42 U.S.C. § 1383c

Eligibility for medical assistance of aged, blind, or disabled individuals under State’s medical assistance plan

Read at: OLRCuscode.house.gov CornellLII GovInfogovinfo.gov JustiaTitle 42 CasesGoogle Scholar

(a) Determination by Commissioner pursuant to agreement between Commissioner and State; costs

The Commissioner of Social Security may enter into an agreement with any State which wishes to do so under which the Commissioner will determine eligibility for medical assistance in the case of aged, blind, or disabled individuals under such State’s plan approved under subchapter XIX. Any such agreement shall provide for payments by the State, for use by the Commissioner of Social Security in carrying out the agreement, of an amount equal to one-half of the cost of carrying out the agreement, but in computing such cost with respect to individuals eligible for benefits under this subchapter, the Commissioner of Social Security shall include only those costs which are additional to the costs incurred in carrying out this subchapter.

(b) Preservation of benefit status for certain disabled widows and widowers(1) An eligible disabled widow or widower (described in paragraph (2)) who is entitled to a widow’s or widower’s insurance benefit based on a disability for any month under section 402(e) or (f) of this title but is not eligible for benefits under this subchapter in that month, and who applies for the protection of this subsection under paragraph (3), shall be deemed for purposes of subchapter XIX to be an individual with respect to whom benefits under this subchapter are paid in that month if he or she—(A) has been continuously entitled to such widow’s or widower’s insurance benefits from the first month for which the increase described in paragraph (2)(C) was reflected in such benefits through the month involved, and(B) would be eligible for benefits under this subchapter in the month involved if the amount of the increase described in paragraph (2)(C) in his or her widow’s or widower’s insurance benefits, and any subsequent cost-of-living adjustments in such benefits under section 415(i) of this title, were disregarded.(2) For purposes of paragraph (1), the term “eligible disabled widow or widower” means an individual who—(A) was entitled to a monthly insurance benefit under subchapter II for December 1983,(B) was entitled to a widow’s or widower’s insurance benefit based on a disability under section 402(e) or (f) of this title for January 1984 and with respect to whom a benefit under this subchapter was paid in that month, and(C) because of the increase in the amount of his or her widow’s or widower’s insurance benefits which resulted from the amendments made by section 134 of the Social Security Amendments of 1983 (Public Law 98–21) (eliminating the additional reduction factor for disabled widows and widowers under age 60), was ineligible for benefits under this subchapter in the first month in which such increase was paid to him or her (and in which a retroactive payment of such increase for prior months was not made).(3) This subsection shall only apply to an individual who files a written application for protection under this subsection, in such manner and form as the Commissioner of Social Security may prescribe, no later than July 1, 1988.(4) For purposes of this subsection, the term “benefits under this subchapter” includes payments of the type described in section 1382e(a) of this title or of the type described in section 212(a) of Public Law 93–66.(c) Loss of benefits upon entitlement to child’s insurance benefits based on disabilityIf any individual who has attained the age of 18 and is receiving benefits under this subchapter on the basis of blindness or a disability which began before he or she attained the age of 22—(1) becomes entitled, on or after the effective date of this subsection, to child’s insurance benefits which are payable under section 402(d) of this title on the basis of such disability or to an increase in the amount of the child’s insurance benefits which are so payable, and(2) ceases to be eligible for benefits under this subchapter because of such child’s insurance benefits or because of the increase in such child’s insurance benefits,such individual shall be treated for purposes of subchapter XIX as receiving benefits under this subchapter so long as he or she would be eligible for benefits under this subchapter in the absence of such child’s insurance benefits or such increase.(d) Retention of medicaid when SSI benefits are lost upon entitlement to early widow’s or widower’s insurance benefits(1) This subsection applies with respect to any person who—(A) applies for and obtains benefits under subsection (e) or (f) of section 402 of this title (or under any other subsection of section 402 of this title if such person is also eligible for benefits under such subsection (e) or (f)) being then not entitled to hospital insurance benefits under part A of subchapter XVIII, and(B) is determined to be ineligible (by reason of the receipt of such benefits under section 402 of this title) for supplemental security income benefits under this subchapter or for State supplementary payments of the type described in section 1382e(a) of this title (or payments of the type described in section 212(a) of Public Law 93–66).(2) For purposes of subchapter XIX, each person with respect to whom this subsection applies—(A) shall be deemed to be a recipient of supplemental security income benefits under this subchapter if such person received such a benefit for the month before the month in which such person began to receive a benefit described in paragraph (1)(A), and(B) shall be deemed to be a recipient of State supplementary payments of the type referred to in section 1382e(a) of this title (or payments of the type described in section 212(a) of Public Law 93–66) if such person received such a payment for the month before the month in which such person began to receive a benefit described in paragraph (1)(A),for so long as such person (i) would be eligible for such supplemental security income benefits, or such State supplementary payments (or payments of the type described in section 212(a) of Public Law 93–66), in the absence of benefits described in paragraph (1)(A), and (ii) is not entitled to hospital insurance benefits under part A of subchapter XVIII.(Aug. 14, 1935, ch. 531, title XVI, § 1634, as added Pub. L. 92–603, title III, § 301, Oct. 30, 1972, 86 Stat. 1478; amended Pub. L. 99–272, title XII, § 12202(a), Apr. 7, 1986, 100 Stat. 290; Pub. L. 99–643, § 6(a), Nov. 10, 1986, 100 Stat. 3578; Pub. L. 100–203, title IX, §§ 9108, 9116(a), Dec. 22, 1987, 101 Stat. 1330–302, 1330–305; Pub. L. 101–508, title V, § 5103(c)(1), Nov. 5, 1990, 104 Stat. 1388–251; Pub. L. 103–296, title I, § 107(a)(4), title II, § 201(b)(3)(D), Aug. 15, 1994, 108 Stat. 1478, 1504; Pub. L. 104–121, title I, § 105(b)(4)(B), Mar. 29, 1996, 110 Stat. 854.)Editorial NotesReferences in Text

