{"data":{"id":"us/42-cfr-435.551","jurisdiction":"us","citation":"42 CFR 435.551","heading":"Applicable individual.","body":"An applicable individual is an individual who is not a specified excluded individual as defined at § 435.554 and who is—\n(a) Eligible to enroll or is enrolled under the State plan under § 435.119; or\n(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:\n(1) At least 19 and under 65 years of age;\n(2) Not pregnant;\n(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\n(4) Not otherwise eligible to enroll under the State plan.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 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"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"101c3e59b6a001eea147998772b24e241fd3f6a1d4f0795c2d1d9b60524c2141","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-435.550","next":"us/42-cfr-435.552"},"notice":"GroundRules: Original legal text. Not legal advice."}