 |
United States Code (Last Updated: May 24, 2014) |
 |
Title 42. THE PUBLIC HEALTH AND WELFARE |
|
Chapter 7. SOCIAL SECURITY |
|
SubChapter XIX. GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS |
§ 1396d. Definitions
-
For purposes of this subchapter— (a) Medical assistance The term “medical assistance” means payment of part or all of the cost of the following care and services or the care and services themselves, or both (if provided in or after the third month before the month in which the recipient makes application for assistance or, in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection (p)(1) of this section, if provided after the month in which the individual becomes such a beneficiary) for individuals, and, with respect to physicians’ or dentists’ services, at the option of the State, to individuals (other than individuals with respect to whom there is being paid, or who are eligible, or would be eligible if they were not in a medical institution, to have paid with respect to them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in section 1396a(a)(10)(A) of this title) not receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI of this chapter, or part A of subchapter IV of this chapter, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI of this chapter, who are— (i) under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, (ii) relatives specified in section 606(b)(1) of this title) and shall not apply with respect to payments under subchapter IV (other than under part E of subchapter IV) or payments under subchapter XXI. (bb) Counseling and pharmacotherapy for cessation of tobacco use by pregnant women (1) For purposes of this subchapter, the term “counseling and pharmacotherapy for cessation of tobacco use by pregnant women” means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for cessation of tobacco use by pregnant women who use tobacco products or who are being treated for tobacco use that is furnished— (A) by or under the supervision of a physician; or (B) by any other health care professional who— (i) is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and (ii) is authorized to receive payment for other services under this subchapter or is designated by the Secretary for this purpose. (2) Subject to paragraph (3), such term is limited to— (A) services recommended with respect to pregnant women in “Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline”, published by the Public Health Service in May 2008, or any subsequent modification of such Guideline; and (B) such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women. (3) Such term shall not include coverage for drugs or biologicals that are not otherwise covered under this subchapter. (cc) Requirement for certain States Notwithstanding subsections (y), (z), and (aa), in the case of a State that requires political subdivisions within the State to contribute toward the non-Federal share of expenditures required under the State plan under section 1396a(a)(2) of this title, the State shall not be eligible for an increase in its Federal medical assistance percentage under such subsections if it requires that political subdivisions pay a greater percentage of the non-Federal share of such expenditures, or a greater percentage of the non-Federal share of payments under section 1396r–4 of this title, than the respective percentages that would have been required by the State under the State plan under this subchapter, State law, or both, as in effect on
December 31, 2009 , and without regard to any such increase. Voluntary contributions by a political subdivision to the non-Federal share of expenditures under the State plan under this subchapter or to the non-Federal share of payments under section 1396r–4 of this title, shall not be considered to be required contributions for purposes of this subsection. The treatment of voluntary contributions, and the treatment of contributions required by a State under the State plan under this subchapter, or State law, as provided by this subsection, shall also apply to the increases in the Federal medical assistance percentage under section 5001 of the American Recovery and Reinvestment Act of 2009.(dd) Increased FMAP for additional expenditures for primary care services Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1396a(a)(13)(C) of this title furnished on or after
January 1, 2013 , and beforeJanuary 1, 2015 , that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1396u–2(f) of this title) exceeds the payment rate applicable to such services under the State plan as ofJuly 1, 2009 , the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia shall be equal to 100 percent. The preceding sentence does not prohibit the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified in such sentence.
References In Text
Section 606 of this title, referred to in subsec. (a)(ii), was repealed and a new section 606 enacted by Pub. L. 104–193, title I, § 103(a)(1),
Section 211 of Pub. L. 93–66, referred to in subsec. (k), is section 211 of Pub. L. 93–66,
The Indian Self-Determination Act, referred to in subsec. (l)(2)(B), is title I of Pub. L. 93–638,
The Indian Health Care Improvement Act, referred to in subsec. (l)(2)(B), is Pub. L. 94–437,
Clause (ii), referred to in subsec. (l)(2)(B), was redesignated as cl. (iii) by Pub. L. 101–508, title IV, § 4704(c)(3),
Section 607 of this title, referred to in subsec. (m)(1), was repealed and a new section 607 enacted by Pub. L. 104–193, title I, § 103(a)(1),
Section 212 of Public Law 93–66, referred to in subsec. (q)(1)(A), is section 212 of Pub. L. 93–66, title II,
Section 5001 of Public Law 111–5, referred to in subsec. (aa)(1)(A), (2)(A), is set out as a note under this section.
Section 10202 of the Patient Protection and Affordable Care Act, referred to in subsec. (aa)(3), is section 10202 of Pub. L. 111–148, which is set out as a note under this section.
The Robert T. Stafford Disaster Relief and Emergency Assistance Act, referred to in subsec. (aa)(2), is Pub. L. 93–288,
Section 5001 of the American Recovery and Reinvestment Act of 2009, referred to in subsec. (cc), is section 5001 of Pub. L. 111–5, which is set out as a note under this section.
Amendments
2012—Subsec. (aa)(1)(A). Pub. L. 112–96, § 3204(a)(1)(A), substituted “the State’s regular FMAP shall be increased by 50 percent of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsections (y) and (z), and subsections (b) and (c) of section 5001 of Public Law 111–5.” for “the Federal medical assistance percentage determined for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, increased by 50 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year after the application of only subsection (a) of section 5001 of Public Law 111–5 (if applicable to the preceding fiscal year) and without regard to this subsection, subsection (y), and subsections (b) and (c) of section 5001 of Public Law 111–5.”
Subsec. (aa)(1)(B). Pub. L. 112–141 substituted “25 percent (or 50 percent in the case of fiscal year 2013)” for “25 percent”.
Pub. L. 112–96, § 3204(a)(1)(B), substituted “State’s regular FMAP for such fiscal year shall be increased by 25 percent of the number of percentage points by which the State’s regular FMAP for such fiscal year is less than the Federal medical assistance percentage received by the State during the preceding fiscal year.” for “Federal medical assistance percentage determined for the preceding fiscal year under this subsection for the State, increased by 25 percent of the number of percentage points by which the Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act, is less than the Federal medical assistance percentage determined for the State for the preceding fiscal year under this subsection.”
Subsec. (aa)(2)(A). Pub. L. 112–96, § 3204(a)(2)(A), substituted “State’s regular FMAP for the fiscal year” for “Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act,” and “subsections (y) and (z)” for “subsection (y)”.
Subsec. (aa)(2)(B). Pub. L. 112–96, § 3204(a)(2)(B), substituted “State’s regular FMAP for the fiscal year” for “Federal medical assistance percentage determined for the State for the fiscal year without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act,”.
Subsec. (aa)(3), (4). Pub. L. 112–96, § 3204(a)(3), (4), added par. (3) and redesignated former par. (3) as (4).
2010—Subsec. (a). Pub. L. 111–148, § 2304, inserted “or the care and services themselves, or both” before “(if provided in or after” in introductory provisions.
Subsec. (a)(xiv). Pub. L. 111–148, § 10201(c)(1), inserted “or 1396a(a)(10)(A)(i)(IX)” after “section 1396a(a)(10)(A)(i)(VIII)”.
Pub. L. 111–148, § 2001(a)(5)(C), added cl. (xiv).
Subsec. (a)(xv). Pub. L. 111–148, § 2001(e)(2)(A), added cl. (xv).
Subsec. (a)(xvi). Pub. L. 111–148, § 2303(a)(4)(A), added cl. (xvi).
Subsec. (a)(xvii). Pub. L. 111–148, § 2402(d)(2)(B), added cl. (xvii).