Section 134 of the Social Security Amendments of 1983 (Public Law 98–21), referred to in subsec. (b)(2)(C), is section 134 of Pub. L. 98–21, title I, Apr. 20, 1983, 97 Stat. 97, which amended section 402 of this title and enacted provisions set out as a note under section 402 of this title.

Section 212(a) of Public Law 93–66, referred to in subsecs. (b)(4) and (d)(1)(B), (2), is section 212(a) of Pub. L. 93–66, title II, July 9, 1973, 87 Stat. 155, which is set out as a note under section 1382 of this title.

The effective date of this subsection, referred to in subsec. (c)(1), is July 1, 1987, except as otherwise provided. See section 10(b) of Pub. L. 99–643, set out as an Effective Date of 1986 Amendments note under section 1396a of this title.

Amendments

1996—Subsec. (e). Pub. L. 104–121 struck out subsec. (e) which read as follows: “Each person to whom benefits under this subchapter by reason of disability are not payable for any month solely by reason of clause (i) or (v) of section 1382(e)(3)(A) of this title shall be treated, for purposes of subchapter XIX of this chapter, as receiving benefits under this subchapter for the month.”

1994—Subsecs. (a), (b)(3). Pub. L. 103–296, § 107(a)(4), substituted “Commissioner of Social Security” for “Secretary” wherever appearing and “the Commissioner will” for “he will” in subsec. (a).

Subsec. (e). Pub. L. 103–296, § 201(b)(3)(D), added subsec. (e).

