[Federal Register Volume 59, Number 221 (Thursday, November 17, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-28317]
[[Page Unknown]]
[Federal Register: November 17, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 435 and 436
Medicaid
Administration for Children and Families
45 CFR Part 233
RIN 0970-AA07
Aid to Families With Dependent Children; Extension of Medicaid
When Support Collection Results in Termination of Eligibility
AGENCIES: Administration for Children and Families (ACF) and Health
Care Financing Administration (HCFA), HHS.
ACTION: Final rule.
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SUMMARY: These final rules interpret section 20 of the Child Support
Enforcement Amendments of 1984, as amended by section 303(e) of the
Family Support Act of 1988, and section 8003 of the Omnibus Budget
Reconciliation Act of 1989. The 1984 law extended Medicaid coverage for
a period of four months to certain dependent children and adult
relatives who become ineligible for Aid to Families with Dependent
Children (AFDC) as a result, wholly or partly, of the collection or
increased collection of child or spousal support under title IV-D of
the Social Security Act (the Act). The regulations are applicable to
the AFDC and Medicaid programs in all jurisdictions.
EFFECTIVE DATE: November 17, 1994.
FOR FURTHER INFORMATION CONTACT:
AFDC: Mr. Mack Storrs, ACF/OFA 5th Floor, 370 L'Enfant Promenade S.W.,
Washington, DC 20447, telephone (202) 401-9289.
Medicaid: Mr. Marinos T. Svolos, HCFA Room 323, East High Rise
Building, 6325 Security Boulevard, Baltimore, Maryland 21207, telephone
(410) 966-4451.
SUPPLEMENTARY INFORMATION:
Statutory Authority
Section 20 of the Child Support Enforcement Amendments of 1984
(Public Law 98-378) amended both the AFDC and Medicaid titles of the
Act. Title IV-A (AFDC) was amended by adding a new paragraph (h) to
section 406 of the Act. This new paragraph provides that: ``[e]ach
dependent child and each relative with whom such a child is living
(including the spouse of such relative as described in subsection (b)),
who becomes ineligible for aid to families with dependent children as a
result (wholly or partly) of the collection or increased collection of
child or spousal support under Part D, and who has received such aid in
at least three of the six months immediately preceding the month in
which such ineligibility begins, shall be deemed to be a recipient of
aid to families with dependent children for purposes of title XIX for
an additional four calendar months beginning with the month in which
such ineligibility begins.''
Section 20 of Public Law 98-378 also amended section
1902(a)(10(A)(i)(I) to require Medicaid coverage of eligible
individuals pursuant to section 406(h) of the Act. Both amendments
apply only to those individuals who became ineligible for AFDC on or
after August 16, 1984, the date of enactment of Public Law 98-378, and
before October 1, 1988, and who received AFDC in at least three of the
six months immediately preceding the month of ineligibility.
Section 303(e) of the Family Support Act of 1988 (Public Law 100-
485) amended section 20 of the Child Support Enforcement Amendments of
1984 to extend for one year, through September 30, 1989, the authority
of this provision. Section 8003 of the Omnibus Budget Reconciliation
Act of 1989 (Public Law 101-239) removed the sunset date for this
section, thus making it a permanent provision of the Act.
Notice of Proposed Rulemaking (NPRM)
A NPRM was published in the Federal Register on November 27, 1992
(57 FR 56294), amending 45 CFR Part 233 and 42 CFR Parts 435 and 436 to
set forth the circumstances under which individuals become eligible for
the four-month period of extended Medicaid coverage because they have
lost AFDC as a result (wholly or partly) of the collection or increased
collection of child or spousal support. The proposed rules interpreted
the statute to require either the new receipt of, or an increase in,
the collection of child or spousal support which renders the family
ineligible for AFDC.
As required by statute, the proposed rules provide that individuals
must have received AFDC in at least three of the six months immediately
preceding the month in which AFDC ineligibility begins in order to
qualify for the extended Medicaid coverage. As we pointed out in the
preamble to the proposed rules, individuals who do not actually receive
an AFDC payment for any month because of the rounding of the payment
amount to zero, the recoupment of an overpayment, or the elimination of
payments for those who are eligible for amounts less than $10 are
deemed to be AFDC recipients for that month for purposes of determining
eligibility for continued Medicaid coverage under this provision.
