C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA › Subpart K—Federal Financial Participation

42 C.F.R. § 435.1005

Beneficiaries in institutions eligible under a special income standard

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For beneficiaries in institutions whose Medicaid eligibility is based on a special income standard established under § 435.236, FFP is available in expenditures for services provided to those individuals only if their income before deductions, as determined by SSI budget methodology, does not exceed 300 percent of the SSI benefit amount payable under section 1611(b)(1) of the Act to an individual in his own home who has no income or resources.

[58 FR 4933, Jan. 19, 1993]
Notes of Decisions
Cited in 5 cases, 1980–2019 · leading case: Case of Hamner, 427 So. 2d 1188 (La. 1983).
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Case of Hamner, 427 So. 2d 1188 (La. 1983). “42 C.F.R. § 435.1005 (1980) provides that federal financial participation is available only if an applicant's income "does not exceed 300% of the SSI benefit amount payable under § 1611(b)(1)".”
Indiana Fam. & Soc. Servs. Admin. v. Lance Patterson, 119 N.E.3d 99 (Ind. Ct. App. 2019). · cites it 2× “§ 1396a(a)(10)(A)(ii)(V); 42 C.F.R. § 435.1005 . B. Medicaid Eligibility Determination [7] States participating in Medicaid must establish reasonable standards for determining eligibility, including the reasonable evaluation of an applicant’s income and resources.”
Georgia, Dep't of Med. Assistance ex rel. Toal v. Shalala, 8 F.3d 1565 (11th Cir. 1993). “In 1989, the Secretary published a "Notice of Proposed Rulemaking” that proposed an amendment to 42 C.F.R. § 435.1005 to specifically incorporate a reference to SSI methodology.”
Herweg v. Ray, 619 F.2d 1265 (8th Cir. 1980). “20) ( 42 C.F.R. § 435.1005 ), and (2) the applicant’s net income (gross monthly income less applicable SSI disregards) is less than Iowa’s higher income standard of $600/month.”
M.P. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.), No. A-5177-16T4 (N.J. Super. Ct. App. Div. Nov. 28, 2018). “236 and 42 CFR § 435.1005 . In order to determine medically necessary services in a A-5177-16T4 5 nursing home, a pre-admission screening (PAS) is completed by "professional staff designated by the Department, based on a comprehensive needs assessment which demonstrates that the…”
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