1990—Subsec. (d). Pub. L. 101–508 designated existing provisions as par. (1), substituted “This subsection applies with respect to any person who—” for “If any person—” in introductory provisions, redesignated former pars. (1) and (2) as subpars. (A) and (B), respectively, in subpar. (A) substituted “being then not entitled” for “as required by section 1382(e)(2) of this title, being then at least 60 years of age but not entitled”, in subpar. (B) substituted “section 1382e(a) of this title (or payments of the type described in section 212(a) of Public Law 93–66).” for “section 1382e(a) of this title,” and substituted par. (2) for former concluding provisions which read as follows: “such person shall nevertheless be deemed to be a recipient of supplemental security income benefits under this subchapter for purposes of subchapter XIX of this chapter, so long as he or she (A) would be eligible for such supplemental security income benefits, or such State supplementary payments, in the absence of such benefits under section 402 of this title, and (B) is not entitled to hospital insurance benefits under part A of subchapter XVIII of this chapter.”

1987—Subsec. (b)(3). Pub. L. 100–203, § 9108, substituted “no later than July 1, 1988” for “during the 15-month period beginning with the month in which this subsection is enacted [April 1986]”.

Subsec. (d). Pub. L. 100–203, § 9116(a), added subsec. (d).

1986—Subsec. (a). Pub. L. 99–272, § 12202(a)(1), designated existing provisions as subsec. (a).

Subsec. (b). Pub. L. 99–272, § 12202(a)(2), added subsec. (b).

Subsec. (c). Pub. L. 99–643 added subsec. (c).

Statutory Notes and Related SubsidiariesEffective Date of 1996 Amendment

Amendment by Pub. L. 104–121 applicable to any individual who applies for, or whose claim is finally adjudicated with respect to, supplemental security income benefits under this subchapter based on disability on or after Mar. 29, 1996, with special rule in case of any individual who has applied for, and whose claim has been finally adjudicated with respect to, such benefits before Mar. 29, 1996, see section 105(b)(5) of Pub. L. 104–121, set out as a note under section 1382 of this title.

Effective Date of 1994 Amendment

Amendment by section 107(a)(4) of Pub. L. 103–296 effective Mar. 31, 1995, see section 110(a) of Pub. L. 103–296, set out as a note under section 401 of this title.

Amendment by section 201(b)(3)(D) of Pub. L. 103–296 applicable with respect to supplemental security income benefits under this subchapter by reason of disability which are otherwise payable in months beginning after 180 days after Aug. 15, 1994, with Secretary of Health and Human Services to issue regulations necessary to carry out such amendment not later than 180 days after Aug. 15, 1994, see section 201(b)(3)(E)(i) of Pub. L. 103–296, set out as a note under section 1382 of this title.

Effective Date of 1990 Amendment

Amendment by Pub. L. 101–508 applicable with respect to medical assistance provided after December 1990, see section 5103(e) of Pub. L. 101–508, set out as a note under section 402 of this title.

Effective Date of 1987 Amendment

Pub. L. 100–203, title IX, § 9108, Dec. 22, 1987, 101 Stat. 1330–302, provided that the amendment made by that section is effective July 1, 1987.

Pub. L. 100–203, title IX, § 9116(e), Dec. 22, 1987, 101 Stat. 1330–306, provided that: “The amendments made by subsection (a) [amending this section] shall apply with respect to any individual without regard to whether the determination of his or her ineligibility for supplemental security income benefits by reason of the receipt of benefits under section 202 of the Social Security Act [section 402 of this title] (as described in section 1634(d)(2) of such Act [subsec. (d)(2) of this section]) occurred before, on, or after the date of the enactment of this Act [Dec. 22, 1987]; but no individual shall be eligible for assistance under title XIX of such Act [subchapter XIX of this chapter] by reason of such amendments for any period before July 1, 1988.”

Effective Date of 1986 Amendment

Amendment by Pub. L. 99–643 effective July 1, 1987, except as otherwise provided, see section 10(b) of Pub. L. 99–643, set out as a note under section 1396a of this title.

Pub. L. 99–272, title XII, § 12202(c), Apr. 7, 1986, 100 Stat. 291, provided that: “The amendment made by subsection (a)(2) [amending this section] shall not have the effect of deeming an individual eligible for medical assistance for any month which begins less than two months after the date of the enactment of this Act [Apr. 7, 1986].”

