#10: Section 1115 Demonstration and Waiver Application

List of Medicaid Eligibility Groups

Eligibility Group Name	Social Security Act and CFR Citations
Mandatory Categorically Needy
Low Income Families	1931
Transitional Medical Assistance	408(a)(11)(A) 1931(c)(2) 1925 1902(a)(52)
Extended Medicaid due to Child or Spousal Support Collections	408(a)(11)(B) 42 CFR 435.115 1931(c)(1)
Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care	1902(a)(10)(A)(i)(I) 473(b)(3) 42 CFR 435.145
Qualified Pregnant Women and Children	42 CFR 435.116 - old 1902(a)(10)(A)(i)(III) 1905(n)
Mandatory Poverty Level Related Pregnant Women	1902(a)(10)(A)(i)(IV) 1902(l)(1)(A)
Mandatory Poverty Level Related Infants	1902(a)(10)(A)(i)(IV) 1902(l)(1)(B)
Mandatory Poverty Level Related Children Aged 1-5	1902(a)(10)(A)(i)(VI) 1902(l)(1)(C)
Mandatory Poverty Level Related Children Aged 6-18	1902(a)(10)(A)(i)(VII) 1902(l)(1)(D)
Deemed Newborns	1902(e)(4) 42 CFR 435.117
Individuals Receiving SSI	1902(a)(10)(A)(i)(II)(aa) 42 CFR 435.120
Aged, Blind and Disabled Individuals in 209(b) States	1902(f) 42 CFR 435.121
Individuals Receiving Mandatory State Supplements	42 CFR 435.130
Individuals Who Are Essential Spouses	42 CFR 435.131 1905(a)
Institutionalized Individuals Continuously Eligible Since 1973	42 CFR 435.132
Blind or Disabled Individuals Eligible in 1973	42 CFR 435.133
Individuals Who Lost Eligibility for SSI/SSP Due to an Increase in OASDI Benefits in 1972	42 CFR 435.134
Individuals Who Would be Eligible for SSI/SSP but for OASDI COLA increases since April, 1977	1939(a)(5)(E) 42 CFR 435.135 Section 503 of P.L. 94-566
Disabled Widows and Widowers Ineligible for SSI due to Increase in OASDI	1634(b) 42 CFR 435.137
Disabled Widows and Widowers Ineligible for SSI due to Early Receipt of Social Security	42 CFR 435.138 1634(d)
Working Disabled under 1619(b)	1902(a)(10)(A)(i)(II) 1905(q) 1619(b)
Disabled Adult Children	1634( c )
Qualified Medicare Beneficiaries	1902(a)(10)(E)(i) 1905(p)
Qualified Disabled and Working Individuals	1902(a)(10)(E)(ii) 1905(s) 1905(p)(3)(A)(i)
Specified Low Income Medicare Beneficiaries	1902(a)(10)(E)(iii) 1905(p)(3)(A)(ii)
Qualifying Individuals	1902(a)(10)(E)(iv) 1905(p)(3)(A)(ii)
Optional Categorically Needy
Children with Non-IV-E Adoption Assistance	1902(a)(10)(A)(ii)(VIII) 42 CFR 435.227
Independent Foster Care Adolescents	1902(a)(10)(A)(ii)(XVII) 1905(w)
Optional Targeted Low Income Children (M-CHIP)	1902(a)(10)(A)(ii)(XIV) 1905(u)(2)(B) 42 CFR 435.229 and 435.4
Children under 21 Not Receiving Cash	1902(a)(10)(A)(ii)(I) – (IV) 1905(a)(i) 42 CFR 435.222
Families Who Would Qualify for Cash if Requirements Were More Broad	1902(a)(10)(A)(ii)(III) 42 CFR 435.223 1905(a)
Individuals Eligible for Cash except for Child Care Subsidy	1902(a)(10)(A)(ii)(II) 42 CFR 435.220
Optional Poverty Level Related Pregnant Women and Infants	1902(a)(10)(A)(ii)(IX) 1902(l)(2)
