GroundRules
42 CFR 435.551: Applicable individual.
Where this section sits in the code
- Title 42—Public Health
- 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 F—Categorical Requirements for Eligibility
An applicable individual is an individual who is not a specified excluded individual as defined at § 435.554 and who is—
(a) Eligible to enroll or is enrolled under the State plan under § 435.119; or
(b) Otherwise eligible to enroll or is enrolled in a demonstration project under section 1115(a)(2) of the Act that provides coverage that meets minimum essential coverage requirements as defined under § 435.4, and who is:
(1) At least 19 and under 65 years of age;
(2) Not pregnant;
(3) Not entitled to or enrolled for benefits under part A of title XVIII or enrolled for benefits under part B of title XVIII; and
(4) Not otherwise eligible to enroll under the State plan.
Collected 2026-08-27T02:26:11Z. Source file · JSON