us/statute/42/1396a/m/4

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Notwithstanding subsection (a)(17), for qualified medicare beneficiaries described in section 1396d(p)(1) of this title —

(A) the income standard to be applied is the income standard described in section 1396d(p)(1)(B) of this title , and

(B) except as provided in section 1382a(b)(4)(B)(ii) of this title , costs incurred for medical care or for any other type of remedial care shall not be taken into account in determining income.

Any different treatment provided under this paragraph for such individuals shall not, because of subsection (a)(17), require or permit such treatment for other individuals.

in view

Whole section

▸rulespec code

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statutes/42/1396a/m.yaml

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Rules

optional_senior_age_threshold_years

Parameter

source: 42 U.S.C. 1396a(m)(1)(A)

- name: optional_senior_age_threshold_years
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396a(m)(1)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: 65 years of age or older
  versions:
    - effective_from: '2024-01-01'
      formula: '65'

optional_senior_or_disabled_income_level_maximum_rate

Parameter

source: 42 U.S.C. 1396a(m)(2)(A)

- name: optional_senior_or_disabled_income_level_maximum_rate
  kind: parameter
  dtype: Rate
  source: 42 U.S.C. 1396a(m)(2)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: not more than 100 percent
  versions:
    - effective_from: '2024-01-01'
      formula: '1.00'

meets_optional_senior_or_disabled_age_or_disability_condition

Derived

source: 42 U.S.C. 1396a(m)(1)(A)

- name: meets_optional_senior_or_disabled_age_or_disability_condition
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: condition
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: who are 65 years of age or older or are disabled individuals
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#optional_senior_age_threshold_years
            output: optional_senior_age_threshold_years
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        individual_age_years >= optional_senior_age_threshold_years
        or disabled_as_determined_under_section_1382c_a_3

state_income_level_within_federal_maximum

Derived

source: 42 U.S.C. 1396a(m)(2)(A)

- name: state_income_level_within_federal_maximum
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(2)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: may not exceed a percentage (not more than 100 percent) of the official poverty line
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#optional_senior_or_disabled_income_level_maximum_rate
            output: optional_senior_or_disabled_income_level_maximum_rate
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        state_established_income_level_poverty_line_rate <=
        optional_senior_or_disabled_income_level_maximum_rate

income_does_not_exceed_state_optional_senior_or_disabled_level

Derived

source: 42 U.S.C. 1396a(m)(1)(B), (2)(A), (2)(C)

- name: income_does_not_exceed_state_optional_senior_or_disabled_level
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(B), (2)(A), (2)(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: whose income ... does not exceed an income level established by the State
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#state_income_level_within_federal_maximum
            output: state_income_level_within_federal_maximum
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        income_determined_for_this_subsection <= state_established_income_level_amount
        and state_income_level_within_federal_maximum

resources_do_not_exceed_optional_senior_or_disabled_resource_level

Derived

source: 42 U.S.C. 1396a(m)(1)(C), (2)(B)

- name: resources_do_not_exceed_optional_senior_or_disabled_resource_level
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(C), (2)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: whose resources ... do not exceed ... the maximum amount of resources
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: the State may use under paragraph (1)(C) such resource level ... which is higher
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        resources_determined_for_supplemental_security_income_program <=
        maximum_resources_for_supplemental_security_income_program

        or (
          state_provides_medical_assistance_to_individuals_not_described_in_subsection_a_10_A
          and state_elects_higher_resource_level_for_non_a10A_individuals
          and individual_not_described_in_subsection_a_10_A
          and state_optional_resource_level_amount_for_non_a10A_individuals > maximum_resources_for_supplemental_security_income_program
          and resources_determined_for_supplemental_security_income_program <= state_optional_resource_level_amount_for_non_a10A_individuals
        )

is_optional_senior_or_disabled_for_medicaid

Derived

source: 42 U.S.C. 1396a(m)(1)

- name: is_optional_senior_or_disabled_for_medicaid
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: definition
          source:
            corpus_citation_path: us/statute/42/1396a/m
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#meets_optional_senior_or_disabled_age_or_disability_condition
            output: meets_optional_senior_or_disabled_age_or_disability_condition
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#income_does_not_exceed_state_optional_senior_or_disabled_level
            output: income_does_not_exceed_state_optional_senior_or_disabled_level
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: >-
              us:statutes/42/1396a/m#resources_do_not_exceed_optional_senior_or_disabled_resource_level
            output: resources_do_not_exceed_optional_senior_or_disabled_resource_level
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        meets_optional_senior_or_disabled_age_or_disability_condition
        and income_does_not_exceed_state_optional_senior_or_disabled_level
        and resources_do_not_exceed_optional_senior_or_disabled_resource_level

▸citations (3)

References

This rule cites 3 other rules.

42 USC § 1396d (p)(1)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)
42 USC § 1396d (p)(1)(B)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)(B)
42 USC § 1382a (b)(4)(B)(ii)inferredUS Federal › Statutes › Title 42 › § 1382a › (b)(4)(B)(ii)

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us/statute/42/1396a/m/4 · Axiom

Official source

Notwithstanding subsection (a)(17), for qualified medicare beneficiaries described in section 1396d(p)(1) of this title —

(A) the income standard to be applied is the income standard described in section 1396d(p)(1)(B) of this title , and

(B) except as provided in section 1382a(b)(4)(B)(ii) of this title , costs incurred for medical care or for any other type of remedial care shall not be taken into account in determining income.