Subsec. (a)(4). Pub. L. 111–148, § 4107(a)(1), added subpar. (D).
Subsec. (a)(13). Pub. L. 111–148, § 4106(a), amended par. (13) generally. Prior to amendment, par. (13) read as follows: “other diagnostic, screening, preventive, and rehabilitative services, including any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level;”.
Subsec. (a)(28), (29). Pub. L. 111–148, § 2301(a)(1), added par. (28) and redesignated former par. (28) as (29).
Subsec. (b). Pub. L. 111–148, § 10201(c)(2), inserted “, (z),” before “and (aa)” in first sentence.
Pub. L. 111–148, § 4106(b), substituted “, (4)” for “and (4)” and inserted before period at end of first sentence “, and (5) in the case of a State that provides medical assistance for services and vaccines described in subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing for such services and vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y) (without regard to paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance for such services and vaccines and for items and services described in subsection (a)(4)(D)”.
Pub. L. 111–148, § 2006(1), substituted “subsections (y) and (aa)” for “subsection (y)” in first sentence.
Pub. L. 111–148, § 2005(c)(1), substituted “shall be 55 percent” for “shall be 50 per centum” in first sentence.
Pub. L. 111–148, § 2001(a)(3)(A), inserted “subsection (y) and” before “section 1396u–3(d) of this title” in first sentence.
Subsec. (l)(3). Pub. L. 111–148, § 2301(a)(2), added par. (3).
Subsec. (o)(1)(A). Pub. L. 111–148, § 2302(a)(1), substituted “subparagraphs (B) and (C)” for “subparagraph (B)”.
Subsec. (o)(1)(C). Pub. L. 111–148, § 2302(a)(2), added subpar. (C).
Subsec. (y). Pub. L. 111–148, § 2001(a)(3)(B), added subsec. (y).
Subsec. (y)(1). Pub. L. 111–152, § 1201(1)(B), added par. (1) and struck out former par. (1). Prior to amendment, par. (1) related to the amount of increase for the Federal medical assistance percentage.
Subsec. (y)(1)(B)(ii)(II). Pub. L. 111–152, § 1201(1)(A), redesignated subcl. (II) as par. (5) of subsec. (z).
Pub. L. 111–148, § 10201(c)(3)(A), inserted “includes inpatient hospital services,” after “100 percent of the poverty line, that”.
Subsec. (y)(2)(A). Pub. L. 111–148, § 10201(c)(3)(B), substituted “as of
Subsec. (z). Pub. L. 111–148, § 10201(c)(4), added subsec. (z).
Subsec. (z)(1)(A). Pub. L. 111–152, § 1201(2)(A), substituted “
Subsec. (z)(1)(B)(i). Pub. L. 111–152, § 1201(2)(A), substituted “paragraph (3)” for “subsection (y)(1)(B)(ii)(II)”.
Subsec. (z)(2). Pub. L. 111–152, § 1201(2)(B), added par. (2) and struck out former par. (2), which read as follows:
“(A) During the period that begins on
“(B) For purposes of subparagraph (A), a State described in this subparagraph is a State that—
“(i) is described in clauses (i) and (ii) of paragraph (1)(B); and
“(ii) is the State with the highest percentage of its population insured during 2008, based on the Current Population Survey.”
Subsec. (z)(3). Pub. L. 111–152, § 1201(2)(C), redesignated par. (5) as (3), struck out heading, and substituted “A State is” for “For purposes of the table in subclause (I), a State is”.
Pub. L. 111–152, § 1201(2)(B), struck out par. (3), which read as follows: “Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after
Subsec. (z)(4). Pub. L. 111–152, § 1201(2)(B), struck out par. (4) which read as follows: “The increase in the Federal medical assistance percentage for a State under paragraphs (1), (2), or (3) shall apply only for purposes of this subchapter and shall not apply with respect to—
“(A) disproportionate share hospital payments described in section 1396r–4 of this title;
“(B) payments under subchapter IV;
“(C) payments under subchapter XXI; and
“(D) payments under this subchapter that are based on the enhanced FMAP described in section 1397ee(b) of this title.”
Subsec. (z)(5). Pub. L. 111–152, § 1201(2)(C), redesignated par. (5) as (3).
Pub. L. 111–152, § 1201(1)(A), redesignated subsec. (y)(1)(B)(ii)(II) as subsec. (z)(5) and realigned margins.
Subsec. (aa). Pub. L. 111–148, § 2006(2), added subsec. (aa).
Subsec. (aa)(1), (2). Pub. L. 111–148, § 10201(c)(5), substituted “without regard to this subsection, subsection (y), subsection (z), and section 10202 of the Patient Protection and Affordable Care Act” for “without regard to this subsection and subsection (y)” wherever appearing.
Subsec. (bb). Pub. L. 111–148, § 4107(a)(2), added subsec. (bb).
Subsec. (cc). Pub. L. 111–148, § 10201(c)(6), added subsec. (cc).
Subsec. (dd). Pub. L. 111–152, § 1202(b), added subsec. (dd).
2008—Subsec. (p)(1)(C). Pub. L. 110–275, § 112, inserted “or, effective beginning with
Subsec. (p)(5)(A). Pub. L. 110–275, § 118(a), inserted at end “The Secretary shall provide for the translation of such application form into at least the 10 languages (other than English) that are most often used by individuals applying for hospital insurance benefits under section 426 or 426–1 of this title and shall make the translated forms available to the States and to the Commissioner of Social Security.”
2006—Subsec. (u)(2)(B). Pub. L. 109–171 inserted at end “Such term excludes any child eligible for medical assistance only by reason of section 1396a(a)(10)(A)(ii)(XIX) of this title.”
2004—Subsec. (a)(27), (28). Pub. L. 108–357, § 712(a)(1)(A), added par. (27) and redesignated former par. (27) as (28).
Subsec. (x). Pub. L. 108–357, § 712(a)(1)(B), added subsec. (x).
2000—Subsec. (a)(xiii). Pub. L. 106–354, § 2(a)(4), added cl. (xiii).
Subsec. (b). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(1)], in last sentence, substituted “the State’s available allotment under section 1397dd of this title” for “the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year”.
Pub. L. 106–354, § 2(c), in first sentence, struck out “and” before “(3)” and inserted before period at end “, and (4) the Federal medical assistance percentage shall be equal to the enhanced FMAP described in section 1397ee(b) of this title with respect to medical assistance provided to individuals who are eligible for such assistance only on the basis of section 1396a(a)(10)(A)(ii)(XVIII) of this title”.
Subsec. (p)(5). Pub. L. 106–554, § 1(a)(6) [title VII, § 709(a)], added par. (5).
Subsec. (p)(6). Pub. L. 106–554, § 1(a)(6) [title IX, § 911(a)(2)], added par. (6).
Subsec. (u)(1)(B). Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(d)(2)], struck out “and section 1397dd(d) of this title” before period at end.
1999—Subsec. (a)(xii). Pub. L. 106–170, § 201(a)(2)(C), added cl. (xii).
Subsec. (a)(15). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(aa)(3)], substituted “1396a(a)(31) of this title” for “1396a(a)(31)(A) of this title”.
Subsec. (b). Pub. L. 106–113, § 1000(a)(6) [title VI, § 605(a)], inserted “(other than expenditures under section 1396r–4 of this title)” after “with respect to expenditures” in last sentence.
Subsec. (b)(1). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(l)], substituted “83 per centum,” for “83 per centum,,”.
Subsec. (l)(2)(B). Pub. L. 106–113, § 1000(a)(6) [title VI, § 608(m)], substituted “an entity” for “a entity” in introductory provisions.