Effective Date

Pub. L. 92–603, title III, § 301, Oct. 30, 1972, 86 Stat. 1465, provided that this section is effective Jan. 1, 1974.

Notice of Possible Eligibility for Medicaid Assistance

Pub. L. 100–203, title IX, § 9116(b), Dec. 22, 1987, 101 Stat. 1330–306, provided that: “The Secretary of Health and Human Services, acting through the Social Security Administration, shall (within 3 months after the date of the enactment of this Act [Dec. 22, 1987]) issue a notice to all individuals who will have attained age 60 but not age 65 as of April 1, 1988, and who received supplemental security income benefits under title XVI of the Social Security Act [this subchapter] prior to attaining age 60 but lost those benefits by reason of the receipt of widow’s or widower’s insurance benefits (or other benefits as described in section 1634(d)(1) of that Act [subsec. (d)(1) of this section] as added by subsection (a) of this section) under title II of that Act [subchapter II of this chapter]. Each such notice shall set forth and explain the provisions of section 1634(d) of the Social Security Act (as so added), and shall inform the individual that he or she should contact the Secretary or the appropriate State agency concerning his or her possible eligibility for medical assistance benefits under such title XIX [subchapter XIX of this chapter].”

State Determinations

Pub. L. 100–203, title IX, § 9116(c), Dec. 22, 1987, 101 Stat. 1330–306, provided that: “Any determination required under section 1634(d) of the Social Security Act [subsec. (d) of this section] with respect to whether an individual would be eligible for benefits under title XVI of such Act [this subchapter] (or State supplementary payments) in the absence of benefits under section 202 [section 402 of this title] shall be made by the appropriate State agency.”

Pub. L. 99–643, § 6(b), Nov. 10, 1986, 100 Stat. 3578, provided that: “Any determination required under section 1634(c) of the Social Security Act [subsec. (c) of this section] with respect to whether an individual would be eligible for benefits under title XVI of such Act [this subchapter] in the absence of children’s benefits (or an increase thereof) shall be made by the appropriate State agency.”

Identification of Potential Beneficiaries Under Subsection (b) of This Section

Pub. L. 99–272, title XII, § 12202(b), Apr. 7, 1986, 100 Stat. 291, provided that:“(1) As soon as possible after the date of the enactment of this Act [Apr. 7, 1986], the Secretary of Health and Human Services shall provide each State with the names of all individuals receiving widow’s or widower’s insurance benefits under subsection (e) or (f) of section 202 of the Social Security Act [section 402(e) or (f) of this title] based on a disability who might qualify for medical assistance under the plan of that State approved under title XIX of such Act [subchapter XIX of this chapter] by reason of the application of section 1634(b) of the Social Security Act [subsec. (b) of this section].“(2) Each State shall—“(A) using the information so provided and any other information it may have, promptly notify all individuals who may qualify for medical assistance under its plan by reason of such section 1634(b) of their right to make application for such assistance,“(B) solicit their applications for such assistance, and“(C) make the necessary determination of such individuals’ eligibility for such assistance under such section and under such title XIX.”

Application to Northern Mariana Islands

For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under section 1801 of Title 48, Territories and Insular Possessions.

Puerto Rico, Guam, and Virgin Islands

Enactment of provisions of Pub. L. 92–603, eff. Jan. 1, 1974, not applicable to Puerto Rico, Guam, and the Virgin Islands, see section 303(b) of Pub. L. 92–603, set out as a note under section 301 of this title.

Notes of Decisions

Cited in 26 cases (5 in the last 5 years), 1977–2025 · leading case: McMahon v. Novello, 192 F. Supp. 2d 54 (W.D.N.Y. 2001).

Sort: Relevance Newest Treatment

McMahon v. Novello, 192 F. Supp. 2d 54 (W.D.N.Y. 2001). · cites it 13× “Plaintiffs sought injunctive relief guaranteeing their statutory and constitutional 5 rights and requiring full implementation of 42 U.S.C. § 1383c(c); a declaratory judgment that these policies violate, inter alia, the Social Security Act; and reinstating the Medicaid benefits…”

Darling v. Bowen, 685 F. Supp. 1125 (W.D. Mo. 1988). · cites it 8× “42 U.S.C. § 1383c, Pub.L. 99-272, § 12202 (a) and (b).”

