Definitions.—

Official source

“(9) Definitions.— In this subsection: “(A) Applicable individual.— “(i) In general.— The term ‘ applicable individual ’ means an individual (other than a specified excluded individual (as defined in clause (ii)))— “(I) who is eligible to enroll (or is enrolled) under the State plan under subsection (a)(10)(A)(i)(VIII); or “(II) who— “(aa) is otherwise eligible to enroll (or is enrolled) under a waiver of such plan that provides coverage that is equivalent to minimum essential coverage (as described in section 5000A(f)(1)(A) of the Internal Revenue Code of 1986 and as determined in accordance with standards prescribed by the Secretary in regulations); and “(bb) has attained the age of 19 and is under 65 years of age, is not pregnant, is not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits 139 STAT. 312 under part B of title XVIII, and is not otherwise eligible to enroll under such plan. “(ii) Specified excluded individual.— For purposes of clause (i), the term ‘ specified excluded individual ’ means an individual, as determined by the State (in accordance with standards specified by the Secretary)— “(I) who is described in subsection (a)(10)(A)(i)(IX); “(II) who— “(aa) is an Indian or an Urban Indian (as such terms are defined in paragraphs (13) and (28) of section 4 of the Indian Health Care Improvement Act); “(bb) is a California Indian described in section 809(a) of such Act; or “(cc) has otherwise been determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary; “(III) who is the parent, guardian, caretaker relative, or family caregiver (as defined in section 2 of the RAISE Family Caregivers Act) of a dependent child 13 years of age and under or a disabled individual; “(IV) who is a veteran with a disability rated as total under section 1155 of title 38, United States Code; “(V) who is medically frail or otherwise has special medical needs (as defined by the Secretary), including an individual— “(aa) who is blind or disabled (as defined in section 1614); “(bb) with a substance use disorder; “(cc) with a disabling mental disorder; “(dd) with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living; or “(ee) with a serious or complex medical condition; “(VI) who— “(aa) is in compliance with any requirements imposed by the State pursuant to section 407; or “(bb) is a member of a household that receives supplemental nutrition assistance program benefits under the Food and Nutrition Act of 2008 and is not exempt from a work requirement under such Act; “(VII) who is participating in a drug addiction or alcoholic treatment and rehabilitation program (as defined in section 3(h) of the Food and Nutrition Act of 2008); “(VIII) who is an inmate of a public institution; or 139 STAT. 313 “(IX) who is pregnant or entitled to postpartum medical assistance under paragraph (5) or (16) of subsection (e). “(B) Educational program.— The term ‘ educational program ’ includes— “(i) an institution of higher education (as defined in section 101 of the Higher Education Act of 1965); and “(ii) a program of career and technical education (as defined in section 3 of the Carl D. Perkins Career and Technical Education Act of 2006). “(C) State.— The term ‘ State ’ means 1 of the 50 States or the District of Columbia. “(D) Work program.— The term ‘ work program ’ has the meaning given such term in section 6(o)(1) of the Food and Nutrition Act of 2008.

Definitions.—

Official source

- name: monthly_activity_hours_requirement kind: parameter dtype: Decimal source: 42 USC 1396a(xx)(2)(A)-(E) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: not less than 80 hours versions: - effective_from: '2026-12-31' formula: '80'

- name: seasonal_worker_income_lookback_months kind: parameter dtype: Count source: 42 USC 1396a(xx)(2)(G) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: average monthly income over the preceding 6 months versions: - effective_from: '2026-12-31' formula: '6'

- name: hardship_unemployment_rate_threshold kind: parameter dtype: Rate source: 42 USC 1396a(xx)(3)(B)(ii)(II)(bb)(AA) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: 8 percent versions: - effective_from: '2026-12-31' formula: '0.08'

- name: hardship_national_unemployment_rate_multiplier kind: parameter dtype: Decimal source: 42 USC 1396a(xx)(3)(B)(ii)(II)(bb)(BB) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: 1.5 times the national unemployment rate versions: - effective_from: '2026-12-31' formula: '1.5'

