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. § 435.211

Optional eligibility for individuals who would be eligible for cash assistance if they were not in medical institutions

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(a) Basis. This section implements section 1902(a)(10)(A)(ii)(IV) of the Act.

(b) Eligibility. The agency may provide Medicaid to any group or groups of individuals specified in § 435.201(a)(1) through (3) who are institutionalized in a title XIX reimbursable medical institution and who:

(1) Are ineligible for the SSI or an optional State supplement program in States that provide Medicaid to optional State supplement recipients, because of lower income standards used under the program to determine eligibility for institutionalized individuals; but

(2) Would be eligible for aid or assistance under SSI or an optional State supplement program (as specified in § 435.232 or § 435.234) if they were not institutionalized.

[81 FR 86452, Nov. 30, 2016]
Notes of Decisions
Cited in 2 cases, 1980–1982 · leading case: Herweg v. Ray, 619 F.2d 1265 (8th Cir. 1980).
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Herweg v. Ray, 619 F.2d 1265 (8th Cir. 1980). · cites it 7× “210 ; (2) those who are ineligible for SSI because of lower income standards used to determine eligibility for institutionalized individuals, but who would be SSI eligible if not institutionalized, 42 C.F.R. § 435.211 ; and (3) institutionalized individuals who are not SSI…”
State of New Jersey v. Dep't of Health & Human Servs., 670 F.2d 1284 (3rd Cir. 1982). “) (current version at 42 C.F.R. § 435.211 ). B With this general statutory and regulatory background in mind, we proceed to discuss the facts involved in this particular appeal.”
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