Also under the proposed rules, continued Medicaid under this
provision ends for any individual family member who moves to another
State. In the preamble to the proposed rules, we stated that Medicaid
ends effective with the month following the month the individual moves
to the new State. Although benefits end when an individual moves to
another State, eligibility can be reinstated in the State in which he
or she was entitled to the extended coverage if the individual re-
establishes residence there before the end of the four-month period. It
was the Department's view that extended Medicaid benefits are available
only in the State in which the family became ineligible for AFDC
benefits. For example, if a family moved to another State in March, the
first month of the extended period, and moved back in May, the third
month of the extended period, they would be eligible for extended
Medicaid benefits for the months of May and June.
The preamble to the proposed rules recognized that States require
collection of support made by absent parents and spouses to be paid
directly to the IV-D agency. Nevertheless, AFDC recipients occasionally
receive child or spousal support directly. Because current regulations
require that these payments must be turned over to the IV-D agency, we
consider direct payments which are properly turned over to the IV-D
agency to be collections of support for the purposes of this provision.
Thus, extended Medicaid coverage will be provided when collections of
child or spousal support are received by the eligible assistance unit
and are turned over to the IV-D agency if these payments result (wholly
or partly) in the loss of AFDC.
The proposed rules indicated that section 406(h) of the Act
provides certain individuals with extended Medicaid if they lose AFDC
eligibility ``as a result (wholly or partly) of the collection or
increased collection of child or spousal support * * *'' (emphasis
added). They separately specified the circumstances under which AFDC
ineligibility would be considered to be due ``wholly'' to a collection
and when they would be considered to be due ``partly'' to a support
collection. They also discussed at length examples of cases in which
the child or spousal support collection ``wholly'' or ``partly''
affected the family's AFDC eligibility and made a clear distinction
between the ``wholly'' or ``partly'' cases.
Our interpretation of Congressional intent as it relates to the
term ``wholly'' or ``partly'' limits the Medicaid extension under this
provision to cases where ineligibility can be attributed, at least
partly, to the initiation of or an increase in the amount of a child or
spousal support collection. The proposed and final regulations both
reflect our position that the collection of support must actually cause
or actively contribute to ineligibility for AFDC, even if there are
other factors which also contribute to ineligibility or could
simultaneously cause it.
The proposed rules provided that extensions of Medicaid eligibility
pursuant to expiration of the earnings disregards as set forth in 45
CFR 233.20(a)(14) or pursuant to section 303(a) of the Family Support
Act of 1988 (P.L. 100-485) are not affected by this provision. Thus, if
a family is entitled to extended Medicaid as a result of earned income
under section 303(a) and is also simultaneously entitled to extended
Medicaid as a result of the initiation of or a change in the amount of
the child or spousal support collection, the assistance unit would be
entitled to the full twelve-month extension of Medicaid available under
the section 303(a) transitional provision if it meets the requirements
of section 1925 of the Act. However, the periods run concurrently so
that one extended period cannot be delayed until the end of the other
extended period.
Response to Specific Individual Comments
We received five comments on the proposed rules. Three were from
State government agencies, one was from an advocacy group and one was
from a health services organization. A discussion of these comments and
our responses follows.
Comment: One advocacy group requested that the Department clarify
the definition of support collections which would trigger entitlement
to extended Medicaid coverage. It recommended that the change must be
in the amount of support collected. The advocacy group was concerned
that the language in the discussion of the proposed regulations
referring to an increase in the ``ongoing support payment'' may be read
as referring to an increase in the amount the absent parent has to pay,
rather than an increase in the amount which is collected in a given
month.
Response: We have eliminated any reference to an increase in an
``ongoing support payment.'' We believe this will eliminate any
confusion between support ordered and support collected. The amount of
support ordered is not material when establishing eligibility for
extended benefits. This eligibility is based on the amount of support
which is collected.
