301.md?p=a-6) before August 22, 1996, and approved by the [Secretary](/usc/42/1301.md?p=a-6) on or before July 1, 1997, if the waiver affects eligibility of individuals for [medical assistance](/usc/42/1396d.md?p=a) under this subchapter, such waiver may (but need not) continue to be applied, at the option of the [State](/usc/42/619.md?p=5), in relation to this subchapter after the date the waiver would otherwise expire.
- (e) **State option to use 1 application form—** Nothing in this section, or part A of subchapter IV, shall be construed as preventing a [State](/usc/42/619.md?p=5) from providing for the same application form for assistance under a [State](/usc/42/619.md?p=5) program funded under part A of subchapter IV (on or after the welfare reform effective date) and for [medical assistance](/usc/42/1396d.md?p=a) under this subchapter.
- (f) **Additional rules of construction—**
  - (1) With respect to the reference in [section 1396a(a)(5) of this title](/usc/42/1396a.md?p=a-5) to a [State](/usc/42/619.md?p=5) plan approved under part A of subchapter IV, a [State](/usc/42/619.md?p=5) may treat such reference as a reference either to a [State](/usc/42/619.md?p=5) program funded under such part (as in effect on and after the welfare reform effective date) or to the [State](/usc/42/619.md?p=5) plan under this subchapter.
  - (2) Any reference in [section 1396a(a)(55) of this title](/usc/42/1396a.md?p=a-55) to a [State](/usc/42/619.md?p=5) plan approved under part A of subchapter IV shall be deemed a reference to a [State](/usc/42/619.md?p=5) program funded under such part.
  - (3) In applying [section 1396b(f) of this title](/usc/42/1396b.md?p=f), the applicable income limitation otherwise determined shall be subject to increase in the same manner as income or resource [standards](/usc/42/1320d.md?p=7) of a [State](/usc/42/619.md?p=5) may be increased under [subsection (b)(2)(B)](#b-2-B).
- (g) **Relation to other provisions—** The provisions of this section shall apply notwithstanding any other provision of this chapter.
- (h) **Transitional increased Federal matching rate for increased administrative costs—**
  - (1) **In general—** Subject to the succeeding provisions of this subsection, the [Secretary](/usc/42/1301.md?p=a-6) shall provide that with respect to administrative expenditures described in [paragraph (2)](#h-2) the per centum specified in [section 1396b(a)(7) of this title](/usc/42/1396b.md?p=a-7) shall be increased to such percentage as the [Secretary](/usc/42/1301.md?p=a-6) specifies.
  - (2) **Administrative expenditures described—** The administrative expenditures described in this paragraph are expenditures described in [section 1396b(a)(7) of this title](/usc/42/1396b.md?p=a-7) that a [State](/usc/42/619.md?p=5) demonstrates to the satisfaction of the [Secretary](/usc/42/1301.md?p=a-6) are attributable to administrative costs of eligibility determinations that (but for the enactment of this section) would not be incurred.
  - (3) **Limitation—** The total amount of additional Federal funds that are expended as a result of the application of this subsection for the period beginning with [fiscal year](/usc/42/619.md?p=3) 1997 shall not exceed $500,000,000. In applying this paragraph, the [Secretary](/usc/42/1301.md?p=a-6) shall ensure the equitable distribution of additional funds among the [States](/usc/42/619.md?p=5).
- (i) **Welfare reform effective date—** In this section, the term “welfare reform effective date” means the effective date, with respect to a [State](/usc/42/619.md?p=5), of title I of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (as specified in section 116 of such Act).

## Source credit

(Aug. 14, 1935, ch. 531, title XIX, § 1931, as added Pub. L. 104–193, title I, § 114(a)(2), Aug. 22, 1996, 110 Stat. 2177; amended Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 602(a)], Nov. 29, 1999, 113 Stat. 1536, 1501A–394.)

## Notes

### Editorial Notes

### References in Text

For effective date, with respect to a State, of title I of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (as specified in section 116 of such Act), referred to in subsec. (i), see section 116 of Pub. L. 104–193, set out as an Effective Date note under section 601 of this title.

### Prior Provisions

A prior section 1931 of act Aug. 14, 1935, was renumbered section 1939 and is classified to section 1396v of this title.

### Amendments

1999—Subsec. (h)(3). Pub. L. 106–113, § 1000(a)(6) [title VI, § 602(a)(1)], struck out “and ending with fiscal year 2000” after “fiscal year 1997”.

Subsec. (h)(4). Pub. L. 106–113, § 1000(a)(6) [title VI, § 602(a)(2)], struck out heading and text of par. (4). Prior to amendment, text read as follows: “This subsection shall only apply with respect to a State for expenditures incurred during the first 12 calendar quarters in which the State program funded under part A of subchapter IV of this chapter (as in effect on and after the welfare reform effective date) is in effect.”

### Statutory Notes and Related Subsidiaries

### Effective Date of 1999 Amendment

Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 602(b)], Nov. 29, 1999, 113 Stat. 1536, 1501A–394, provided that: “The amendments made by this section [amending this section] shall take effect as if included in the enactment of section 114 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104–193; 110 Stat. 2177).”

### Effective Date

Section effective July 1, 1997, with transition rules relating to State options to accelerate such date, rules relating to claims, actions, and proceedings commenced before such date, rules relating to closing out of accounts for terminated or substantially modified programs and continuance in office of Assistant Secretary for Family Support, and provisions relating to termination of entitlement under AFDC program, see section 116 of Pub. L. 104–193, as amended, set out as a note under section 601 of this title.