Cordero v. Astrue, 574 F. Supp. 2d 373 (S.D.N.Y. 2008). · cites it 2× “See 42 U.S.C. § 1383c(a)(3)(J). To determine whether DAA is a material contributing factor, the ALJ must determine whether the individual would still be disabled if he or she stopped using drugs and alcohol.”

Fuzie v. Manor Care, Inc., 461 F. Supp. 689 (N.D. Ohio 1977). · cites it 2× “Pursuant to Title XIX, the federal government reimburses qualifying states for a portion of expenditures made by such states for certain medical care and services provided to eligible recipients by qualified providers, 42 U.S.C. § 1383c. In order to qualify for federal…”

Morabito v. Blum, 528 F. Supp. 252 (S.D.N.Y. 1981). “This action challenges the State of New York’s termination of an agreement (“the Section 1634 agreement”) entered into by the State of New York and the Secretary of Health and Human Services pursuant to section 1634 of the Social Security Act, 42 U.S.C. § 1383c. It also contests…”

Darling v. Bowen, 878 F.2d 1069 (8th Cir. 1989). · cites it 6× “News 291 (not codified in 42 U.S.C. § 1383c). Further, section 12202 instructs the states, after receiving the names of eligible persons, to promptly notify such persons of their right to make application for assistance.”

Cefalu v. Barnhart, 387 F. Supp. 2d 486 (W.D. Pa. 2005). “§ 423 (d)(1); 42 U.S.C. § 1383c(a)(3)(A). When resolving the issue of whether a claimant is disabled and whether the claimant is entitled to either DIB or SSI benefits, the Commissioner applies a five-step analysis.”

Alberta NOLAND, Et Al., Appellants, v. Donna SHALALA, Sec'y of Dep't of Health & Human Servs., Appellee, 12 F.3d 258 (D.C. Cir. 1994). · cites it 2× “1989), construing § 12202 of the Consolidated Omnibus Budget Reconciliation Act of 1986 (codified at 42 U.S.C. § 1383c(b) (1988)), which has a purpose similar to that of the Pickle Amendment.”

Rousseau v. Bordeleau, 624 F. Supp. 355 (D.R.I. 1985). · cites it 2× “Additional statutory support for the view that the States determine Medical Assistance eligibility can be found at 42 U.S.C. § 1383c. This section of the statute allows the Secretary to agree with the State to determine eligibility for Medical Assistance for the aged, blind and…”

Trull Nursing Home, Inc. v. State Dep't of Human Servs., 461 A.2d 490 (Me. 1983). “See also 42 U.S.C.A. § 1383c (1974). This action arises from a decision by the Department denying Trull part of the reimbursement claimed by Trull under the Medicaid program.”

Ghazibayat v. Schweiker, 554 F. Supp. 1005 (S.D.N.Y. 1983). “In addition the standard for judicial review is also identical, 42 U.S.C. § 1383c(3). As a result, cases under 42 U.”

Ambrosini v. Astrue, 727 F. Supp. 2d 414 (W.D. Pa. 2010). “” 42 U.S.C. § 1383c(a)(3)(A). When resolving the issue of whether a claimant is disabled and whether the claimant is entitled to either DIB or SSI benefits, the Commissioner utilizes the familiar five-step sequential evaluation.”

Show all 26 citing cases →

— 42 U.S.C. § 1383c(3) — 4 cases

Ghazibayat v. Schweiker, 554 F. Supp. 1005 (S.D.N.Y. 1983). “In addition the standard for judicial review is also identical, 42 U.S.C. § 1383c(3). As a result, cases under 42 U.”

(SS) Bielski v. Comm'r of Soc. Sec. (E.D. Cal. 2025).