Comment: One State agency recommended a change in the definition of
``collection'' of child or spousal support to cover situations where
collections of child or spousal support contribute to a loss of
eligibility but no initiation of or increase in collections occurred.
Another State agency believed that the proposed definition is more
restrictive than the wording of the statute and that there was no
legislative history presented to conclude that Congress intended to
define the entitlement as narrowly as proposed.
Response: As a condition of extended Medicaid coverage, the final
regulations continue to require that ineligibility for AFDC must result
from a change in support collection; that is, either the new receipt
of, or an increase in, the amount of a child or spousal support
collection. As we stated in the preamble to the proposed rules, we
believe that the Conference Report, H.R. Rep. No. 925, 98th Cong., 2d
Sess. (1984), contemplates a change in the amount of the child or
spousal support collection. In describing the House bill, the
Conference Report states that ``[i]f a family loses AFDC eligibility as
the result (wholly or partly) of increased collection of support
payments * * *, the State must continue to provide Medicaid benefits *
* *.'' Id. at 55 (emphasis added). The Conference Agreement followed
the House bill, but with an amendment limiting the application of the
provision to families who become ineligible for AFDC before October 1,
1988.
Similarly, the Report of the Committee on Ways and Means, H.R. Rep.
No. 527, 98th Cong., 1st Sess. at pages 11, 23, 52, and 56 refers
repeatedly to either an ``increase in child support payments'' or to
``a change in child support levels.''
Comment: Two State agencies believed that the definition of
``collection'' was convoluted, unnecessarily complex, and difficult to
administer. One agency believed the definition would make automation
more difficult and expensive.
Response: We believe that any difficulty in the proposed definition
stemmed from our attempt to interpret the law broadly. The
interpretation requires States to compare the different possible causes
for the loss of AFDC, but was designed to allow continued eligibility
under a number of different circumstances.
We could have interpreted section 406(h) to mean that continued
eligibility is available only when changes in support collections alone
lead to a loss of AFDC. Extended coverage would not have been available
if any other factors contributed to or caused ineligibility. We instead
chose to cover individuals who lose AFDC under any circumstances in
which the change in support either causes or contributes to the loss of
AFDC. This interpretation, by its nature, has increased the complexity
of the rule.
We have attempted in the final regulation to express these concepts
more simply and concisely. We have done so by removing the emphasis in
the proposed regulation on the distinction between the loss of AFDC
which results ``wholly'' instead of ``partly'' from support
collections. Instead, we have placed the emphasis on extended Medicaid
whenever a support collection has either caused or actively contributed
to the loss of AFDC. As in the proposed regulation, a family can
qualify for extended Medicaid when the support collection alone causes
ineligibility for AFDC or when the support collection, in conjunction
with other changes in income or family circumstances, contributes to
ineligibility. The following examples demonstrate these concepts, as we
have revised them. They are keyed to the regulations at
Secs. 435.115(h)(1), 436.114(h)(1) and 233.20(a)(15)(iii)(A).
An example of how the final rule would apply in
Secs. 435.115(h)(1)(i), 436.114(h)(1)(i) and 233.20(a)(15)(iii)(A)(1)
is an assistance unit which receives $250 in countable child support
collections monthly. The applicable standard of need is $375. In the
next month the countable child support collection increases to $400. In
this example, the resulting ineligibility is due to the collection of
child support, and the Medicaid extension would apply.
Another illustration includes a situation which conforms to
Secs. 435.115(h)(1)(i), 436.114(h)(1)(i) and 233.20(a)(15)(iii)(A)(1)
of the final regulations. An assistance unit receives $200 in countable
child support collections and $100 in title II benefits monthly. The
applicable standard of need is $325. In the next month both the child
support collection and title II increase by $75, for a total increase
of $150 a month. Here, the resulting ineligibility is due to the child
support collection because the change in support by itself, when added
to the unchanged title II benefit, would cause ineligibility. Thus, the
Medicaid extension would apply.
