Centers for Medicare & Medicaid Services, HHS § 435.910

§ 435.908 Assistance with application. (3) The uses the agency will make of each SSN, including its use for The agency must allow an individual verifying income, eligibility, and or individuals of the applicant’s choice amount of medical assistance pay- to accompany, assist, and represent the ments under §§ 435.940 through 435.960. applicant in the application process or a redetermination of eligibility. (c)–(d) [Reserved] (e) If an applicant cannot recall his EFFECTIVE DATE NOTE: At 77 FR 17208, Mar. SSN or SSNs or has not been issued a 23, 2012, § 435.908 was revised, effective Jan. 1, SSN the agency must— 2014. For the convenience of the user, the revised text is set forth as follows: (1) Assist the applicant in completing an application for an SSN; § 435.908 Assistance with application and (2) Obtain evidence required under renewal. SSA regulations to establish the age, (a) The agency must provide assistance to the citizenship or alien status, and the any individual seeking help with the applica- true identity of the applicant; and tion or renewal process in person, over the (3) Either send the application to telephone, and online, and in a manner that is accessible to individuals with disabilities SSA or, if there is evidence that the and those who are limited English proficient, applicant has previously been issued a consistent with § 435.905(b) of this subpart. SSN, request SSA to furnish the num- (b) The agency must allow individual(s) of ber. the applicant or beneficiary’s choice to as- (f) The agency must not deny or sist in the application process or during a re- delay services to an otherwise eligible newal of eligibility. applicant pending issuance or § 435.909 Automatic entitlement to verification of the individual’s SSN by Medicaid following a determination SSA. of eligibility under other programs. (g) The agency must verify each SSN The agency must not require a sepa- of each applicant and beneficiary with rate application for Medicaid from an SSA, as prescribed by the Commis- individual, if— sioner, to insure that each SSN fur- nished was issued to that individual, (a) The individual receives AFDC; or and to determine whether any others (b) The agency has an agreement were issued. with the Social Security Administra- tion (SSA) under section 1634 of the (h) Exception. (1) A State may give a Act for determining Medicaid eligi- Medicaid identification number to an bility; and— applicant who, because of well estab- (1) The individual receives SSI; lished religious objections, refuses to (2) The individual receives a manda- obtain a Social Security Number tory State supplement under either a (SSN). The identification number may federally-administered or State-admin- be either an SSN obtained by the State istered program; or on the applicant’s behalf or another (3) The individual receives an op- unique identifier. tional State supplement and the agen- (2) The term well established religious cy provides Medicaid to beneficiaries of objections means that the applicant— optional supplements under § 435.230. (i) Is a member of a recognized religious sect or division of the sect; and § 435.910 Use of social security num- (ii) Adheres to the tenets or teach- ber. ings of the sect or division of the sect (a) The agency must require, as a and for that reason is conscientiously condition of eligibility, that each indi- opposed to applying for or using a na- vidual (including children) requesting tional identification number. Medicaid services furnish each of his or (3) A State may use the Medicaid her social security numbers (SSNs). identification number established by (b) The agency must advise the appli- the State to the same extent as an SSN cant of— is used for purposes described in para- (1) [Reserved] graph (b)(3) of this section. (2) The statute or other authority [44 FR 17937, Mar. 23, 1979, as amended at 51 under which the agency is requesting FR 7211, Feb. 28, 1986; 66 FR 2667, Jan. 11, the applicant’s SSN; and 2001]

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EFFECTIVE DATE NOTE: At 77 FR 17209, Mar. (c) The agency must determine eligi- 23, 2012, § 435.910 was amended by redesig- bility within the standards except in nating paragraphs (h)(2) and (h)(3), as (h)(3) unusual circumstances, for example— and (h)(4), respectively; adding a new para- (1) When the agency cannot reach a graph (h)(2); revising paragraphs (a), (f), (g), and (h)(1), effective Jan. 1, 2014. For the con- decision because the applicant or an venience of the user, the added and revised examining physician delays or fails to text is set forth as follows: take a required action, or (2) When there is an administrative § 435.910 Use of Social Security number. or other emergency beyond the agen- (a) Except as provided in paragraph (h) of cy’s control. this section, the agency must require, as a (d) The agency must document the condition of eligibility, that each individual reasons for delay in the applicant’s (including children) seeking Medicaid furnish each of his or her Social Security num- case record. bers (SSN). (e) The agency must not use the time standards— (1) As a waiting period before deter- * * * * * mining eligibility; or (f) The agency must not deny or delay (2) As a reason for denying eligibility services to an otherwise eligible individual (because it has not determined eligi- pending issuance or verification of the indi- bility within the time standards). vidual’s SSN by SSA or if the individual meets one of the exceptions in paragraph (h) [44 FR 17937, Mar. 23, 1979, as amended at 45 of this section. FR 24887, Apr. 11, 1980; 54 FR 50762, Dec. 11, (g) The agency must verify the SSN fur- 1989] nished by an applicant or beneficiary to insure the SSN was issued to that individual, EFFECTIVE DATE NOTE: At 77 FR 17209, Mar. and to determine whether any other SSNs 23, 2012, § 435.911 was redesignated as § 435.912 were issued to that individual. and a new § 435.911 was added, effective Jan. (h) Exception. (1) The requirement of para- 1, 2014. For the convenience of the user, the graph (a) of this section does not apply and added text is set forth as follows: a State may give a Medicaid identification § 435.911 Determination of eligibility. number to an individual who— (i) Is not eligible to receive an SSN; (a) Statutory basis. This section implements (ii) Does not have an SSN and may only be sections 1902(a)(4), (a)(8), (a)(10)(A), (a)(19), issued an SSN for a valid non-work reason in and (e)(14) and section 1943 of the Act. accordance with 20 CFR 422.104; or (b)(1) Applicable modified adjusted gross in- (iii) Refuses to obtain an SSN because of come standard means 133 percent of the Fed- well-established religious objections. eral poverty level or, if higher— (2) The identification number may be ei- (i) In the case of parents and other care- ther an SSN obtained by the State on the ap- taker relatives described in § 435.110(b) of this plicant’s behalf or another unique identifier. part, the income standard established in accordance with § 435.110(c) of this part; (ii) In the case of pregnant women, the in- * * * * * come standard established in accordance with § 435.116(c) of this part; DETERMINATION OF MEDICAID (iii) In the case of individuals under age 19, ELIGIBILITY the income standard established in accordance with § 435.118(c) of this part; § 435.911 Timely determination of eli- (iv) The income standard established under gibility. § 435.218(b)(1)(iv) of this part, if the State has (a) The agency must establish time elected to provide coverage under such section and, if applicable, coverage under the standards for determining eligibility State’s phase-in plan has been implemented and inform the applicant of what they for the individual whose eligibility is being are. These standards may not exceed— determined. (1) Ninety days for applicants who (2) [Reserved] apply for Medicaid on the basis of dis- (c) For each individual who has submitted ability; and an application described in § 435.907 or whose (2) Forty-five days for all other appli- eligibility is being renewed in accordance cants. with § 435.916 and who meets the non-finan- cial requirements for eligibility (or for whom (b) The time standards must cover the agency is providing a reasonable oppor- the period from the date of application tunity to provide documentation of citizen- to the date the agency mails notice of ship or immigration status, in accordance its decision to the applicant. with sections 1903(x), 1902(ee) or 1137(d) of the

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