(SS) Allmon v. Comm'r of Soc. Sec. (E.D. Cal. 2025).

Juanita Solorzano v. Comm'r of Soc. Sec. (E.D. Cal. 2025).

— 42 U.S.C. § 1383c(a) — 3 cases

State of Mississippi, Off. of the Governor Div. of Medicaid v. Louis W. Sullivan, Sec'y of U.S. Dep't of Health & Human Servs., 951 F.2d 80 (5th Cir. 1992).

Peggy Armstrong Russell Hansen Yvonne Hansen & Mary Howell v. Charles Palmer, in His Capacity as Dir., Iowa Dep't of Human Servs., 879 F.2d 437 (8th Cir. 1989).

Disabled Rights Union v. Kizer, 744 F. Supp. 221 (C.D. Cal. 1990).

— 42 U.S.C. § 1383c(a)(3) — 1 case

Coulette Osmore v. Michael Astrue, 472 F. App'x 529 (9th Cir. 2012).

— 42 U.S.C. § 1383c(a)(3)(A) — 4 cases

Mathot v. Comm'r of Soc. Sec. (W.D.N.C. 2022).

Davison v. Comm'r of Soc. Sec. (D.N.J. 2020).

— 42 U.S.C. § 1383c(a)(3)(C)(i) — 1 case

Helms v. Apfel, 33 F. Supp. 2d 1113 (S.D. Iowa 1998).

— 42 U.S.C. § 1383c(a)(3)(D) — 1 case

Travis v. Bowen, 633 F. Supp. 264 (D.D.C. 1986).

— 42 U.S.C. § 1383c(a)(3)(J) — 1 case

Cordero v. Astrue, 574 F. Supp. 2d 373 (S.D.N.Y. 2008). “See 42 U.S.C. § 1383c(a)(3)(J). To determine whether DAA is a material contributing factor, the ALJ must determine whether the individual would still be disabled if he or she stopped using drugs and alcohol.”

— 42 U.S.C. § 1383c(b) — 3 cases

Darling v. Bowen, 878 F.2d 1069 (8th Cir. 1989). “News 291 (not codified in 42 U.S.C. § 1383c). Further, section 12202 instructs the states, after receiving the names of eligible persons, to promptly notify such persons of their right to make application for assistance.”

Alberta NOLAND, Et Al., Appellants, v. Donna SHALALA, Sec'y of Dep't of Health & Human Servs., Appellee, 12 F.3d 258 (D.C. Cir. 1994). “1989), construing § 12202 of the Consolidated Omnibus Budget Reconciliation Act of 1986 (codified at 42 U.S.C. § 1383c(b) (1988)), which has a purpose similar to that of the Pickle Amendment.”

Darling v. Sullivan, 914 F.2d 132 (8th Cir. 1990).

— 42 U.S.C. § 1383c(b)(2) — 3 cases

Darling v. Bowen, 685 F. Supp. 1125 (W.D. Mo. 1988). “42 U.S.C. § 1383c, Pub.L. 99-272, § 12202 (a) and (b).”

Darling v. Sullivan, 914 F.2d 132 (8th Cir. 1990).

— 42 U.S.C. § 1383c(b)(l) — 3 cases

Darling v. Bowen, 685 F. Supp. 1125 (W.D. Mo. 1988). “42 U.S.C. § 1383c, Pub.L. 99-272, § 12202 (a) and (b).”

— 42 U.S.C. § 1383c(c) — 2 cases

McMahon v. Novello, 192 F. Supp. 2d 54 (W.D.N.Y. 2001). “Plaintiffs sought injunctive relief guaranteeing their statutory and constitutional 5 rights and requiring full implementation of 42 U.S.C. § 1383c(c); a declaratory judgment that these policies violate, inter alia, the Social Security Act; and reinstating the Medicaid benefits…”

Dadone v. Saul, Comm'r of Soc. Sec. (S.D. Ohio 2021).

— 42 U.S.C. § 1383c(e) — 1 case

Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.