An example of how the definition of ``collection'' applies in
combination with other changes in family circumstances, as indicated in
Secs. 435.115(h)(1)(ii), 436.114(h)(1)(ii) and
233.20(a)(15)(iii)(A)(2), would be as follows. An assistance unit
received $275 in countable child support collections and the applicable
standard of assistance was $375. In the next month, the countable child
support collection increased to $325 and at the same time one of the
older children left home. As a result, the applicable standard of
assistance was reduced to $300. The countable child support collection
of $325 exceeded the new standard of $300 and resulted in the
assistance unit's ineligibility.
Under the clarified definition of ``collection'' in the final
regulation, the family would be eligible for extended Medicaid, since
the collection of child support increased and contributed to the
ineligibility. In this instance, the reduction in the standard of
assistance worked in combination with the increased collection of
support to cause the ineligibility. It thus contributed to the family's
ineligibility. Neither change would have caused ineligibility by
itself.
However, suppose that in this example the $275 received by the
assistance unit was raised to $325 and the $375 standard of assistance
was reduced to $250. In this case, the increase in child support would
have no effect on eligibility for AFDC. That is because the change in
the standard of assistance would have caused ineligibility even before
the child support collection was raised from $275 to $325. Because the
change in the support collection neither caused nor contributed to
ineligibility for AFDC, the family would not be eligible for extended
Medicaid.
Thus, under the definition included in the final rule, other
changes affecting eligibility and occurring in conjunction with a
change in the amount of the support collection would not negate the
family's entitlement to extended Medicaid, as long as the support
collection contributes to ineligibility for AFDC.
Comment: One State questioned the discussion of payments made by
absent parents directly to the AFDC recipient. The State asserted that
if these payments are turned in as required, the money flows through
the child support mechanism as would money collected by the State
directly from the absent parent. As such it represents a ``collection''
under title IV-D. If the money is not forwarded to the State agency, it
is budgeted accordingly (as income to the family), and penalties (for
non-cooperation) are imposed as appropriate. The regulations are silent
on the issue of monies not forwarded so the State assumes there is no
intent to provide the extension when the support causes ineligibility
when budgeted, since to provide such an extension in this case would be
contrary to the statute.
Response: There is no intent to provide the extension in such
situations. The State is correct that monies not forwarded to the State
agency would not constitute a ``collection'' under title IV-D, as
required by the statute. Such monies would be budgeted as income to the
family in a IV-A income State, with sanctions for non-cooperation
imposed as appropriate. In a IV-D recovery State, the IV-D agency must
recover all such payments. The IV-D agency would enter into a repayment
agreement with the custodial parent in accordance with 45 CFR 303.80.
We have revised the regulation in several places in order to make it
clear that support collections must be child or spousal support
collected under title IV-D.
Comment: One State agency commented that, given the erratic nature
of child support payments, the proposed policy could result in
disparate treatment for clients with equal amounts of child support.
Another State agency expressed concern that the application of the
proposed regulations may provide an incentive for an absent parent not
to pay child support when a child is approaching the age of majority or
some other income change is expected to occur.
Response: Because of the sporadic nature of the receipt of support
payments and other changes in family circumstances, it would be
difficult to determine when such a situation might occur. Nevertheless,
it is true that, in some cases, an increase in support collection would
coincide with other circumstances affecting AFDC eligibility. The
statute places no special requirements on the circumstances which
resulted in the increased support collection which, in turn, triggered
the four-month period. If a family receives a change in support
payments which in some way causes that family to lose AFDC, regardless
of the circumstances, then that family is entitled to four extra months
of Medicaid coverage. The statute places no relevance on the regularity
or timing of payments.
Comment: Two commenters suggested that extended Medicaid should be
continued when a family or individual moves out of the State and is no
longer a resident of the State. One commenter suggested that the State
where the individual was originally eligible for extended Medicaid
should be responsible for providing any remaining months of extended
Medicaid, particularly where the individual was enrolled in a managed
care organization. The other commenter suggested that the new State
should be automatically responsible for paying for the remaining months
of the extended period.