Subsec. (v). Pub. L. 106–169, § 121(c)(5)(A), redesignated subsec. (v), related to independent foster care adolescent, as (w).
Pub. L. 106–169, § 121(a)(2), added subsec. (v), related to independent foster care adolescent.
Pub. L. 106–170, § 201(a)(2)(B), added subsec. (v).
Subsec. (w). Pub. L. 106–169, § 121(c)(5), redesignated subsec. (v) as (w) and substituted “1396a(a)(10)(A)(ii)(XVII)” for “1396a(a)(10)(A)(ii)(XV)”.
1997—Subsec. (a)(25). Pub. L. 105–33, § 4702(a)(1), added par. (25). Former par. (25) redesignated (26).
Subsec. (a)(26). Pub. L. 105–33, § 4802(a)(1), added par. (26). Former par. (26) redesignated (27).
Pub. L. 105–33, § 4702(a)(1)(B), redesignated par. (25) as (26) and substituted comma for period at end.
Subsec. (a)(27). Pub. L. 105–33, § 4802(a)(1)(B), redesignated par. (26) as (27).
Subsec. (b). Pub. L. 105–100, § 162(1), inserted “for the State for a fiscal year, and that do not exceed the amount of the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year,” after “subsection (u)(3) of this section”.
Pub. L. 105–33, § 4911(a)(1), inserted at end “Notwithstanding the first sentence of this subsection, in the case of a State plan that meets the condition described in subsection (u)(1) of this section, with respect to expenditures described in subsection (u)(2)(A) of this section or subsection (u)(3) of this section the Federal medical assistance percentage is equal to the enhanced FMAP described in section 1397ee(b) of this title.”
Pub. L. 105–33, § 4732(b), substituted “Subject to section 1396u–3(d) of this title, the term” for “The term”.
Pub. L. 105–33, § 4725(b)(1), in first sentence, substituted “, (2)” for “and (2)” and inserted before period “, and (3) for purposes of this subchapter and subchapter XXI of this chapter, the Federal medical assistance percentage for the District of Columbia shall be 70 percent”.
Subsec. (l)(2)(B)(iii). Pub. L. 105–33, § 4712(d)(1), inserted “including requirements of the Secretary that an entity may not be owned, controlled, or operated by another entity,” after “such a grant,”.
Subsec. (o)(3). Pub. L. 105–33, § 4711(c)(1), substituted “amount determined in section 1396a(a)(13)(B) of this title” for “amount described in section 1396a(a)(13)(D) of this title” in concluding provisions.
Subsec. (p)(3). Pub. L. 105–33, § 4714(a)(2), inserted “(subject to section 1396a(n)(2) of this title)” after “means” in introductory provisions.
Subsec. (t). Pub. L. 105–33, § 4702(a)(2), added subsec. (t).
Subsec. (u). Pub. L. 105–33, § 4911(a)(2), added subsec. (u).
Subsec. (u)(1)(B). Pub. L. 105–100, § 162(2)(A), substituted “the fourth sentence of subsection (b) of this section” for “paragraph (2)”.
Subsec. (u)(2)(A). Pub. L. 105–100, § 162(2)(B), substituted “subparagraph (B)” for “subparagraph (C), but not in excess, for a State for a fiscal year, of the amount described in subparagraph (B) for the State and fiscal year”.
Subsec. (u)(2)(B), (C). Pub. L. 105–100, § 162(2)(C), added subpar. (B) and struck out former subpars. (B) and (C) which read as follows:
“(B) The amount described in this subparagraph, for a State for a fiscal year, is the amount of the State’s allotment under section 1397dd of this title (not taking into account reductions under section 1397dd(d)(2) of this title) for the fiscal year reduced by the amount of any payments made under section 1397ee of this title to the State from such allotment for such fiscal year.
“(C) For purposes of this paragraph, the term ‘optional targeted low-income child’ means a targeted low-income child as defined in section 1397jj(b)(1) of this title who would not qualify for medical assistance under the State plan under this subchapter based on such plan as in effect on
Subsec. (u)(3). Pub. L. 105–100, § 162(2)(D), substituted “described in this paragraph” for “described in this subparagraph” and “
Subsec. (u)(4). Pub. L. 105–100, § 162(2)(E), added par. (4).
1996—Subsec. (l)(2)(B)(i), (ii)(II). Pub. L. 104–299 substituted “section 254b of this title” for “section 254b, 254c, 256, or 256a of this title”.
1994—Subsecs. (j), (q)(2). Pub. L. 103–296 substituted “Commissioner of Social Security” for “Secretary”.
1993—Subsec. (a)(xi). Pub. L. 103–66, § 13603(e)(1)–(3), added cl. (xi).
Subsec. (a)(7). Pub. L. 103–66, § 13601(a)(1), struck out “including personal care services (A) prescribed by a physician for an individual in accordance with a plan of treatment, (B) provided by an individual who is qualified to provide such services and who is not a member of the individual’s family, (C) supervised by a registered nurse, and (D) furnished in a home or other location; but not including such services furnished to an inpatient or resident of a nursing facility” after “services”.
Subsec. (a)(17). Pub. L. 103–66, § 13605(a), inserted before semicolon at end “, and without regard to whether or not the services are performed in the area of management of the care of mothers and babies throughout the maternity cycle”.
Subsec. (a)(19). Pub. L. 103–66, § 13603(e)(4), amended par. (19) generally, inserting reference to TB-related services described in section 1396a(z)(2)(F) of this title.
Subsec. (a)(21). Pub. L. 103–66, § 13601(a)(2), struck out “and” at end.
Subsec. (a)(22). Pub. L. 103–66, § 13601(a)(4), redesignated par. (23) as (22). Former par. (22) redesignated (25).
Subsec. (a)(23). Pub. L. 103–66, § 13601(a)(4), redesignated par. (24) as (23). Former par. (23) redesignated (22).
Subsec. (a)(24). Pub. L. 103–66, § 13601(a)(5), added par. (24). Former par. (24) redesignated (23).
Pub. L. 103–66, § 13601(a)(3), which directed amendment of par. (24) by substituting semicolon for comma at end, was executed by substituting semicolon for period at end to reflect the probable intent of Congress.
Subsec. (a)(25). Pub. L. 103–66, § 13601(a)(4), redesignated par. (22) as (25), transferred such par. to appear after par. (23), and substituted period for semicolon at end.
Subsec. (l)(2)(B). Pub. L. 103–66, § 13631(f)(2)(B), in concluding provisions, inserted “or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act for the provision of primary health services” before “. In applying clause”.
Subsec. (l)(2)(B)(i). Pub. L. 103–66, § 13631(f)(2)(A), substituted “256, or 256a” for “or 256”.
Pub. L. 103–66, § 13606(a)(1), struck out “or” at end.
Subsec. (l)(2)(B)(ii). Pub. L. 103–66, § 13631(f)(2)(A), substituted “256, or 256a” for “or 256” in subcl. (II).
Pub. L. 103–66, § 13606(a)(2), (3), realigned margin and substituted a comma for semicolon at end.
Subsec. (l)(2)(B)(iv). Pub. L. 103–66, § 13606(a)(4), (5), added cl. (iv).
Subsec. (r)(1)(A)(i). Pub. L. 103–66, § 13631(g)(1)(A), inserted “and, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule referred to in section 1396s(c)(2)(B)(i) of this title for pediatric vaccines” after “child health care”.
