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 C—Options for Coverage

42 C.F.R. § 435.201

Individuals included in optional groups

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(a) The agency may choose to cover as optional categorically needy any group or groups of the following individuals who are not receiving cash assistance and who meet the appropriate eligibility criteria for groups specified in the separate sections of this subpart:

(1) Aged individuals (65 years of age of older);

(2) Blind individuals (as defined in § 435.530);

(3) Disabled individuals (as defined in § 435.541);

(4) Individuals under age 21 (or, at State option, under age 20, 19, or 18) or reasonable classifications of these individuals; and

(5) Parents and other caretaker relatives (as defined in § 435.4).

(b) If the agency provides Medicaid to any individual in an optional group specified in paragraph (a) of this section, the agency must provide Medicaid to all individuals who apply and are found eligible to be members of that group.

(c) States that elect to use more restrictive eligibility requirements for Medicaid than the SSI requirements for any group or groups of aged, blind, and disabled individuals under § 435.121 must apply the specific requirements of § 435.230 in establishing eligibility of these groups of individuals as optional categorically needy.

[58 FR 4927, Jan. 19, 1993, as amended at 81 FR 86452, Nov. 30, 2016]
Notes of Decisions
Cited in 3 cases, 2001–2020 · leading case: Indiana Fam. & Soc. Servs. Admin. v. Lance Patterson, 119 N.E.3d 99 (Ind. Ct. App. 2019).
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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); 42 C.F.R. § 435.201 ; Herweg v. Ray, 455 U.”
G.C. Vs. Div. of Med. Assistance & Health Servs. & Ocean Cnty. Bd. of Soc. Servs. E.M. Vs. Div. of Med. Assistance & Health Servs. & Essex Cnty. Bd. of Soc. Servs. (Div. of Med. Assistance & Health Servs.) (Consol.) (N.J. Super. Ct. App. Div. 2020). “See also 42 CFR 435.201(a)(1) — (3) (allowing states to provide coverage to aged, blind and disabled "as optional categorically needy" individuals).”
Townsend v. Quasim, 163 F. Supp. 2d 1281 (W.D. Wash. 2001). “§§ 1396a(a)(10)(A)(ii), 1396d(a); 42 C.F.R. § 435.201 . The State Medicaid Plan may also cover “medically needy” persons whose income exceeds the categorically needy income eligibility limit.”
— 42 C.F.R. § 435.201(a)(1) — 1 case
G.C. Vs. Div. of Med. Assistance & Health Servs. & Ocean Cnty. Bd. of Soc. Servs. E.M. Vs. Div. of Med. Assistance & Health Servs. & Essex Cnty. Bd. of Soc. Servs. (Div. of Med. Assistance & Health Servs.) (Consol.) (N.J. Super. Ct. App. Div. 2020). “See also 42 CFR 435.201(a)(1) — (3) (allowing states to provide coverage to aged, blind and disabled "as optional categorically needy" individuals).”
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