Any different treatment provided under this paragraph for such individuals shall not, because of subsection (a)(17), require or permit such treatment for other individuals.

in view

Whole section

▸rulespec code

Shown source

statutes/42/1396a/m.yaml

Displaying the canonical repository encoding.

This encoding covers the parent provision us/statute/42/1396a/m; no dedicated encoding exists for this exact provision yet.

View on GitHub

Rules

optional_senior_age_threshold_years

Parameter

source: 42 U.S.C. 1396a(m)(1)(A)

- name: optional_senior_age_threshold_years
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396a(m)(1)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: 65 years of age or older
  versions:
    - effective_from: '2024-01-01'
      formula: '65'

optional_senior_or_disabled_income_level_maximum_rate

Parameter

source: 42 U.S.C. 1396a(m)(2)(A)

- name: optional_senior_or_disabled_income_level_maximum_rate
  kind: parameter
  dtype: Rate
  source: 42 U.S.C. 1396a(m)(2)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: not more than 100 percent
  versions:
    - effective_from: '2024-01-01'
      formula: '1.00'

meets_optional_senior_or_disabled_age_or_disability_condition

Derived

source: 42 U.S.C. 1396a(m)(1)(A)

- name: meets_optional_senior_or_disabled_age_or_disability_condition
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: condition
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: who are 65 years of age or older or are disabled individuals
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#optional_senior_age_threshold_years
            output: optional_senior_age_threshold_years
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        individual_age_years >= optional_senior_age_threshold_years
        or disabled_as_determined_under_section_1382c_a_3

state_income_level_within_federal_maximum

Derived

source: 42 U.S.C. 1396a(m)(2)(A)

- name: state_income_level_within_federal_maximum
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(2)(A)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: may not exceed a percentage (not more than 100 percent) of the official poverty line
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#optional_senior_or_disabled_income_level_maximum_rate
            output: optional_senior_or_disabled_income_level_maximum_rate
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        state_established_income_level_poverty_line_rate <=
        optional_senior_or_disabled_income_level_maximum_rate

income_does_not_exceed_state_optional_senior_or_disabled_level

Derived

source: 42 U.S.C. 1396a(m)(1)(B), (2)(A), (2)(C)

- name: income_does_not_exceed_state_optional_senior_or_disabled_level
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(B), (2)(A), (2)(C)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: whose income ... does not exceed an income level established by the State
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#state_income_level_within_federal_maximum
            output: state_income_level_within_federal_maximum
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        income_determined_for_this_subsection <= state_established_income_level_amount
        and state_income_level_within_federal_maximum

resources_do_not_exceed_optional_senior_or_disabled_resource_level

Derived

source: 42 U.S.C. 1396a(m)(1)(C), (2)(B)

- name: resources_do_not_exceed_optional_senior_or_disabled_resource_level
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)(C), (2)(B)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: whose resources ... do not exceed ... the maximum amount of resources
        - path: versions[0].formula
          kind: exception
          source:
            corpus_citation_path: us/statute/42/1396a/m
            excerpt: the State may use under paragraph (1)(C) such resource level ... which is higher
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        resources_determined_for_supplemental_security_income_program <=
        maximum_resources_for_supplemental_security_income_program

        or (
          state_provides_medical_assistance_to_individuals_not_described_in_subsection_a_10_A
          and state_elects_higher_resource_level_for_non_a10A_individuals
          and individual_not_described_in_subsection_a_10_A
          and state_optional_resource_level_amount_for_non_a10A_individuals > maximum_resources_for_supplemental_security_income_program
          and resources_determined_for_supplemental_security_income_program <= state_optional_resource_level_amount_for_non_a10A_individuals
        )

is_optional_senior_or_disabled_for_medicaid

Derived

source: 42 U.S.C. 1396a(m)(1)

- name: is_optional_senior_or_disabled_for_medicaid
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396a(m)(1)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: definition
          source:
            corpus_citation_path: us/statute/42/1396a/m
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#meets_optional_senior_or_disabled_age_or_disability_condition
            output: meets_optional_senior_or_disabled_age_or_disability_condition
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396a/m#income_does_not_exceed_state_optional_senior_or_disabled_level
            output: income_does_not_exceed_state_optional_senior_or_disabled_level
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: >-
              us:statutes/42/1396a/m#resources_do_not_exceed_optional_senior_or_disabled_resource_level
            output: resources_do_not_exceed_optional_senior_or_disabled_resource_level
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        meets_optional_senior_or_disabled_age_or_disability_condition
        and income_does_not_exceed_state_optional_senior_or_disabled_level
        and resources_do_not_exceed_optional_senior_or_disabled_resource_level

▸citations (3)

References

This rule cites 3 other rules.

42 USC § 1396d (p)(1)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)
42 USC § 1396d (p)(1)(B)inferredUS Federal › Statutes › Title 42 › § 1396d › (p)(1)(B)
42 USC § 1382a (b)(4)(B)(ii)inferredUS Federal › Statutes › Title 42 › § 1382a › (b)(4)(B)(ii)