Subsec. (r)(1)(B)(iii). Pub. L. 103–66, § 13631(g)(1)(B), inserted “(according to the schedule referred to in section 1396s(c)(2)(B)(i) of this title for pediatric vaccines)” after “appropriate immunizations”.
1990—Subsec. (a). Pub. L. 101–508, § 4722, inserted at end “No service (including counseling) shall be excluded from the definition of ‘medical assistance’ solely because it is provided as a treatment service for alcoholism or drug dependency.”
Pub. L. 101–508, § 4402(d)(2), inserted at end “The payment described in the first sentence may include expenditures for medicare cost-sharing and for premiums under part B of subchapter XVIII of this chapter for individuals who are eligible for medical assistance under the plan and (A) are receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI of this chapter, or part A of subchapter IV of this chapter, or with respect to whom supplemental security income benefits are being paid under subchapter XVI of this chapter, or (B) with respect to whom there is being paid a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in section 1396a(a)(10)(A) of this title, and, except in the case of individuals 65 years of age or older and disabled individuals entitled to health insurance benefits under subchapter XVIII of this chapter who are not enrolled under part B of subchapter XVIII of this chapter, other insurance premiums for medical or any other type of remedial care or the cost thereof.”
Subsec. (a)(x). Pub. L. 101–508, § 4713(b), added cl. (x).
Subsec. (a)(2)(C). Pub. L. 101–508, § 4704(e)(1), repealed Pub. L. 101–239, § 6402(c)(1). See 1989 Amendment note below.
Subsec. (a)(7). Pub. L. 101–508, § 4721(a), substituted “services including personal care services” for “services” and added subpars. (A) to (D).
Subsec. (a)(13). Pub. L. 101–508, § 4719(a), inserted before semicolon at end “, including any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level”.
Subsec. (a)(22). Pub. L. 101–508, § 4711(a)(1), which directed amendment of par. (22) by striking “and” at end, could not be executed because the word did not appear.
Subsec. (a)(23). Pub. L. 101–508, § 4712(a)(1), inserted “and” after semicolon at end.
Pub. L. 101–508, § 4711(a)(2), (3), which directed amendment of subsec. (a) by redesignating par. (23) as (24) and adding a new par. (23), was executed by adding the new par. (23), there being no former par. (23).
Subsec. (a)(24). Pub. L. 101–508, § 4712(a)(2), (3), which directed amendment of subsec. (a) by redesignating par. (24) as (25) and adding a new par. (24), was executed by adding the new par. (24), there being no former par. (24).
Subsec. (h)(1)(A). Pub. L. 101–508, § 4755(a)(1)(A), inserted “or in another inpatient setting that the Secretary has specified in regulations” after “section 1395x(f) of this title”.
Subsec. (l)(2)(A). Pub. L. 101–508, § 4704(c)(1), substituted “patient” for “outpatient”.
Subsec. (l)(2)(B). Pub. L. 101–508, § 4704(d)(2), which directed amendment of subpar. (B) by inserting “and includes an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93–638).” after and below cl. (ii), was executed by inserting the new language after cl. (iii) to reflect the probable intent of Congress and the intervening redesignation of former cl. (ii) as (iii) by Pub. L. 101–508, § 4704(c)(3). See below.
Pub. L. 101–508, § 4704(c)(2), substituted “entity” for “facility” in introductory provisions.
Subsec. (l)(2)(B)(ii), (iii). Pub. L. 101–508, § 4704(c)(3), (d)(1), added cl. (ii), redesignated former cl. (ii) as (iii), and substituted comma for period at end of cl. (iii).
Subsec. (n)(2). Pub. L. 101–508, § 4601(a)(2), substituted “age of 19” for “age of 7 (or any age designated by the State that exceeds 7 but does not exceed 8)”.
Subsec. (o)(1)(A). Pub. L. 101–508, § 4717, inserted “and for which payment may otherwise be made under subchapter XVIII of this chapter” after “section 1395d(d)(2)(A) of this title”.
Subsec. (o)(3). Pub. L. 101–508, § 4705(a)(1), struck out “a State which elects not to provide medical assistance for hospice care, but provides medical assistance for skilled nursing or intermediate care facility services with respect to” after “In the case of” in introductory provisions.
Pub. L. 101–508, § 4705(a)(3), (4), in concluding provisions, substituted “the additional amount described in section 1396a(a)(13)(D) of this title” for “the amounts allocated under the plan for room and board in the facility, in accordance with the rates established under section 1396a(a)(13) of this title,” and struck out at end “For purposes of this paragraph and section 1396a(a)(13)(D) of this title, the term ‘room and board’ includes performance of personal care services, including assistance in activities of daily living, in socializing activities, administration of medication, maintaining the cleanliness of a resident’s room, and supervising and assisting in the use of durable medical equipment and prescribed therapies.”
Subsec. (o)(3)(A), (C). Pub. L. 101–508, § 4705(a)(2), substituted “nursing facility or intermediate care facility for the mentally retarded” for “skilled nursing or intermediate care facility”.
Subsec. (p)(1)(B). Pub. L. 101–508, § 4501(e)(1)(A), which directed amendment of subpar. (B) by inserting “, except as provided in paragraph (2)(D)” after “supplementary social security income program”, was executed by inserting the new language after “supplemental security income program” to reflect the probable intent of Congress.
Subsec. (p)(2)(B). Pub. L. 101–508, § 4501(a)(1), inserted “and” at end of cl. (ii), substituted “100 percent.” for “95 percent, and” in cl. (iii), and struck out cl. (iv) which read as follows: “
Subsec. (p)(2)(C). Pub. L. 101–508, § 4501(a)(2), substituted “95 percent, and” for “90 percent,” in cl. (iii) and “100 percent.” for “95 percent, and” in cl. (iv) and struck out cl. (v) which read as follows: “
Subsec. (p)(2)(D). Pub. L. 101–508, § 4501(e)(1)(B), added subpar. (D).
Subsec. (p)(4). Pub. L. 101–508, § 4501(c)(2), inserted at end “In the case of any State which is providing medical assistance to its residents under a waiver granted under section 1315 of this title, the Secretary shall require the State to meet the requirement of section 1396a(a)(10)(E) of this title in the same manner as the State would be required to meet such requirement if the State had in effect a plan approved under this subchapter.”
Subsec. (p)(4)(B). Pub. L. 101–508, § 4501(c)(1), inserted “or 1396a(a)(10)(E)(iii) of this title” after “subparagraph (B)”.
1989—Subsec. (a)(2)(B). Pub. L. 101–239, § 6404(a)(2), substituted “subsection (l)(1)” for “subsection (l)” in two places.
Subsec. (a)(2)(C). Pub. L. 101–239, § 6404(a)(3), added cl. (C) relating to Federally-qualified health center services.
Pub. L. 101–239, § 6402(c)(1), which directed addition of cl. (C) relating to ambulatory services, was repealed by Pub. L. 101–508, § 4704(e)(1).
Subsec. (a)(4)(B). Pub. L. 101–239, § 6403(d)(2), amended cl. (B) generally. Prior to amendment, cl. (B) read as follows: “effective
Subsec. (a)(21), (22). Pub. L. 101–239, § 6405(a), added par. (21) and redesignated former par. (21) as (22).
Subsec. (l). Pub. L. 101–239, § 6404(b), designated existing provisions as par. (1), redesignated former cls. (1) and (2) as (A) and (B), respectively, and added par. (2).
Subsec. (p)(1)(A). Pub. L. 101–239, § 6408(d)(4)(B), inserted “, but not including an individual entitled to such benefits only pursuant to an enrollment under section 1395i–2a of this title” after “section 1395i–2 of this title”.
