42 CFR 435.119 - Qualified family members.

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Effective Date Note:
At 77 FR 17204, Mar. 23, 2012, Subpart B was amended by revising the heading, effective Jan. 1, 2014. For the convenience of the user, the revised text is set forth as follows:
Subpart B—Mandatory Coverage
§ 435.119 Qualified family members.
(a) Definition. A qualified family member is any member of a family, including pregnant women and children eligible for Medicaid under § 435.116 of this subpart, who would be receiving AFDC cash benefits on the basis of the unemployment of the principal wage earner under section 407 of the Act had the State not chosen to place time limits on those benefits as permitted under section 407(b)(2)(B)(i) of the Act.
(b) State plan requirement. The State plan must provide that the State makes Medicaid available to any individual who meets the definition of “qualified family member” as specified in paragraph (a) of this section.
(c) Applicability. The provisions in this section are applicable in the 50 States and the District of Columbia from October 1, 1990, through September 30, 1998. The provisions are applicable in American Samoa from October 1, 1992, through September 30, 1998.
[58 FR 48614, Sept. 17, 1993]
§ 435.119, Nt.
Effective Date Note:
At 77 FR 17205, Mar. 23, 2012, § 435.119 was revised, effective . For the convenience of the user, the added and revised text is set forth as follows:
§ 435.119 Coverage for individuals age 19 or older and under age 65 at or below 133 percent FPL.
(a) Basis. This section implements section 1902(a)(10)(A)(i)(VIII) of the Act.
(b) Eligibility. The agency must provide Medicaid to individuals who:
(1) Are age 19 or older and under age 65;
(2) Are not pregnant;
(3) Are not entitled to or enrolled for Medicare benefits under part A or B of title XVIII of the Act;
(4) Are not otherwise eligible for and enrolled for mandatory coverage under a State's Medicaid State plan in accordance with subpart B of this part; and
(5) Have household income that is at or below 133 percent FPL for the applicable family size.
(c) Coverage for dependent children. (1) A State may not provide Medicaid under this section to a parent or other caretaker relative living with a dependent child if the child is under the age specified in paragraph (c)(2) of this section, unless such child is receiving benefits under Medicaid, the Children's Health Insurance Program under subchapter D of this chapter, or otherwise is enrolled in minimum essential coverage as defined in § 435.4 of this part.
(2) For the purpose of paragraph (c)(1) of this section, the age specified is under age 19, unless the State had elected as of March 23, 2010 to provide Medicaid to individuals under age 20 or 21 under § 435.222 of this part, in which case the age specified is such higher age.

Title 42 published on 2014-10-01

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