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 B—Mandatory Coverage

42 C.F.R. § 435.135

Individuals who become ineligible for cash assistance as a result of OASDI cost-of-living increases received after April 1977

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(a) If an agency provides Medicaid to aged, blind, or disabled individuals receiving SSI or State supplements, it must provide Medicaid to individuals who—

(1) Are receiving OASDI;

(2) Were eligible for and receiving SSI or State supplements but became ineligible for those payments after April 1977; and

(3) Would still be eligible for SSI or State supplements if the amount of OASDI cost-of-living increases paid under section 215(i) of the Act, after the last month after April 1977 for which those individuals were both eligible for and received SSI or a State supplement and were entitled to OASDI, were deducted from current OASDI benefits.

(b) Cost-of-living increases include the increases received by the individual or his or her financially responsible spouse or other family member (e.g., a parent).

(c) If the agency adopts more restrictive eligibility requirements than those under SSI, it must provide Medicaid to individuals specified in paragraph (a) of this section on the same basis as Medicaid is provided to individuals continuing to receive SSI or State supplements. If the individual incurs enough medical expenses to reduce his or her income to the financial eligibility standard for the categorically needy, the agency must cover that individual as categorically needy. In determining the amount of his or her income, the agency may deduct the cost-of-living increases paid under section 215(i) after the last month after April 1977 for which that individual was both eligible for and received SSI or a State supplement and was entitled to OASDI, up to the amount that made him or her ineligible for SSI.

[51 FR 12330, Apr. 10, 1986]
Notes of Decisions
Cited in 10 cases, 1979–2017 · leading case: Stenson v. Blum, 476 F. Supp. 1331 (S.D.N.Y. 1979).
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Stenson v. Blum, 476 F. Supp. 1331 (S.D.N.Y. 1979). “As an example, under 42 C.F.R. § 435.135 , a person who becomes financially ineligible for SSI because of a cost of living increase in his Social Security benefits remains eligible to receive Medicaid benefits as a former SSI recipient.”
Alberta NOLAND, Et Al., Appellants, v. Donna SHALALA, Sec'y of Dep't of Health & Human Servs., Appellee, 12 F.3d 258 (D.C. Cir. 1994). · cites it 2× “2 The regulation disputed here, 42 CFR § 435.135 , addresses the effect of the Pickle Amendment in both SSI and 209(b) states.”
Ciampa v. Schweiker, 511 F. Supp. 670 (D. Mass. 1981). · cites it 2× “They challenge a federal regulation at 42 C.F.R. § 435.135 (1979) and state regulations in the Massachusetts Public Assistance Policy Manual (MPAPM) ch.”
Crippen v. Kheder, 741 F.2d 102 (6th Cir. 1984). · cites it 2× “This supposedly follows from 42 C.F.R. § 435.135 (a) which provides: *106 (a) If an agency provides medicaid to aged, blind, or disabled individuals receiving SSI or optional state supplements, it must provide medicaid to individuals who— (1) Are receiving OASDI; (2) Were…”
Lynch v. Rank, 604 F. Supp. 30 (N.D. Cal. 1984). “ther with her agents, employees, and representatives, their successors in interest, and all persons acting in concert or participating with them, are hereby perpetually enjoined and restrained from permitting or requiring any state to deny Medicaid benefits to persons otherwise…”
Lynch v. Rank, 747 F.2d 528 (9th Cir. 1984). “” 42 C.F.R. § 435.135 (1983). To comply with this regulation, DHS chose to restrict the applicability of the amendment to persons who had become ineligible for SSI “solely” because of an OASDI cost-of-living increase.”
Lynch v. Rank, 639 F. Supp. 69 (N.D. Cal. 1985). “On March 9, 1984, this Court, inter alia, permanently enjoined the Secretary “and all persons acting in concert or participating” with her from “permitting or requiring any state to deny Medicaid benefits to persons otherwise entitled thereto under the Pickle Amendment, on the…”
Noland v. Sullivan, 785 F. Supp. 179 (D.D.C. 1992). · cites it 2× “42 C.F.R. § 435.135 (c) (1990) (emphasis added).”
In re the Matter of: Verdell Fredrick Borth v. Comm'r, Minnesota Dep't of Human Servs., Carver Cnty. (Minn. Ct. App. 2017). · cites it 3× “42 C.F.R. § 435.135 (a) (2015). To qualify for the Pickle disregard, Borth must establish three elements: (1) he receives or is entitled to SSDI; (2) he is eligible for and receiving SSI or Minnesota Supplemental Aid (MSA) in any one month concurrently since April 1977; and, (3)…”
Rick Earl v. Dr. Raquel Hatter, Comm'r, Tennessee Dep't of Human Servs. (Tenn. Ct. App. 2012). “§ 1396 (a) and made a regulation at 42 C.F.R. 435.135; it has been adopted in Tennessee at Tenn.”
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