Response: In the preamble to the notice of proposed rulemaking,
HCFA took the position that ``[c]ontinued Medicaid under this provision
ends for any individual who moves to another State.'' The preamble
further provided, however, that eligibility could be reinstated if the
individual returns to the State and the individual would be entitled to
any remaining months of extended benefits. We believe that it is
reasonable to allow States to terminate families who become residents
of other States during the extended Medicaid period.
Nothing in section 406(h) explicitly requires a State to continue
extended benefits for an individual who has moved to another State. In
addition, our interpretation of this provision conforms with the
longstanding policy that States are only required to provide Medicaid
to their own residents. The Medicaid statute establishes a framework of
cooperative federalism in which each state develops a plan for
providing medical assistance for its residents. The statute establishes
a general framework for the State's Medicaid program; however, States
have some flexibility to tailor the program to meet the particular
needs of their residents. As a result, each State plan is different.
From the outset of the Medicaid program, State residency has been
an important aspect of Medicaid eligibility. Section 1902(b)(2), 42
U.S.C. section 1396a(b)(2), prohibits the Secretary from approving a
plan which imposes any residency requirement which excludes individuals
who reside in the State, regardless of whether or not the residence is
maintained permanently or at a fixed address. On the other hand, there
has never been any general statutory requirement that a State cover
individuals who are not its residents or continue to cover those who
are no longer its residents. Indeed, section 1902(b)(2) implicitly
recognizes that States may limit Medicaid coverage to their own
residents.
Moreover, the statute requires the State plan to include provisions
for furnishing medical assistance under the plan ``to individuals who
are residents of the State but are absent therefrom'' (section
1902(a)(16); 42 U.S.C. section 1396a(a)(16)). This provision recognizes
a State's continued responsibility for its Medicaid eligible residents
during temporary periods of absence in another jurisdiction, but only
as long as they remain residents. In light of these rules, we have for
many years taken the position that the Secretary is permitted to
approve a plan which limits eligibility to all State residents and
consequently denies medical assistance to individuals who do not reside
in the State. It is our understanding that most States expressly
require individuals to be residents of the State in order to receive
medical assistance under the State plan, although they could choose to
cover non-residents.
The right to continued receipt of Medicaid normally ends when an
individual establishes residency in a new State. If an individual seeks
medical assistance in the new State, eligibility is determined based on
the State plan of the new State. If Congress had intended in section
406(h) a major departure from this traditional role of States under the
Medicaid statute, we believe this would have been clear from either the
statute or legislative history. Our review of the statute and the
legislative history for section 406(h) does not reflect that Congress
intended this result.
We also do not believe that section 406(h) requires an individual's
new State of residence to provide continued Medicaid coverage. This
provision simply deems an individual to be an AFDC recipient for
Medicaid purposes for an additional four calendar months; that is, as
an add-on to the period of coverage the individual has already received
under the State plan of his or her original State. HCFA does not regard
section 406(h) as creating a portable status that entitles the
individual to different Medicaid coverage in a different State.
The fact that an individual is an AFDC recipient in State A does
not get that individual Medicaid benefits in State B. Similarly, the
fact that an individual is deemed to be an AFDC recipient in State A
would not necessarily get that individual Medicaid benefits in State B
(unless State B chooses to cover the individual or has an interstate
agreement which does so). If the individual is deemed to be an AFDC
recipient for Medicaid purposes for an additional four months, the
individual should therefore receive extended Medicaid only in the State
in which he or she lost AFDC status and was granted the four months of
extended coverage.
One commenter also raised the question of whether our policy has
constitutional implications because the commenter believes that it
violates an individual's right to interstate travel. The commenter
points out that other residents in the new State would be eligible for
extended benefits while the newly arrived individuals with exactly the
same circumstances would not be eligible. We believe that the commenter
is incorrect in assuming that the individual who has moved is equally
situated with other residents of the new State who are receiving the
additional four months of Medicaid. The individual's former State may
well have had a higher AFDC eligibility standard than the new State,
which enabled the individual to get Medicaid in the old State before he
or she lost AFDC because of a support payment. In the new State, the
individual may never have been eligible for AFDC even without the
increased collection.