- name: community_engagement_met_by_activity_or_income kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(2) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx excerpt: meets 1 or more of the following conditions versions: - effective_from: '2026-12-31' formula: >- monthly_work_hours >= monthly_activity_hours_requirement or monthly_community_service_hours >= monthly_activity_hours_requirement or monthly_work_program_hours >= monthly_activity_hours_requirement or enrolled_in_educational_program_at_least_half_time or monthly_combined_engagement_activity_hours >= monthly_activity_hours_requirement or monthly_income >= applicable_minimum_wage_hourly_rate * monthly_activity_hours_requirement or (seasonal_worker and average_monthly_income_over_preceding_6_months >= applicable_minimum_wage_hourly_rate * monthly_activity_hours_requirement)

- name: educational_program kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(B) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx - path: versions[0].formula kind: import import: target: us:statutes/26/3304#institution_of_higher_education output: institution_of_higher_education hash: sha256:86fc1e04b86968a3fea7737fce53a8297bc20be9c7896e4527512caed95bff86 versions: - effective_from: '2026-12-31' formula: |- institution_of_higher_education or enrolled_in_career_and_technical_education_program

- name: mandatory_community_engagement_deeming_applies kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(A) metadata: proof: atoms: - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- was_specified_excluded_individual_for_part_or_all_of_month or was_under_age_19_for_part_or_all_of_month or was_entitled_to_or_enrolled_for_medicare_part_a_or_b_for_part_or_all_of_month or was_described_in_subsection_a_10_A_i_I_through_VII_for_part_or_all_of_month or was_inmate_of_public_institution_during_3_month_period_ending_first_day_of_month

- name: short_term_hardship_event kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(B)(ii) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- received_high_acuity_services_for_part_or_all_of_month or county_has_presidential_emergency_or_disaster_for_part_or_all_of_month or county_unemployment_rate >= min(hardship_unemployment_rate_threshold, hardship_national_unemployment_rate_multiplier * national_unemployment_rate) or individual_or_dependent_must_travel_outside_community_for_extended_medically_necessary_services

- name: optional_hardship_deeming_applies kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(B)(i) metadata: proof: atoms: - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- state_plan_provides_optional_short_term_hardship_deeming and short_term_hardship_event and (county_has_presidential_emergency_or_disaster_for_part_or_all_of_month or county_unemployment_rate >= min(hardship_unemployment_rate_threshold, hardship_national_unemployment_rate_multiplier * national_unemployment_rate) or individual_requested_hardship_deeming)

- name: deemed_to_have_demonstrated_community_engagement kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- mandatory_community_engagement_deeming_applies or optional_hardship_deeming_applies

- name: state_may_waive_verification_for_deemed_community_engagement kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(C) metadata: proof: atoms: - path: versions[0].formula kind: condition source: corpus_citation_path: us/statute/42/1396a/xx excerpt: may elect to not require an individual to verify information resulting in such deeming versions: - effective_from: '2026-12-31' formula: |- state_elects_not_to_require_verification_for_deemed_community_engagement and deemed_to_have_demonstrated_community_engagement

- name: demonstrated_community_engagement_for_month kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(2)-(3) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- community_engagement_met_by_activity_or_income or deemed_to_have_demonstrated_community_engagement

- name: specified_excluded_individual kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(A)(ii) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- described_in_subsection_a_10_A_i_IX or is_indian_urban_indian_california_indian_or_ihs_eligible_indian or is_parent_guardian_caretaker_relative_or_family_caregiver_of_dependent_child_age_13_or_under_or_disabled_individual or is_veteran_with_total_disability_rating or is_medically_frail_or_has_special_medical_needs or complies_with_tanf_work_requirements_or_is_nonexempt_snap_work_requirement_household_member or participates_in_drug_addiction_or_alcoholic_treatment_and_rehabilitation_program or is_inmate_of_public_institution or is_pregnant_or_entitled_to_postpartum_medical_assistance

- name: applicable_individual kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(A)(i) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- not specified_excluded_individual and (eligible_or_enrolled_under_subsection_a_10_A_i_VIII or (eligible_or_enrolled_under_equivalent_minimum_essential_coverage_waiver and has_attained_age_19_and_is_under_age_65 and not pregnant and not entitled_to_or_enrolled_for_medicare_part_a_or_b and not otherwise_eligible_to_enroll_under_state_plan))