Effective date of State plan as determinative of duty of State to provide medical assistance to aged, blind, or disabled individuals

3 rules

Notwithstanding any other provision of this subchapter, except as provided in subsection (e) and section 1382h(b)(3) of this title and section 1396r–5 of this title , except with respect to qualified disabled and working individuals (described in section 1396d(s) of this title ), and except with respect to qualified medicare beneficiaries, qualified severely impaired individuals, and individuals described in subsection (m)(1), no State not eligible to participate in the State plan program established under subchapter XVI shall be required to provide medical assistance to any aged, blind, or disabled individual (within the meaning of subchapter XVI) for any month unless such State would be (or would have been) required to provide medical assistance to such individual for such month had its plan for medical assistance approved under this subchapter and in effect on January 1, 1972 , been in effect in such month, except that for this purpose any such individual shall be deemed eligible for medical assistance under such State plan if (in addition to meeting such other requirements as are or may be imposed under the State plan) the income of any such individual as determined in accordance with section 1396b(f) of this title (after deducting any supplemental security income payment and State supplementary payment made with respect to such individual, and incurred expenses for medical care as recognized under State law regardless of whether such expenses are reimbursed under another public program of the State or political subdivision thereof) is not in excess of the standard for medical assistance established under the State plan as in effect on January 1, 1972 . In States which provide medical assistance to individuals pursuant to paragraph (10)(C) of subsection (a) of this section, an individual who is eligible for medical assistance by reason of the requirements of this section concerning the deduction of incurred medical expenses from income shall be considered an individual eligible for medical assistance under paragraph (10)(A) of that subsection if that individual is, or is eligible to be (1) an individual with respect to whom there is payable a State supplementary payment on the basis of which similarly situated individuals are eligible to receive medical assistance equal in amount, duration, and scope to that provided to individuals eligible under paragraph (10)(A), or (2) an eligible individual or eligible spouse, as defined in subchapter XVI, with respect to whom supplemental security income benefits are payable; otherwise that individual shall be considered to be an individual eligible for medical assistance under paragraph (10)(C) of that subsection. In States which do not provide medical assistance to individuals pursuant to paragraph (10)(C) of that subsection, an individual who is eligible for medical assistance by reason of the requirements of this section concerning the deduction of incurred medical expenses from income shall be considered an individual eligible for medical assistance under paragraph (10)(A) of that subsection.

Effective date of State plan as determinative of duty of State to provide medical assistance to aged, blind, or disabled individuals

3 rules

Official source

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name: countable_income_for_209b_comparison kind: derived entity: Person dtype: Money period: Month unit: USD source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- income ... after deducting any supplemental security income payment and State supplementary payment ... and incurred expenses for medical care versions: - effective_from: '1974-01-01' formula: >- max(0, individual_income_for_medical_assistance_eligibility - supplemental_security_income_payment - state_supplementary_payment - incurred_medical_care_expenses_recognized_under_state_law)

name: income_not_in_excess_of_1972_medical_assistance_standard kind: derived entity: Person dtype: Judgment period: Month source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: predicate source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- is not in excess of the standard for medical assistance established under the State plan as in effect on January 1, 1972 versions: - effective_from: '1974-01-01' formula: >- countable_income_for_209b_comparison <= medical_assistance_standard_under_state_plan_on_january_1_1972

name: is_209b_ssi_recipient_for_medicaid kind: derived entity: Person dtype: Judgment period: Month source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: import import: target: us:statutes/42/1382c/a/1#aged_blind_or_disabled_individual output: aged_blind_or_disabled_individual hash: >- sha256:c275ea56e2d71cc7cd5338993032e28442f0f8e0cb27efcf41134e84db3e9984 - path: versions[0].formula kind: condition source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- no State not eligible to participate in the State plan program established under subchapter XVI - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- except with respect to qualified disabled and working individuals ... qualified medicare beneficiaries, qualified severely impaired individuals, and individuals described in subsection (m)(1) - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- unless such State would be ... required ... had its plan ... in effect on January 1, 1972 - path: versions[0].formula kind: import import: target: >- us:statutes/42/1396a/f#income_not_in_excess_of_1972_medical_assistance_standard output: income_not_in_excess_of_1972_medical_assistance_standard hash: sha256:local versions: - effective_from: '1974-01-01' formula: >- state_not_eligible_to_participate_in_state_plan_program_established_under_subchapter_xvi and aged_blind_or_disabled_individual and not qualified_disabled_and_working_individual_described_in_section_1396d_s and not qualified_medicare_beneficiary and not qualified_severely_impaired_individual and not individual_described_in_subsection_m_1 and ( state_would_have_been_required_to_provide_medical_assistance_under_january_1_1972_plan or ( other_requirements_imposed_under_state_plan_met and income_not_in_excess_of_1972_medical_assistance_standard ) )

- name: countable_income_for_209b_comparison kind: derived entity: Person dtype: Money period: Month unit: USD source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- income ... after deducting any supplemental security income payment and State supplementary payment ... and incurred expenses for medical care versions: - effective_from: '1974-01-01' formula: >- max(0, individual_income_for_medical_assistance_eligibility - supplemental_security_income_payment - state_supplementary_payment - incurred_medical_care_expenses_recognized_under_state_law)

- name: income_not_in_excess_of_1972_medical_assistance_standard kind: derived entity: Person dtype: Judgment period: Month source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: predicate source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- is not in excess of the standard for medical assistance established under the State plan as in effect on January 1, 1972 versions: - effective_from: '1974-01-01' formula: >- countable_income_for_209b_comparison <= medical_assistance_standard_under_state_plan_on_january_1_1972

- name: is_209b_ssi_recipient_for_medicaid kind: derived entity: Person dtype: Judgment period: Month source: 42 U.S.C. 1396a(f) metadata: proof: atoms: - path: versions[0].formula kind: import import: target: us:statutes/42/1382c/a/1#aged_blind_or_disabled_individual output: aged_blind_or_disabled_individual hash: sha256:c275ea56e2d71cc7cd5338993032e28442f0f8e0cb27efcf41134e84db3e9984 - path: versions[0].formula kind: condition source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- no State not eligible to participate in the State plan program established under subchapter XVI - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- except with respect to qualified disabled and working individuals ... qualified medicare beneficiaries, qualified severely impaired individuals, and individuals described in subsection (m)(1) - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/f excerpt: >- unless such State would be ... required ... had its plan ... in effect on January 1, 1972 - path: versions[0].formula kind: import import: target: us:statutes/42/1396a/f#income_not_in_excess_of_1972_medical_assistance_standard output: income_not_in_excess_of_1972_medical_assistance_standard hash: sha256:local versions: - effective_from: '1974-01-01' formula: |- state_not_eligible_to_participate_in_state_plan_program_established_under_subchapter_xvi and aged_blind_or_disabled_individual and not qualified_disabled_and_working_individual_described_in_section_1396d_s and not qualified_medicare_beneficiary and not qualified_severely_impaired_individual and not individual_described_in_subsection_m_1 and ( state_would_have_been_required_to_provide_medical_assistance_under_january_1_1972_plan or ( other_requirements_imposed_under_state_plan_met and income_not_in_excess_of_1972_medical_assistance_standard ) )