(a)(1) This section only applies to individuals excepted from application of MAGI-based methods in accordance with § 435.603(j).
(2) Basic requirements. Subject to the provisions of paragraphs (b) and (c) of this section, in determining financial responsibility of relatives and other persons for individuals under Medicaid, the agency must apply the following requirements and methodologies:
(i) Except for a spouse of an individual or a parent for a child who is under age 21 or blind or disabled, the agency must not consider income and resources of any relative as available to an individual.
(ii) In relation to individuals under age 21 (as described in section 1905(a)(i) of the Act), the financial responsibility requirements and methodologies that apply include considering the income and resources of parents or spouses whose income and resources will be considered if the individual under age 21 were dependent under the State's approved State plan under title IV-A of the Act in effect as of July 16, 1996, whether or not they are actually contributed, except as specified under paragraph (c) of this section. These requirements and methodologies must be applied in accordance with the provisions of the State's approved title IV-A State plan as of July 16, 1996.
(iii) When a couple ceases to live together, the agency must count only the income of the individual spouse in determining his or her eligibility, beginning the first month following the month the couple ceases to live together.
(iv) In the case of eligible institutionalized spouses who are aged, blind, and disabled and who have shared the same room in a title XIX Medicaid institution, the agency has the option of considering these couples as eligible couples for purposes of counting income and resources or as eligible individuals, whichever is more advantageous to the couple.
(b) Requirements for States using more restrictive requirements. Subject to the provisions of paragraph (c) of this section, in determining financial eligibility of aged, blind, or disabled individuals in States that apply eligibility requirements more restrictive than those used under SSI, the agency must apply:
(1) The requirements and methodologies for financial responsibility of relatives used under the SSI program; or
(2) More extensive requirements for relative responsibility than specified in § 435.602(a) but no more extensive than the requirements under the Medicaid plan in effect on January 1, 1972.
(c) Use of less restrictive methodologies. The agency may apply income and resources methodologies that are less restrictive than those used under the cash assistance programs as specified in the State Medicaid plan in accordance with § 435.601(d).
(d) [Reserved]
[58 FR 4930, Jan. 19, 1993, as amended at 59 FR 43052, Aug. 22, 1994; 81 FR 86456, Nov. 30, 2016]
Notes of Decisions
Cited in
17
cases, 1981–2008 · leading case:
Markva v. Haveman, 168 F. Supp. 2d 695 (E.D. Mich. 2001).
Markva v. Haveman, 168 F. Supp. 2d 695 (E.D. Mich. 2001).
· cites it 4× “42 C.F.R. § 435.602 (a)(1). The defendants argue that the anti-deeming provisions in the statute and regulation prevent state agencies from treating as available the income or resources of anyone except an applicant’s spouse or parent in determining eligibility and amount of the…”
Reed v. Blinzinger, 639 F. Supp. 130 (S.D. Ind. 1986).
· cites it 4× “§ 1396a(a)(17)(D); 42 C.F.R. § 435.602 . Under § 2640, all siblings living in a household must now be included in the filing unit for AFDC benefits and have their income counted.”
Steuben Cnty. Dep't of Soc. Servs. v. Deats, 560 N.E.2d 760 (NY 1990).
· cites it 3× “Respondent relies on a Federal statutory provision governing the determination of an applicant’s Medicaid eligibility (42 USC § 1396a [a] [17] [D]) and on a regulation limiting the class of individuals who can be required to reimburse State agencies for the Medicaid expenditures…”
Shaffer-Doan Ex Rel. Doan v. COM., DPW, 960 A.2d 500 (Pa. Commw. Ct. 2008).
· cites it 2× “§ 4321(2); see generally 42 CFR § 435.602 (requiring agencies to consider income and resources of parents of children, when the children are under the age of 21, or are "blind and disabled").”
Sundberg v. Mansour, 627 F. Supp. 616 (W.D. Mich. 1986).
· cites it 2× “The regulation implementing this provision states: “(a) Except for a spouse of an individual or a parent for a child who is under age 21 or blind or disabled, the agency must not — (1) Consider income and resources of any relative available to an individual_” 42 C.F.R. § 435.602…”
Markva v. Haveman, 317 F.3d 547 (6th Cir. 2003).
· cites it 4× “” The regulation in 42 C.F.R. § 435.602 , in turn, provides: Financial responsibility of relatives and other individuals.”
Vance v. Hegstrom, 793 F.2d 1018 (9th Cir. 1986).
· cites it 2× “” Title 42 C.F.R. § 435.602 , entitled “Limitation on the financial responsibility of relatives,” refers only to the spouse of an individual or a parent of a child who is under twenty-one or blind or disabled.”
In re the Est. of Imburgia, 127 Misc. 2d 756 (N.Y. Sur. Ct. 1984).
· cites it 2× “However, the regulations amplify the code provision by not only prohibiting deeming from any relative other than a spouse or parent, but also prohibiting collecting any reimbursement from any relative, except a spouse or parent (42 CFR 435.602). The executors’ argument that the…”
Gibson v. Puett, 630 F. Supp. 542 (M.D. Tenn. 1985).
“” 42 C.F.R. 435.602. In addition, another Medicaid regulation provides that each “state Medicaid agency must provide Medicaid to individuals who would be eligible for AFDC except for an eligibility requirement used in that program that is specifically prohibited under Title XIX.”
Rosado v. Bowen, 698 F. Supp. 1191 (D.N.J. 1987).
· cites it 2× “§ 1396a(a)(17)(D), and its implementing regulations, 42 C.F.R. § 435.602 (a)(1) and 435.113 (Complaint, Sixth Cause of Action, ¶ 82); and (7) forcing plaintiffs to use Title II benefits for other than their intended use violates plaintiffs’ Due Process and Equal Protection…”
Olson v. Reagen, 631 F. Supp. 154 (S.D. Iowa 1986).
“§ 1396a(a)(17)(D); 42 C.F.R. 435.602 (implementing regulation).”
Rodriguez ex rel. Corella v. Chen, 985 F. Supp. 1189 (D. Ariz. 1996).
“601, 42 CFR 435.602, 42 CFR 435.622 The Cahills also did not understand from the information given as to why their applications for QMB and SLMB benefits had been *1193 denied.”
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