Subsec. (p)(3)(A). Pub. L. 101–239, § 6408(d)(4)(A)(i), amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: “Premiums under subchapter XVIII of this chapter (including under part B and, if applicable, under section 1395i–2 of this title).”
Subsec. (p)(3)(A)(i). Pub. L. 101–239, § 6408(d)(4)(A)(ii), substituted “section 1395i–2 or 1395i–2a” for “section 1395i–2”.
Subsec. (p)(3)(C). Pub. L. 101–234, § 201(b)(1), substituted “Deductibles” for “Subject to paragraph (4), deductibles” and “section 1395e of this title and section 1395l(b) of this title)” for “section 1395e of this title, section 1395l(b) of this title, and section 1395m(c)(1) of this title”.
Subsec. (p)(4), (5). Pub. L. 101–234, § 201(b)(2), redesignated par. (5) as (4) and struck out former par. (4) which read as follows: “In a State which provides medical assistance for prescribed drugs under subsection (a)(12) of this section, instead of providing to qualified medicare beneficiaries, under paragraph (3)(C), medicare cost-sharing with respect to the annual deductible for covered outpatient drugs under section 1395m(c)(1) of this title, the State may provide to such beneficiaries, before charges for covered outpatient drugs for a year reach such deductible amount, benefits for prescribed drugs in the same amount, duration, and scope as the benefits made available under the State plan for individuals described in section 1396a(a)(10)(A)(i) of this title.”
Subsec. (r). Pub. L. 101–239, § 6403(c), inserted at end “The Secretary shall, not later than
Pub. L. 101–239, § 6403(a), added subsec. (r).
Subsec. (s). Pub. L. 101–239, § 6408(d)(2), added subsec. (s).
1988—Subsec. (a). Pub. L. 100–647, § 8434(b)(3), substituted “in the case of medicare cost-sharing with respect to a qualified medicare beneficiary” for “in the case of a qualified medicare beneficiary” in introductory provisions.
Subsec. (a)(ix). Pub. L. 100–485, § 303(b)(2), added cl. (ix).
Subsec. (a)(5)(B). Pub. L. 100–360, § 411(k)(4), substituted “described in clause (A) if” for “described in subparagraph (A) if”.
Subsec. (a)(17). Pub. L. 100–360, § 411(h)(4)(E), amended Pub. L. 100–203, § 4073(d)(1), see 1987 Amendment note below.
Subsec. (i). Pub. L. 100–360, § 411(k)(14)(A), added subsec. (i).
Subsec. (m). Pub. L. 100–485, § 401(d)(2), added subsec. (m).
Subsec. (o)(1). Pub. L. 100–360, § 411(k)(8)(A), made clarifying amendment to directory language of Pub. L. 100–203, § 4114, see 1987 Amendment note below.
Subsec. (o)(1)(B). Pub. L. 100–360, § 411(k)(8)(B), struck out “only” after “For purposes of this subchapter” and substituted “immune deficiency syndrome (AIDS)” for “immunodeficiency syndrome”.
Subsec. (o)(3). Pub. L. 100–485, § 608(f)(3), realigned the margin of par. (3).
Subsec. (p)(1). Pub. L. 100–647, § 8434(a), redesignated subpars. (C) and (D) as (B) and (C), respectively, and struck out former subpar. (B) which read: “who, but for section 1396a(a)(10)(E) of this title, is not eligible for medical assistance under the plan,”.
Subsec. (p)(1)(B). Pub. L. 100–360, § 301(a)(2), struck out “and the election of the State” after “1396a(a)(10)(E) of this title”.
Subsec. (p)(1)(C). Pub. L. 100–360, § 301(c)(1), as amended by Pub. L. 100–485, § 608(d)(14)(E)(i), substituted “paragraph (2)” for “paragraph (2)(A)”.
Subsec. (p)(1)(D). Pub. L. 100–360, § 301(c)(2), as amended by Pub. L. 100–485, § 608(d)(14)(E)(ii), substituted “twice” for “(except as provided in paragraph (2)(B))”.
Subsec. (p)(2)(A). Pub. L. 100–647, § 8434(b)(4), substituted “paragraph (1)(B)” for “paragraph (1)(C)”.
Pub. L. 100–360, § 301(b)(1), as amended by Pub. L. 100–485, § 608(d)(14)(A), substituted “shall be at least the percent provided under subparagraph (B) (but not more than 100 percent)” for “may not exceed a percentage (not more than 100 percent)”.
Pub. L. 100–360, § 301(c)(3)(A), which directed amendment of subpar. (A) by striking “(2)(A)” and inserting “(2)”, was repealed by Pub. L. 100–485, § 608(d)(14)(E)(iii).
Pub. L. 100–360, § 301(b)(2), which directed amendment of subpar. (A) by inserting “(i)” after “(2)(A)”, was repealed by Pub. L. 100–485, § 608(d)(14)(B).
Subsec. (p)(2)(B). Pub. L. 100–360, § 301(b)(2), formerly § 301(b)(3), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(B)–(D)(ii), added subpar. (B) and struck out former subpar. (B) which read as follows: “In the case of a State that provides medical assistance to individuals not described in section 1396a(a)(10)(A) of this title and at the State’s option, the State may use under paragraph (1)(D) such resource level (which is higher than the level described in that paragraph) as may be applicable with respect to individuals described in paragraph (1)(A) who are not described in section 1396a(a)(10)(A) of this title.”
Pub. L. 100–360, § 301(c)(3)(B), which directed amendment of par. (2) by striking subpar. (B), was repealed by Pub. L. 100–485, § 608(d)(14)(E)(iii).
Subsec. (p)(2)(C). Pub. L. 100–360, § 301(b)(2), formerly § 301(b)(3), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(B), (C), (D)(i), (iii), added subpar. (C).
Subsec. (p)(3). Pub. L. 100–360, § 301(d)(1), as added by Pub. L. 100–485, § 608(d)(14)(G)(ii), inserted “without regard to whether the costs incurred were for items and services for which medical assistance is otherwise available under the plan” after “qualified medicare beneficiary” in introductory provisions.
Subsec. (p)(3)(A). Pub. L. 100–360, § 301(d)(2), formerly § 301(d)(1), as renumbered by Pub. L. 100–485, § 608(d)(14)(G)(i), substituted “under subchapter XVIII of this chapter (including under part B and, if applicable, under section 1395i–2 of this title)” for “under part B and (if applicable) under section 1395i–2 of this title”.
Subsec. (p)(3)(B). Pub. L. 100–360, § 301(d)(3), formerly § 301(d)(2), as renumbered by Pub. L. 100–485, § 608(d)(14)(G)(i), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “Deductibles and coinsurance described in section 1395e of this title.”
Subsec. (p)(3)(C). Pub. L. 100–360, § 301(d)(3), formerly § 301(d)(2), as renumbered and amended by Pub. L. 100–485, § 608(d)(14)(F), (G)(i), amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “The annual deductible described in section 1395l(b) of this title.”
Subsec. (p)(4). Pub. L. 100–360, § 301(d)(4), formerly § 301(d)(3), as renumbered by Pub. L. 100–485, § 618(d)(14)(G)(i), added par. (4).
Subsec. (p)(5). Pub. L. 100–360, § 301(g)(2), as amended by Pub. L. 100–485, § 608(d)(14)(J), added par. (5).
1987—Subsec. (a)(4)(A). Pub. L. 100–203, § 4211(f), struck out “skilled” before “nursing”.
