subchapter 23D – MEDICAID ELIGIBILITY GROUPS AND
SECTION .0100 – COVERAGE GROUPS
10A NCAC 23d .0101 MANDATORY GROUPS
The following groups required by 42 U.S.C. 1396a (a)(10) or
1396u-1 shall be eligible for Medicaid:
(1) Individuals who meet the requirements under 42
(2) Individuals receiving four months continued
Medicaid when eligibility under 42 U.S.C. 1396u-1 is lost due to collection or
increased collection of child support.
(3) Individuals receiving transitional Medicaid as
described in 42 U.S.C. 1396s when eligibility under 42 U.S.C. 1396u-1 is lost
due to increased earnings.
(4) Individuals for whom an adoption assistance
agreement is in effect or foster care maintenance payments are being made under
Title IV E of the Social Security Act as described at 42 U.S.C. 673 (b).
(5) Qualified pregnant women as defined at 42 U.S.C.
(6) Qualified children as defined at 42 U.S.C.
(7) Pregnant women, during a 60 day period following
termination of the pregnancy, for pregnancy related and post partum services if
they applied for Medicaid prior to termination of the pregnancy and were
eligible on the date pregnancy is terminated.
(8) Children, born to a woman who was eligible for and
receiving Medicaid on the date of the child's birth, for up to one year from
the date of birth; as described at 42 U.S.C. 1396a(e)(4).
(9) Individuals receiving SSI under Title XVI of the
Social Security Act.
(10) Individuals who meet the requirements under 42
U.S.C. 1382h(a) or (b)(1).
(11) Blind or disabled individuals who were eligible in
December 1973 as blind or disabled and who for each consecutive month since
December 1973 continue to meet December 1973 eligibility criteria.
(12) Individuals who were eligible in December 1973 as
aged, or blind, or disabled with an essential spouse and who, for each
consecutive month since December 1973, continue to live with the essential
spouse and meet December 1973 eligibility criteria.
(13) Individuals who in December 1973 were eligible as
the essential spouse of an aged, or blind, or disabled individual and who for
each consecutive month since December 1973, have continued to live with that
individual who has met December 1973 eligibility criteria.
(14) Qualified Medicare Beneficiaries described at 42
(15) Pregnant women whose countable income does not
exceed the percent of the income official poverty line, established at 42
U.S.C. 1396a(1)(2), for pregnancy related services including labor and
(16) Children born after September 30, 1983 and who are
under age 19 who are described at 42 U.S.C. 1396a(1).
(17) Qualified Disabled and Working Individuals described
at 42 U.S.C. 1396d(s).
(18) Individuals as described at 42 U.S.C.
(19) Individuals who would continue to be eligible for
SSI except for specific Title II benefits or cost-of-living adjustments as
described at 42 U.S.C. 1383c.
History Note: Authority G.S. 108A-54; 42 U.S.C.
1396a(a)(10); 42 U.S.C. 1396a(e)(4); 42 U.S.C. 1396a(f); 42 C.F.R. 435.110; 42
C.F.R. 435.112; 42 C.F.R. 435.113; 42 C.F.R. 435.114; 42 C.F.R. 435.115; 42
C.F.R. 435.116; 42 C.F.R. 435.117; 42 C.F.R. 435.118; 42 C.F.R. 435.121; 42
C.F.R. 435.131; 42 C.F.R. 435.132; 42 C.F.R. 435.133;
Eff. September 1, 1984;
Amended Eff. January 1, 1995; March 1, 1993; January 4,
1993; April 1, 1992;
Temporary Amendment September 13, 1999;
Temporary Amendment Expired June 27, 2000;
Temporary Amendment September 12, 2000;
Amended Eff. August 1, 2002;
Transferred from 10A NCAC 21B .0101 Eff. May 1, 2012.