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 J—Eligibility in the States and District of Columbia

42 C.F.R. § 435.909

Automatic entitlement to Medicaid following a determination of eligibility under other programs

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(a) Automatic enrollment of certain individuals in Medicaid. The agency must not require a separate application for Medicaid from an individual, if the agency has an agreement with the Social Security Administration (SSA) under section 1634 of the Act for determining Medicaid eligibility; and—

(1) The individual receives SSI;

(2) The individual receives a mandatory State supplement under either a federally-administered or State-administered program; or

(3) The individual receives an optional State supplement and the agency provides Medicaid to beneficiaries of optional supplements under § 435.230.

(b) Automatic enrollment of SSI recipients in the Qualified Medicare Beneficiary group. (1) The agency must deem individuals eligible for the Qualified Medicare Beneficiary group as described in § 400.200 of this chapter if the individual receives SSI and is determined eligible for medical assistance under § 435.120 or § 435.121; and—

(i) The individual is entitled to Part A under part 406, subpart B, of this chapter; or

(ii) The individual is entitled to Part A under § 406.20 of this chapter and the agency has a State buy-in agreement authorized under section 1843 of the Act and modified under section 1818(g) of the Act.

(2) The agency may deem individuals eligible for the Qualified Medicare Beneficiary group as described in § 400.200 of this chapter if the individual receives SSI and is determined eligible for medical assistance under §§ 435.120 or 435.121; and—

(i) The individual is entitled to Part A under § 406.5(b) of this chapter; and

(ii) The agency uses the group payer arrangement under § 406.32(g) of this chapter to pay Part A premiums for Qualified Medicare Beneficiaries.

(3) The automatic enrollment of SSI recipients in the Qualified Medicare Beneficiaries group described in paragraphs (b)(1) and (2) of this section is effective no earlier than the effective date of coverage under a buy-in agreement for individuals described in § 407.47(b) of this chapter.

[88 FR 65270, Sept. 21, 2023]
Notes of Decisions
Cited in 9 cases, 1979–2011 · leading case: Jones v. Blinziner, 536 F. Supp. 1181 (N.D. Ind. 1982).
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Jones v. Blinziner, 536 F. Supp. 1181 (N.D. Ind. 1982). · cites it 2× “42 C.F.R. Section 435.909. 20. Medicaid recipients which are going to be terminated, discontinued or suspended due to changes in the recipients’ circumstances or redetermination of the recipients’ eligibility require a notice which is adequate if it contains a statement of what…”
Massachusetts Ass'n of Older Americans v. Alexander Sharp, Ii, Etc., 700 F.2d 749 (1st Cir. 1983). “42 C.F.R. § 435.909 (a) (1981). Plaintiffs, thus, have never filed a separate application for Medicaid.”
Stenson v. Blum, 476 F. Supp. 1331 (S.D.N.Y. 1979). “See generally, 42 C.F.R. § 435.909 (1979). *1335 Class Certification Pursuant to Rule 23(a), 6 in conjunction with Rule 23(b)(2), Stenson has moved for class certification.”
Reynolds v. Giuliani, 35 F. Supp. 2d 331 (S.D.N.Y. 1999). “• Defendants’ policies[] and practices of failing to determine an individual’s eligibility for Medicaid separate from their eligibility for cash assistance violate plaintiffs’ and plaintiff class members’ rights under 42 C.F.R. § 435.909 . • Defendants’ policies[] and practices…”
Kessler v. Blum, 591 F. Supp. 1013 (S.D.N.Y. 1984). “The distinction between an initial application for a determination of Medicaid eligibility and an “application” by a Medicaid recipient (already determined to be Medicaid-eligible) for an additional medical service or supply is evidenced by 42 C.F.R. § 435.909 . That section…”
Doe v. South Carolina Dep't of Health & Human Servs., 727 S.E.2d 605 (S.C. 2011). “§ 1396a(a)(10)(A)(i)(II) (2006); 42 C.F.R. § 435.909 (b)(1) (2010); Pharm.”
Crippen v. Kheder, 741 F.2d 102 (6th Cir. 1984). “Since individuals receiving SSI may not be required to file a separate application for medicaid, 42 C.F.R. § 435.909 , the Department asserts that it must require an application from these individuals once their SSI benefits are terminated.”
Crippen v. Dempsey, 549 F. Supp. 643 (W.D. Mich. 1982). “42 C.F.R. § 435.909 . Once an application has been filed, the state agency has 60 days within which to determine eligibility and inform the applicant of its determination.”
Edwards v. Myers, 167 Cal. App. 3d 1070 (Cal. Ct. App. 1985). “) Moreover, the department urged that since persons receiving SSI are not required to file a separate application for Medicaid ( 42 C.F.R. § 435.909 ), such persons must file written applications for such benefits ( 42 C.”
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