We do not believe the residency requirement for extended Medicaid
has any significant effect on managed care. Ordinarily, an HMO will
lose an enrollee when he or she has moved to another State, because
HMOs have defined service areas and provider networks. In most cases,
when a recipient enrolled in an HMO moves to another State, he or she
would no longer be in the service area of the HMO. As such, the
recipient would no longer be qualified to remain in the HMO, regardless
of the residency requirement. In addition, the effect of the residency
requirement on recipients of extended Medicaid is no different from the
effect of the residency requirement on any Medicaid eligible HMO
recipient who moves from the State.
Regulatory Procedures
Executive Impact Analysis
These regulations have been reviewed pursuant to Executive Order
12866 to ensure their consistency with the priorities and principles
set forth in that Executive Order. An assessment of the costs and
benefits of available regulatory alternatives (including not
regulating) demonstrated that the approach taken in the regulation is
the most cost-effective and least burdensome while achieving the
regulatory objectives.
Paperwork Reduction Act
There will be no reporting or record keeping requirements imposed
on the public or States which would require clearance by the Office of
Management and Budget.
Regulatory Flexibility Act
The Regulatory Flexibility Act (Pub. L. 96-354) requires the
Federal government to anticipate and reduce the impact of regulations
and paperwork requirements on small businesses. The primary impact of
these final rules is on State governments and individuals. Therefore,
we certify that these rules will not have a significant economic impact
on a substantial number of small entities because they affect benefits
to individuals and payments to States. Thus, a regulatory flexibility
analysis as provided in Public Law 96-354, the Regulatory Flexibility
Act (RFA), is not required.
Section 1102(b) of the Social Security Act requires the Secretary
to prepare a regulatory impact analysis if a rule may have a
significant impact on the operations of a substantial number of small
rural hospitals. Such an analysis must conform to the provisions of
section 603 of the RFA. For purposes of section 1102(b) of the Act, we
define a small rural hospital as a hospital which is located outside of
a Metropolitan Statistical Area and has fewer than 50 beds.
We are not preparing a rural impact statement since we have
determined, and the Secretary certifies, that this final rule will not
have a significant economic impact on the operations of a substantial
number of small rural hospitals.
List of Subjects
42 CFR Part 435
Aid to Families with Dependent Children, Grant programs--health,
Medicaid, reporting and record keeping, Supplemental Security Income
(SSI), Wages.
42 CFR Part 436
Aid to Families with Dependent Children, Grant programs--health,
Guam, Medicaid, Puerto Rico, Supplemental Security Income (SSI), Virgin
Islands.
45 CFR Part 233
Aliens, Grant programs--social programs, Public assistance
programs, Reporting and record keeping requirements.
(Catalog of Federal Domestic Assistance Program No. 13.714, Medical
Assistance Program: 13.780, Assistance Payments Maintenance
Assistance.)
Dated: April 4, 1994.
Mary Jo Bane,
Assistant Secretary for Children and Families.
Dated: April 24, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
Approved: November 4, 1994.
Donna E. Shalala,
Secretary of Health and Human Services.
For the reasons set forth in the preamble, parts 435 and 436 of
chapter IV, title 42 and part 233 of chapter II, title 45, Code of
Federal Regulations, are amended as set forth below:
Health Care Financing Administration
42 CFR Chapter IV
PART 435--ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE
NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA
1. The authority citation for Part 435 continues to read as
follows:
Authority: Section 1102 of the Social Security Act (42 U.S.C.
1302).
2. Section 435.115 is amended by adding new paragraphs (f), (g),
and (h) to read as follows:
Sec. 435.115 Individuals deemed to be receiving AFDC.
* * * * *
(f) The State must deem an individual to be receiving AFDC if a new
collection or increased collection of child or spousal support under
title IV-D of the Social Security Act results in the termination of
AFDC eligibility in accordance with section 406(h) of the Social
Security Act. States must continue to provide Medicaid for four
consecutive calendar months, beginning with the first month of AFDC
ineligibility, to each dependent child and each relative with whom such
a child is living (including the eligible spouse of such relative as
described in section 406(b) of the Social Security Act) who:
(1) Becomes ineligible for AFDC on or after August 16, 1984; and
(2) Has received AFDC for at least three of the six months
immediately preceding the month in which the individual becomes
ineligible for AFDC; and
(3) Becomes ineligible for AFDC wholly or partly as a result of the
initiation of or an increase in the amount of the child or spousal
support collection under title IV-D.