Subsec. (a)(5). Pub. L. 100–203, § 4211(h)(6)(A), struck out “skilled” before “nursing” in cl. (A).
Pub. L. 100–203, § 4103(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (a)(9). Pub. L. 100–203, § 4105(a), inserted provision including services furnished to an eligible individual who does not reside in a permanent dwelling or have a fixed home or mailing address.
Subsec. (a)(14). Pub. L. 100–203, § 4211(h)(6)(B), substituted “and nursing facility services” for “, skilled nursing facility services, and intermediate care facility services”.
Subsec. (a)(15). Pub. L. 100–203, § 4211(h)(6)(C), substituted “services in an intermediate care facility for the mentally retarded (other than” for “intermediate care facility services (other than such services”.
Subsec. (a)(17). Pub. L. 100–203, § 4073(d)(1), as amended by Pub. L. 100–360, § 411(h)(4)(E), substituted “(as defined in section 1395x(gg) of this title)” for “(as defined in subsection (m) of this section)”.
Subsec. (c). Pub. L. 100–203, § 4211(e)(1), amended subsec. (c) generally. Prior to amendment, subsec. (c) defined “intermediate care facility”.
Subsec. (d). Pub. L. 100–203, § 4211(e)(2), substituted “intermediate care facility for the mentally retarded” for “intermediate care facility” and “means an” for “may include services in a public”, and in par. (3) inserted “in the case of a public institution” after “(3)”.
Subsec. (f). Pub. L. 100–203, § 4211(e)(3), struck out “skilled” before “nursing” in four places and before “rehabilitation”.
Subsec. (i). Pub. L. 100–203, § 4211(e)(4), struck out subsec. (i) which provided that for purposes of this subchapter “skilled nursing facility” also includes any institution which is located in a State on an Indian reservation and is certified by the Secretary as being a qualified skilled nursing facility by meeting the requirements of section 1395x(j) of this title.
Subsec. (m). Pub. L. 100–203, § 4073(d)(2), struck out subsec. (m) which defined “nurse-midwife”. See section 1395x(gg) of this title.
Subsec. (n)(2). Pub. L. 100–203, § 4101(c)(1), substituted “has not attained the age of 7 (or any age designated by the State that exceeds 7 but does not exceed 8)” for “is under 5 years of age”.
Subsec. (o)(1). Pub. L. 100–203, § 4114, as amended by Pub. L. 100–360, § 411(k)(8)(A), designated existing provisions as subpar. (A), substituted “Subject to subparagraph (B), the” for “The”, and added subpar. (B).
Subsec. (p)(2)(A). Pub. L. 100–203, § 4118(p)(8), struck out “nonfarm” before “official”.
1986—Subsec. (a). Pub. L. 99–509, § 9403(g)(3), inserted “or, in the case of a qualified medicare beneficiary described in subsection (p)(1) of this section, if provided after the month in which the individual becomes such a beneficiary” after “makes application for assistance”.
Subsec. (a)(18). Pub. L. 99–272, § 9505(a)(1), added par. (18). Former par. (18) redesignated (19).
Subsec. (a)(19). Pub. L. 99–514, § 1895(c)(3)(A), added par. (19). Former par. (19) redesignated (20).
Pub. L. 99–272, § 9505(a)(1)(B), redesignated former par. (18) as (19).
Subsec. (a)(20). Pub. L. 99–509, § 9408(c)(1), added par. (20). Former par. (20) redesignated (21).
Pub. L. 99–514, § 1895(c)(3)(A)(ii), redesignated former par. (19) as (20).
Subsec. (a)(21). Pub. L. 99–509, § 9408(c)(1)(B), redesignated former par. (20) as (21).
Subsec. (n)(1)(C). Pub. L. 99–272, § 9501(a), added subpar. (C).
Subsec. (n)(2). Pub. L. 99–272, § 9511(a), inserted “(or such earlier date as the State may designate)” after “
Subsec. (o). Pub. L. 99–272, § 9505(a)(2), added subsec. (o).
Subsec. (o)(3). Pub. L. 99–509, § 9435(b)(2), added par. (3).
Subsec. (p). Pub. L. 99–509, § 9403(b), (d), added subsec. (p).
Subsec. (q). Pub. L. 99–509, § 9404(b), added subsec. (q).
1984—Subsec. (a). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases” in subd. (B) following par. (18).
Pub. L. 98–369, § 2373(b)(17), substituted “clause (vi)” for “clauses (vi)” and “well-being” for “well being” in last sentence.
Subsec. (a)(1). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Subsec. (a)(4). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Pub. L. 98–369, § 2373(b)(15), inserted a semicolon before “(B)”.
Subsec. (a)(9). Pub. L. 98–369, § 2371(a), amended par. (9) generally, inserting “furnished by or under the direction of a physician, without regard to whether the clinic itself is administered by a physician”.
Subsec. (a)(14), (15). Pub. L. 98–369, § 2335(f), substituted “mental diseases” for “tuberculosis or mental diseases”.
Subsec. (a)(17). Pub. L. 98–369, § 2373(b)(16), substituted “the nurse-midwife” for “he” in two places.
Subsec. (b). Pub. L. 98–369, § 2373(b)(18), substituted “section 1301(a)(8)(B) of this title” for “subparagraph (B) of section 1301(a)(8) of this title”.
Subsec. (d)(1). Pub. L. 98–369, § 2373(b)(19), substituted “the institution meets” for “which meet”.
Subsec. (h)(1)(A). Pub. L. 98–369, § 2340(b), amended subpar. (A) generally. Prior to amendment, subpar. (A) read as follows: “inpatient services which are provided in an institution which is accredited as a psychiatric hospital by the Joint Commission on Accreditation of Hospitals;”.
Subsec. (m). Pub. L. 98–369, § 2373(b)(20), substituted “the nurse” for “he” in two places.
Subsec. (n). Pub. L. 98–369, § 2361(b), added subsec. (n).
1982—Subsec. (a)(i). Pub. L. 97–248, § 137(b)(17), struck out “or any reasonable category of such individuals,” after “as the State may choose,”.
Subsec. (a)(viii). Pub. L. 97–248, § 137(b)(18), added cl. (viii).
Subsec. (b)(2). Pub. L. 97–248, § 136(c), substituted “the Northern Mariana Islands, and American Samoa” for “and the Northern Mariana Islands”.
Subsec. (h)(1)(C). Pub. L. 97–248, § 137(f), redesignated cls. (i) and (ii) as subcls. (I) and (II), respectively, and redesignated cls. (A) and (B) as cls. (i) and (ii), respectively.
1981—Subsec. (a). Pub. L. 97–35, § 2172(b), in cl. (i), inserted “or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, or any reasonable category of such individuals,” and in cl. (ii), struck out reference to section 606(a)(2) of this title.
Subsec. (b). Pub. L. 97–35, § 2162(a)(2), inserted reference to Northern Mariana Islands.
1980—Subsec. (a)(17), (18). Pub. L. 96–499, § 965(a)(1)(B), (C), added par. (17) and redesignated former par. (17) as (18).
Subsec. (c). Pub. L. 96–473 substituted “clause (1)” for “clauses (1)”.
Subsec. (m). Pub. L. 96–499, § 965(a)(2), added subsec. (m).
1978—Subsec. (c). Pub. L. 95–292 added cl. (4) to first sentence relating to a requirement that intermediate care facilities meet section 1395x(j)(14) of this title with respect to protection of patients’ personal funds, and inserted reference to that cl. (4) in provisions covering intermediate care facilities on Indian reservations.
1977—Subsec. (a)(2). Pub. L. 95–210, § 2(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (l). Pub. L. 95–210, § 2(b), added subsec. (l).
