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 G—General Financial Eligibility Requirements and Options

42 C.F.R. § 435.622

Individuals in institutions who are eligible under a special income level

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(a) If an agency, under § 435.231, provides Medicaid to individuals in medical institutions, nursing facilities, and intermediate care facilities for Individuals with Intellectual Disabilities who would not be eligible for SSI or State supplements if they were not institutionalized, the agency must use income standards based on the greater need for financial assistance that the individuals would have if they were not in the institution. The standards may vary by the level of institutional care needed by the individual (hospital, nursing facility, or intermediate level care for individuals with intellectual disabilities), or by other factors related to individual needs. (See § 435.1005 for FFP limits on income standards established under this section.)

(b) In determining the eligibility of individuals under the income standards established under this section, the agency must not take into account income that would be disregarded in determining eligibility for SSI or for an optional State supplement.

(c) The agency must apply the income standards established under this section effective with the first day of a period of not less than 30 consecutive days of institutionalization.

[43 FR 45204, Sept. 29, 1978, as amended at 45 FR 24884, Apr. 11, 1980; 53 FR 3595, Feb. 8, 1988. Redesignated and amended at 58 FR 4932, Jan. 19, 1993]
Notes of Decisions
Cited in 2 cases, 1996–2010 · leading case: J.P. v. Missouri State Fam. Support Div., 318 S.W.3d 140 (Mo. Ct. App. 2010).
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J.P. v. Missouri State Fam. Support Div., 318 S.W.3d 140 (Mo. Ct. App. 2010). “” 42 C.F.R. § 435.622 (b). Federal statutory law further provides that “[t]he methodology utilized to determine eligibility for services by the state cannot be more restrictive than the methodology utilized by the federal government.”
Rodriguez ex rel. Corella v. Chen, 985 F. Supp. 1189 (D. Ariz. 1996). “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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