(g)(1) Except as provided in paragraph (g)(2) of this section,
individuals who are eligible for extended Medicaid lose this coverage
if they move to another State during the 4-month period. However, if
they move back to and reestablish residence in the State in which they
have extended coverage, they are eligible for any of the months
remaining in the 4-month period in which they are residents of the
State.
(2) If a State has chosen in its State plan to provide Medicaid to
non-residents, the State may continue to provide the 4-month extended
benefits to individuals who have moved to another State.
(h) For purposes of paragraph (f) of this section:
(1) The new collection or increased collection of child or spousal
support results in the termination of AFDC eligibility when it actively
causes or contributes to the termination. This occurs when:
(i) The change in support collection in and of itself is sufficient
to cause ineligibility. This rule applies even if the support
collection must be added to other, stable income. It also applies even
if other independent factors, alone or in combination with each other,
might simultaneously cause ineligibility; or
(ii) The change in support contributes to ineligibility but does
not by itself cause ineligibility. Ineligibility must result when the
change in support is combined with other changes in income or changes
in other circumstances and the other changes in income or circumstances
cannot alone or in combination result in termination without the change
in support.
(2) In cases of increases in the amounts of both support
collections and earned income, eligibility under this section does not
preclude eligibility under 45 CFR 233.20(a)(14) or section 1925 of the
Social Security Act (which was added by section 303(a) of the Family
Support Act of 1988 (42 U.S.C. 1396r-6)). Extended periods resulting
from both an increase in the amount of the support collection and from
an increase in earned income must run concurrently.
PART 436--ELIGIBILITY IN GUAM, PUERTO RICO, AND THE VIRGIN ISLANDS
1. The authority citation for Part 436 continues to read as
follows:
Authority: Section 1102 of the Social Security Act (42 U.S.C.
1302).
2. Section 436.114 is amended by adding new paragraphs (f), (g),
and (h) to read as follows:
Sec. 436.114 Individuals deemed to be receiving AFDC.
* * * * *
(f) The State must deem an individual to be receiving AFDC if a new
collection or increased collection of child or spousal support under
title IV-D of the Social Security Act results in the termination of
AFDC eligibility in accordance with section 406(h) of the Social
Security Act. States must continue to provide Medicaid for four
consecutive calendar months, beginning with the first month of AFDC
ineligibility, to each dependent child and each relative with whom such
a child is living (including the eligible spouse of such relative as
described in section 406(b) of the Social Security Act) who:
(1) Becomes ineligible for AFDC on or after August 16, 1984; and
(2) Has received AFDC for at least three of the six months
immediately preceding the month in which the individual becomes
ineligible for AFDC; and
(3) Becomes ineligible for AFDC wholly or partly as a result of the
initiation of or an increase in the amount of a child or spousal
support collection under title IV-D.
(g)(1) Except as provided in paragraph (g)(2) of this section,
individuals who are eligible for extended Medicaid lose this coverage
if they move to another State during the 4-month period. However, if
they move back to and reestablish residence in the State in which they
have extended coverage, they are eligible for any of the months
remaining in the 4-month period in which they are residents of the
State.
(2) If a State has chosen in its State plan to provide Medicaid to
non-residents, the State may continue to provide the 4-month extended
benefits to individuals who have moved to another State.
(h) For purposes of paragraph (f) of this section:
(1) The new collection or increased collection of child or spousal
support results in the termination of AFDC eligibility when it actively
causes or contributes to the termination. This occurs when:
(i) The change in support collection in and of itself is sufficient
to cause ineligibility. This rule applies even if the support
collection must be added to other, stable income. It also applies even
if other independent factors, alone or in combination with each other,
might simultaneously cause ineligibility; or
(ii) The change in support contributes to ineligibility but does
not by itself cause ineligibility. Ineligibility must result when the
change in support is combined with other changes in income or changes
in other circumstances and the other changes in income or circumstances
cannot alone or in combination result in termination without the change
in support.