1976—Subsec. (b). Pub. L. 94–437 inserted provision requiring that the Federal medical assistance percentage be 100 per centum for services received through an Indian Health Service facility.
1973—Subsec. (a). Pub. L. 93–233, § 13(a)(13), substituted in introductory text “individuals (other than individuals with respect to whom there is being paid, or who are eligible or would be eligible if they were not in a medical institution, to have paid with respect to them a State supplementary payment and are eligible for medical assistance equal in amount, duration, and scope to the medical assistance made available to individuals described in section 1396a(a)(10)(A) of this title) not receiving aid or assistance under any plan of the State approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter, and with respect to whom supplemental security income benefits are not being paid under subchapter XVI of this chapter” for “individuals not receiving aid or assistance under the State’s plan approved under subchapter I, X, XIV, or XVI, or part A of subchapter IV of this chapter”.
Subsec. (a)(iv). Pub. L. 93–233, § 13(a)(14), inserted “with respect to States eligible to participate in the State plan program established under subchapter XVI of this chapter,” after “blind,”.
Subsec. (a)(v). Pub. L. 93–233, § 13(a)(15), substituted “with respect to States eligible to participate in the State plan program established under subchapter XVI of this chapter,” for “or”.
Subsec. (a)(vi). Pub. L. 93–233, § 13(a)(16), inserted “or” at end of text.
Subsec. (a)(vii). Pub. L. 93–233, § 13(a)(17), added cl. (vii).
Subsec. (a)(16). Pub. L. 93–233, § 18(x)(7), substituted “under age 21, as defined in subsection (h) of this section; and” for “under 21, as defined in subsection (e) of this section;”.
Subsec. (b). Pub. L. 93–233, § 18(y)(2), struck out “; except that the Secretary shall promulgate such percentage as soon as possible after
Subsec. (c). Pub. L. 93–233, § 18(x)(8), substituted “skilled nursing facility” for “skilled nursing home” wherever appearing.
Subsec. (h)(1)(B). Pub. L. 93–233, § 18(w), substituted “(i) involve active treatment” for “, involves active treatment (i)”; struck out “pursuant to subchapter XVIII of this chapter” after “may be prescribed”; and substituted “(ii)” for “(ii) which”, respectively.
Subsec. (h)(2). Pub. L. 93–233, § 18(x)(10), substituted “paragraph (1)” for “paragraph (e)(1)”.
Subsec. (i). Pub. L. 93–233, § 18(x)(9), redesignated subsec. (h) as added by Pub. L. 92–603, § 299L(b), as subsec. (i).
Subsecs. (j), (k). Pub. L. 93–233, § 13(a)(18), added subsecs. (j) and (k).
1972—Subsec. (a). Pub. L. 92–603, § 299B(c), in text following redesignated subsec. (a)(17) substituted “as otherwise provided in paragraph (16),” for “that”.
Subsec. (a)(4). Pub. L. 92–603, §§ 278(a)(21), 299E(b), substituted “skilled nursing facility” for “skilled nursing home” and added cl. (C).
Subsec. (a)(5). Pub. L. 92–603, §§ 278(a)(22), 280, substituted “skilled nursing facility” for “skilled nursing home” and inserted “furnished by a physician (as defined in section 1395x(r)(1) of this title) after “physicians’ services”.
Subsec. (a)(14). Pub. L. 92–603, §§ 278(a)(23), 297(a), substituted “skilled nursing facility” for “skilled nursing home” and inserted reference to intermediate care facility services.
Subsec. (a)(15) to (17). Pub. L. 92–603, § 299B(a), added par. (16) and redesignated existing pars. (15) and (16) as (17) and (15), respectively.
Subsec. (c). Pub. L. 92–603, § 299L(a), inserted provision defining “intermediate care facility” with respect to any institution located in a State on an Indian reservation.
Subsec. (d)(3). Pub. L. 92–603, § 299, inserted provisions relating to reduction of non-Federal expenditures in any calendar quarter prior to
Subsec. (e). Pub. L. 92–603, § 212(a), added subsec. (e).
Subsec. (f). Pub. L. 92–603, § 247(b), added subsec. (f).
Subsec. (g). Pub. L. 92–603, § 275(a), added subsec. (g).
Subsec. (h). Pub. L. 92–603, § 299B(b), added subsec. (h).
Subsec. (i). Pub. L. 92–603, § 299L(b), added subsec. (i),
1971—Subsec. (a)(16). Pub. L. 92–223, § 4(a)(1)(C), added cl. (16).
Subsecs. (c), (d). Pub. L. 92–223, § 4(a)(2), added subsecs. (c) and (d).
1968—Subsec. (a). Pub. L. 90–248, § 230, inserted “, and with respect to physicians’ or dentists’ services, at the option of the State, to individuals not receiving aid or assistance under the State’s plan approved under subchapter I, X, XIV, XVI of this chapter, or part A of subchapter IV of this chapter” after “for individuals” in text preceding cl. (i).
Pub. L. 90–248, § 233(b), inserted provision deeming, for purposes of cl. (vi) of the preceding sentence, a person as essential to another individual if such person is the spouse of and is living with such individual, the needs of such person are taken into account in determining the amount of aid or assistance furnished to such individual (under a State plan approved under subchapter I, X, XIV, or XV of this chapter, and such person is determined, under such a State plan, to be essential to the well being of such individual.
Subsec. (a)(ii). Pub. L. 90–248, § 241(f)(6), inserted “part A of” before “subchapter IV”.
Subsec. (a)(vi). Pub. L. 90–248, § 233(a), added cl. (vi).
Subsec. (a)(4). Pub. L. 90–248, § 302(a), designated existing provisions as cl. (A) and added cl. (B).
Subsec. (b). Pub. L. 90–248, § 248(e), substituted in cl. (2) of first sentence “50” for “55”.
Effective Date Of Amendment
Pub. L. 112–141, div. F, title I, § 100123(c),
Pub. L. 112–96, title III, § 3204(b),
Pub. L. 111–148, title II, § 2005(c)(2),
Amendment by section 2301(a) of Pub. L. 111–148 effective
Amendment by section 2303(a)(4)(A) of Pub. L. 111–148 effective
Amendment by section 2402(d)(2)(B) of Pub. L. 111–148 effective on the first day of the first fiscal year quarter that begins after
Pub. L. 111–148, title IV, § 4106(c),
Pub. L. 111–148, title IV, § 4107(d),
Pub. L. 110–275, title I, § 118(b),
Amendment by Pub. L. 109–171 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 108–357 effective
Pub. L. 106–554, § 1(a)(6) [title VII, § 709(b)],
Pub. L. 106–554, § 1(a)(6) [title VIII, § 802(f)],
Amendment by section 1(a)(6) [title IX, § 911(a)(2)] of Pub. L. 106–554 effective one year after
Amendment by Pub. L. 106–354 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 106–170 applicable to medical assistance for items and services furnished on or after
Amendment by section 121(a)(2) of Pub. L. 106–169 applicable to medical assistance for items and services furnished on or after
Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 605(b)],
Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, § 608(aa)],
Amendment by section 1000(a)(6) [title VI, § 608(l), (m)] of Pub. L. 106–113 effective
Pub. L. 105–100, title I, § 162,
Amendment by section 4702(a) of Pub. L. 105–33 applicable to primary care case management services furnished on or after
Amendment by section 4711(c)(1) of Pub. L. 105–33 effective
Pub. L. 105–33, title IV, § 4712(d)(2),
Amendment by section 4714(a)(2) of Pub. L. 105–33 applicable to payment for (and with respect to provider agreements with respect to) items and services furnished on or after
Pub. L. 105–33, title IV, § 4725(b)(2),
Amendment by section 4911(a) of Pub. L. 105–33 applicable to medical assistance for items and services furnished on or after
Amendment by Pub. L. 104–299 effective
Amendment by Pub. L. 103–296 effective
Amendment by section 13601(a) of Pub. L. 103–66 effective as if included in enactment of section 4721(a) of the Omnibus Budget Reconciliation Act of 1990, Pub. L. 101–508, see section 13601(c) of Pub. L. 103–66, set out as a note under section 1396a of this title.
