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. § 435.915

Effective date

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(a) The agency must make eligibility for Medicaid effective no later than the third month before the month of application if the individual—

(1) Received Medicaid services, at any time during that period, of a type covered under the plan; and

(2) Would have been eligible for Medicaid at the time he received the services if he had applied (or someone had applied for him), regardless of whether the individual is alive when application for Medicaid is made.

(b) The agency may make eligiblity for Medicaid effective on the first day of a month if an individual was eligible at any time during that month.

(c) The State plan must specify the date on which eligibility will be made effective.

[44 FR 17937, Mar. 23, 1979. Redesignated at 77 FR 17209, Mar. 23, 2012]
Notes of Decisions
Cited in 3 cases (1 in the last 5 years), 2014–2025 · leading case: Mykonos v. United States, 59 F. Supp. 3d 100 (D.D.C. 2014).
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Mykonos v. United States, 59 F. Supp. 3d 100 (D.D.C. 2014). “See 42 C.F.R. § 435.915 (a)(1). Mykonos alleges that on November 6, 2013, she -was wrongfully denied enrollment in Medicaid by D.”
Jideani v. Dist. of Columbia, No. 2024-1771 (D.D.C. May 20, 2025). “at 102–03 (citing 42 C.F.R. § 435.915 (a)(1)); see also 20 C.”
Price v. Medicaid Dir., 310 F.R.D. 345 (S.D. Ohio 2015). “42 C.F.R. § 435.915 (b). Ohio has adopted the "first day of the month” rule and has opted to begin Medicaid coverage the first day of the month if that individual meets all eligibility requirements.”
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