Presumptively Eligible Pregnant Women	1902(a)(47) 1920
Presumptively Eligible Children	1902(a)(47) 1920A 42 CFR 1100-1102
Individuals Electing COBRA Continuation Coverage	1902(a)(10)(F) 1902(u)(1)
Individuals Eligible for but not Receiving Cash	42 CFR 435.210 1902(a)(10)(A)(ii)(I) 1905(a) 1902(v)(1)
Individuals Eligible for Cash except for Institutionalization	1902(a)(10)(A)(ii)(IV) 42 CFR 435.211 1905(a)
Individuals in HMOs Guaranteed Eligibility	42 CFR 435.212 1902(e)(2)
Individuals Receiving Home and Community Based Services under Institutional Rules	42 CFR 435.217 1902(a)(10)(A)(ii)(VI)
Individuals Participating in a PACE Program under Institutional Rules	1934
Individuals Receiving Hospice Care	1902(a)(10)(A)(ii)(VII) 1905(o)
Optional State Supplement Recipients - 1634 States, and SSI Criteria States with 1616 Agreements	1902(a)(10)(A)(ii)(IV) 42 CFR 435.232
Optional State Supplement Recipients - 209(b) States, and SSI Criteria States without 1616 Agreements	42 CFR 435.234 1902(a)(10)(A)(ii)(XI)
Qualified Disabled Children under 19	1902(e)(3)
Institutionalized Individuals Eligible under a Special Income Level	42 CFR 435.236 1902(a)(10)(A)(ii)(V) 1905(a)
Poverty Level Aged or Disabled	1902(a)(10)(A)(ii)(X) 1902(m)(1)
Individuals with Tuberculosis	1902(a)(10)(A)(ii)(XII) 1902(z)
Certain Women Needing Treatment for Breast or Cervical Cancer	1902(a)(10)(A)(ii)(XVIII) 1902(aa)
Presumptively Eligible Women with Breast or Cervical Cancer	1920B 1902(aa)
Work Incentives Eligibility Group	1902(a)(10)(A)(ii)(XIII)
Ticket to Work Basic Group	1902(a)(10)(A)(ii)(XV)
Ticket to Work Medical Improvements Group	1902(a)(10)(A)(ii)(XVI)
Family Opportunity Act Children with Disabilities	1902(a)(10)(A)(ii)(XIX) 1902(cc)
Individuals Eligible for Family Planning Services	1902(a)(10)(A)(ii)(XXI)
Individuals Eligible for Home and Community-Based Services	1902(a)(10)(A)(ii)(XXII) 1915(i)
Individuals Eligible for Home and Community-Based Services - Special Income Level	1902(a)(10)(A)(ii)(XXII) 1915(i)
Individuals at or below 133% FPL Age 19 through 64	1902(a)(10)(A)(i) (VIII) early implementation option
Medically Needy
Medically Needy Pregnant Women	1902(a)(10)(C)(ii)(II) 42 CFR 435.301(b)(1)(i) and (iv)
Medically Needy Children under 18	1902(a)(10)(C)(ii)(I) 42 CFR 435.301(b)(1)(ii)
Medically Needy Children Age 18 through 20	42 CFR 435.308 1902(a)(10)(C)
Medically Needy Parents and Other Caretaker Relatives	1902(a)(10)(C) 42 CFR 435.310
Medically Needy Aged	1902(a)(10)(C) 42 CFR 435.320 and 435.330
Medically Needy Blind	1902(a)(10)(C) 42 CFR 435.322 and 435.330
Medically Needy Disabled	1902(a)(10)(C) 42 CFR 435.324 and 435.330
Medically Needy Individuals in HMOs Guaranteed Eligibility	42 CFR 435.326
Medically Needy Blind or Disabled Individuals Eligible in 1973	42 CFR 435.340

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