Amendment by section 13603(e) of Pub. L. 103–66 applicable to medical assistance furnished on or after
Pub. L. 103–66, title XIII, § 13605(b),
Pub. L. 103–66, title XIII, § 13606(b),
Amendment by section 13631(f)(2) of Pub. L. 103–66 applicable, except as otherwise provided, to calendar quarters beginning on or after
Pub. L. 103–66, title XIII, § 13631(g)(2),
Amendment by section 4402(d)(2) of Pub. L. 101–508 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 4501(a), (c), (e)(1) of Pub. L. 101–508 applicable to calendar quarters beginning on or after
Amendment by section 4601(a)(2) of Pub. L. 101–508 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 4704(c), (d), (e)(1) of Pub. L. 101–508 effective as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989, Pub. L. 101–239, see section 4704(f) of Pub. L. 101–508, set out as a note under section 1396a of this title.
Pub. L. 101–508, title IV, § 4705(b),
Amendment by section 4711(a) of Pub. L. 101–508 applicable to home and community care furnished on or after
Amendment by section 4712(a) of Pub. L. 101–508 applicable to community supported living arrangements services furnished on or after the later of
Amendment by section 4713(b) of Pub. L. 101–508 applicable to medical assistance furnished on or after
Pub. L. 101–508, title IV, § 4719(b),
Pub. L. 101–508, title IV, § 4721(b),
Pub. L. 101–508, title IV, § 4755(a)(1)(B),
Amendment by section 6403(a), (c), (d)(2) of Pub. L. 101–239 effective
Amendment by section 6404(a), (b) of Pub. L. 101–239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 6405(a) of Pub. L. 101–239 effective with respect to services furnished by a certified pediatric nurse practitioner or certified family nurse practitioner on or after
Amendment by section 6408(d)(2), (4)(A), (B) of Pub. L. 101–239 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by Pub. L. 101–234 effective
Amendment by Pub. L. 100–647 effective as if included in the enactment of section 301 of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 8434(c) of Pub. L. 100–647, set out as a note under section 1396a of this title.
Amendment by section 303(b)(2) of Pub. L. 100–485 applicable to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 401(d)(2) of Pub. L. 100–485 effective
Amendment by section 608(d)(14)(A)–(G), (J) of Pub. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Coverage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Pub. L. 100–485, set out as a note under section 704 of this title.
Amendment by section 608(f)(3) of Pub. L. 100–485 effective
Amendment by section 301(a)(2)–(d) of Pub. L. 100–360 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Except as specifically provided in section 411 of Pub. L. 100–360, amendment by section 411(h)(4)(E), (k)(4), (8) of Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions.
Pub. L. 100–360, title IV, § 411(k)(14)(B),
Amendment by section 4073(d) of Pub. L. 100–203 effective with respect to services performed on or after
Pub. L. 100–203, title IV, § 4101(c)(3),
Pub. L. 100–203, title IV, § 4103(b),
Pub. L. 100–203, title IV, § 4105(b),
Amendments by section 4211(e), (f), (h)(6) of Pub. L. 100–203 applicable to nursing facility services furnished on or after
Amendment by Pub. L. 99–514 effective, except as otherwise provided, as if included in enactment of the Consolidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Revenue Code.
Amendment by section 9403(b), (d), (g)(3) of Pub. L. 99–509 applicable to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 9404(b) of Pub. L. 99–509 applicable, except as otherwise provided, to payments under this subchapter for calendar quarters beginning on or after
Amendment by section 9408(c)(1) of Pub. L. 99–509 applicable to services furnished on or after
Pub. L. 99–272, title IX, § 9501(d)(1),
Amendment by section 9505(a) of Pub. L. 99–272 applicable to medical assistance provided for hospice care furnished on or after
Pub. L. 99–272, title IX, § 9511(b),
Amendment by section 2335(f) of Pub. L. 98–369 effective
Amendment by section 2340(b) of Pub. L. 98–369 effective
Amendment by section 2361(b) of Pub. L. 98–369 applicable to calendar quarters beginning on or after
Pub. L. 98–369, div. B, title III, § 2371(b),
Amendment by section 136(c) of Pub. L. 97–248 effective
Amendment by section 137(b)(17), (18) of Pub. L. 97–248 effective as if originally included as part of this section as this section was amended by the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97–35, see section 137(d)(2) of Pub. L. 97–248, set out as a note under section 1396a of this title.
Amendment by section 2172(b) of Pub. L. 97–35 effective
For effective date of amendment by Pub. L. 96–499, see section 965(c) of Pub. L. 96–499, set out as a note under section 1396a of this title.
Pub. L. 95–292, § 8(d)(1),
Amendment by Pub. L. 95–210 applicable to medical assistance provided, under a State plan approved under subchapter XIX of this chapter, on and after the first day of the first calendar quarter that begins more than six months after
Amendment by section 13(a)(13)–(18) of Pub. L. 93–233 effective with respect to payments under section 1396b of this title for calendar quarters commencing after
Pub. L. 92–603, title II, § 212(b),
Amendment by section 247(b) of Pub. L. 92–603 effective with respect to services furnished after
Pub. L. 92–603, title II, § 275(b),
Pub. L. 92–603, title II, § 297(b),
Amendment by Pub. L. 92–223 effective
Pub. L. 90–248, title II, § 248(e),
Miscellaneous
Pub. L. 108–357, title VII, § 712(a)(2),
Amendment by Pub. L. 106–170 to be executed as if Pub. L. 106–169 had been enacted after the enactment of Pub. L. 106–170, see section 121(c)(1) of Pub. L. 106–169, set out as a note under section 1396a of this title.
Pub. L. 111–148, title X, § 10202,
Pub. L. 111–5, div. B, title V, § 5001,
Pub. L. 111–3, title I, § 115,
[For definitions of “CHIP”, “Medicaid”, and “Secretary”, see section 1(c) of Pub. L. 111–3, set out as a Definitions note under section 1396 of this title.]
Pub. L. 111–3, title VI, § 614,
[For definitions of “Medicaid” and “Secretary”, see section 1(c) of Pub. L. 111–3, set out as a Definitions note under section 1396 of this title.]
Pub. L. 108–27, title IV, § 401(a),
Pub. L. 106–554, § 1(a)(6) [title VII, § 706],
Pub. L. 105–33, title IV, § 4725(a),
Pub. L. 105–33, title IV, § 4744,
For provisions that certain references to provisions of part A (§ 601 et seq.) of subchapter IV of this chapter be considered references to such provisions of part A as in effect
Pub. L. 101–508, title IV, § 4706,
Pub. L. 100–360, title IV, § 411(l)(3)(C)(i), formerly § 411(l)(3)(C),
Pub. L. 99–272, title IX, § 9514,
Pub. L. 99–272, title IX, § 9515,
Pub. L. 97–35, title XXI, § 2165,
Pub. L. 95–292, § 8(c), (d)(2),