(2) In cases of increases in the amounts of both the support
collections and earned income, eligibility under this section does not
preclude eligibility under 45 CFR 233.20(a)(14) or section 1925 of the
Social Security Act (which was added by section 303(a) of the Family
Support Act of 1988 (42 U.S.C. 1396r-6)). Extended periods resulting
from both an increase in the amount of the support collection and from
an increase in earned income must run concurrently.
Administration for Children and Families
45 CFR Chapter II
PART 233--COVERAGE AND CONDITIONS OF ELIGIBILITY IN FINANCIAL
ASSISTANCE PROGRAMS
1. The authority citation for Part 233 continues to read as
follows:
Authority: 42 U.S.C. 301, 602, 606, 606 note, 607, 1202, 1302,
1352 and 1382 note; sec. 6 of Pub. L. 94-114, 89 Stat. 579; Part
XXIII of Pub. L. 97-35, 95 Stat. 843; Pub. L. 97-248, 96 Stat. 324;
Pub. L. 99-603, 100 Stat. 3359; and sec. 1883 of Pub. L. 99-514, 100
Stat. 2916.
2. Section 233.20 is amended by adding a new paragraph (a)(15) to
read as follows:
Sec. 233.20 Need and amount of assistance.
(a) * * *
(15) For Medicaid eligibility only, pursuant to section 406(h) of
the Act:
(i) Each dependent child and each relative with whom such a child
is living (including the eligible spouse of such relative pursuant to
section 237.50(b) of this chapter) who becomes ineligible for AFDC
wholly or partly because of the initiation of or an increase in the
amount of a child or spousal support collection under title IV-D will
be deemed to be receiving AFDC, but only for purposes of this paragraph
(a)(15), for a period of four consecutive calendar months beginning
with the first month of AFDC ineligibility. To be eligible for extended
Medicaid coverage pursuant to this paragraph (a)(15), each dependent
child and relative must meet the following conditions:
(A) The individual must have become ineligible for AFDC on or after
August 16, 1984; and
(B) The individual must have received AFDC in at least three of the
six months immediately preceding the month in which the individual
becomes ineligible for AFDC; and
(C) The individual must have become ineligible for AFDC wholly or
partly as a result of the initiation of or an increase in the amount of
a child or spousal support collection under title IV-D.
(ii)(A) Except as provided in paragraph (a)(15)(ii)(B) of this
section, individuals who are eligible for extended Medicaid lose this
coverage if they move to another State during the 4-month period.
However, if they move back to and reestablish residence in the State in
which they have extended coverage, they are eligible for any of the
months remaining in the 4-month period in which they are residents of
the State.
(B) If a State has chosen in its State plan to provide Medicaid to
non-residents, the State may continue to provide the 4-month extended
benefits to individuals who have moved to another State.
(iii) For purposes of paragraph (i) of this section:
(A) The new collection or increased collection of child or spousal
support results in the termination of AFDC eligibility when it actively
causes or contributes to the termination. This occurs when:
(1) the change in support collection in and of itself is sufficient
to cause ineligibility. This rule applies even if the support
collection must be added to other, stable income. It also applies even
if other independent factors, alone or in combination with each other,
might simultaneously cause ineligibility; or
(2) The change in support contributes to ineligibility but does not
by itself cause ineligibility. Ineligibility must result when the
change in support is combined with other changes in income or changes
in other circumstances and the other changes in income or circumstances
cannot alone or in combination result in termination without the change
in support.
(B) In cases of increases in the amounts of both the support
collections and earned income, eligibility under this section does not
preclude eligibility under paragraph (a)(14) of this section or section
1925 of the Social Security Act (which was added by section 303(a) of
the Family Support Act of 1988 (42 U.S.C. 139r-6)). Extended periods
result from both an increase in the amount of the support collection
and from an increase in earned income must run concurrently.
* * * * *
[FR Doc. 94-28317 Filed 11-16-94; 8:45 am]
BILLING CODE 4184-01-M