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. § 435.926

Continuous eligibility for children

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(a) Basis. This section implements section 1902(e)(12) of the Act.

(b) Eligibility. The agency must provide continuous eligibility for the period specified in paragraph (c) of this section for an individual who is:

(1) Under age 19; and

(2) Eligible and enrolled for mandatory or optional coverage under the State plan in accordance with subpart B or C of this part.

(c) Continuous eligibility period. (1) The length of the continuous eligibility period is 12 months.

(2) A continuous eligibility period begins on the effective date of the individual's eligibility under § 435.915 or most recent redetermination or renewal of eligibility under § 435.916 and ends after the period specified by the agency under paragraph (c)(1) of this section.

(d) Applicability. A child's eligibility may not be terminated during a continuous eligibility period, regardless of any changes in circumstances, unless:

(1) The child attains age 19;

(2) The child or child's representative requests a voluntary termination of eligibility;

(3) The child ceases to be a resident of the State;

(4) The agency determines that eligibility was erroneously granted at the most recent determination, redetermination or renewal of eligibility because of agency error or fraud, abuse, or perjury attributed to the child or the child's representative; or

(5) The child dies.

[81 FR 86458, Nov. 30, 2016, as amended at 89 FR 94591, Nov. 27, 2024]
Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2024–2024 · leading case: State of Florida v. Centers for Medicare & Medicaid Servs. (M.D. Fla. 2024).
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State of Florida v. Centers for Medicare & Medicaid Servs. (M.D. Fla. 2024). “at 5–6; 42 C.F.R. §§ 435.926 (d), 457.342(b). CMS was, however, “still assessing how non-payment of premiums intersects with [continuous eligibility] under the CAA.”
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