§ 1396a. State plans for medical assistance

(Aug. 14, 1935, ch. 531, title XIX, § 1902, as added Pub. L. 89–97, title I, § 121(a), July 30, 1965, 79 Stat. 344; amended Pub. L. 90–248, title II, §§ 210(a)(6), 223(a), 224(a), (c)(1), 227(a), 228(a), 229(a), 231, 234(a), 235(a), 236(a), 237, 238, 241(f)(1)–(4), title III, § 302(b), Jan. 2, 1968, 81 Stat. 896, 901–906, 908, 911, 917, 929; Pub. L. 91–56, § 2(c), (d), Aug. 9, 1969, 83 Stat. 99; Pub. L. 92–223, § 4(b), Dec. 28, 1971, 85 Stat. 809; Pub. L. 92–603, title II, §§ 208(a), 209(a), (b)(1), 221(c)(5), 231, 232(a), 236(b), 237(a)(2), 239(a), (b), 240, 246(a), 249(a), 255(a), 268(a), 274(a), 278(a)(18)–(20), (b)(14), 298, 299A, 299D(b), Oct. 30, 1972, 86 Stat. 1381, 1389, 1410, 1415–1418, 1424, 1426, 1446, 1450, 1452–1454, 1460, 1462; Pub. L. 93–233, §§ 13(a)(2)–(10), 18(o)–(q), (x)(1)–(4), Dec. 31, 1973, 87 Stat. 960–962, 971, 972; Pub. L. 93–368, § 9(a), Aug. 7, 1974, 88 Stat. 422; Pub. L. 94–48, §§ 1, 2, July 1, 1975, 89 Stat. 247; Pub. L. 94–182, title I, § 111(a), Dec. 31, 1975, 89 Stat. 1054; Pub. L. 94–552, § 1, Oct. 18, 1976, 90 Stat. 2540; Pub. L. 95–142, §§ 2(a)(3), (b)(1), 3(c)(1), 7(b), (c), 9, 19(b)(2), 20(b), Oct. 25, 1977, 91 Stat. 1176, 1178, 1193, 1195, 1204, 1207; Pub. L. 95–210, § 2(c), Dec. 13, 1977, 91 Stat. 1488; Pub. L. 95–559, § 14(a)(1), Nov. 1, 1978, 92 Stat. 2140; Pub. L. 96–272, title III, § 308(c), June 17, 1980, 94 Stat. 531; Pub. L. 96–499, title IX, §§ 902(b), 903(b), 905(a), 912(b), 913(c), (d), 914(b)(1), 916(b)(1), 918(b)(1), 962(a), 965(b), Dec. 5, 1980, 94 Stat. 2613, 2615, 2618–2621, 2624, 2626, 2650, 2652; Pub. L. 96–611, § 5(b), Dec. 28, 1980, 94 Stat. 3568; Pub. L. 97–35, title XXI, §§ 2105(c), 2113(m), 2171(a), (b), 2172(a), 2173(a), (b)(1), 2174(a), 2175(a), (d)(1), 2178(b), 2181(a)(2), 2182, 2193(c)(9), Aug. 13, 1981, 95 Stat. 792, 795, 807–809, 811, 814–816, 828; Pub. L. 97–248, title I, §§ 131(a), (c), formerly (b), 132(a), (c), 134(a), 136(d), 137(a)(3), (b)(7)–(10), (e), 146(a), Sept. 3, 1982, 96 Stat. 367, 369, 370, 373, 375–378, 381, 394; Pub. L. 97–448, title III, § 309(a)(8), Jan. 12, 1983, 96 Stat. 2408; Pub. L. 98–369, div. B, title III, §§ 2303(g)(1), 2314(b), 2335(e), 2361(a), 2362(a), 2363(a)(1), 2367(a), 2368(a), (b), 2373(b)(1)–(10), title VI, § 2651(c), July 18, 1984, 98 Stat. 1066, 1079, 1091, 1104, 1105, 1108, 1109, 1111, 1149; Pub. L. 98–378, § 20(c), Aug. 16, 1984, 98 Stat. 1322; Pub. L. 98–617, § 3(a)(7), (b)(10), Nov. 8, 1984, 98 Stat. 3295, 3296; Pub. L. 99–272, title IX, §§ 9501(b), (c), 9503(a), 9505(b), (c)(1), (d), 9506(a), 9509(a), 9510(a), 9517(b), 9529(a)(1), (b)(1), title XII, § 12305(b)(3), Apr. 7, 1986, 100 Stat. 201, 202, 205, 208–212, 216, 220, 293; Pub. L. 99–509, title IX, §§ 9320(h)(3), 9401(a)–(e)(1), 9402(a), (b), 9403(a), (c), (e)–(g)(1), (4)(A), 9404(a), 9405, 9406(b), 9407(a), 9408(a), (b), (c)(2), (3), 9431(a), (b)(1), 9433(a), 9435(b)(1), Oct. 21, 1986, 100 Stat. 2016, 2050–2058, 2060, 2061, 2066, 2068, 2069; Pub. L. 99–514, title XVIII, § 1895(c)(1), (3)(B), (C), (7), Oct. 22, 1986, 100 Stat. 2935, 2936; Pub. L. 99–570, title XI, § 11005(b), Oct. 27, 1986, 100 Stat. 3207–169; Pub. L. 99–643, §§ 3(b), 7(b), Nov. 10, 1986, 100 Stat. 3575, 3579; Pub. L. 100–93, §§ 5(a), 7, 8(f), Aug. 18, 1987, 101 Stat. 689, 691, 694; Pub. L. 100–203, title IV, §§ 4072(d), 4101(a)(1), (2), (b)(1)–(2)(B), (c)(2), (e)(1)–(5), 4102(b)(1), 4104, 4113(a)(2), (b)(1), (2), (c)(1), (2), (d)(2), 4116, 4118(c)(1), (h)(1), (2), (m)(1)(B), (p)(1)–(4), (6)–(8), 4211(b)(1), (h)(1)–(5), 4212(d)(2), (3), (e)(1), 4213(b)(1), 4218(a), title IX, §§ 9115(b), 9119(d)(1), Dec. 22, 1987, 101 Stat. 1330–117, 1330–140 to 1330–143, 1330–146, 1330–147, 1330–151, 1330–152, 1330–154 to 1330–157, 1330–159, 1330–203, 1330–205, 1330–213, 1330–219, 1330–220, 1330–305, as amended Pub. L. 100–360, title IV, § 411(k)(5)(A), (7)(B)–(D), (10)(G)(ii), (iv), (l)(3)(H), (J), (8)(C), (n)(2), (4), formerly (3), July 1, 1988, 102 Stat. 791, 794, 796, 803, 805, 807, as amended Pub. L. 100–485, title VI, § 608(d)(14)(I), (15)(A), (27)(F)–(H), (28), Oct. 13, 1988, 102 Stat. 2416, 2423; Pub. L. 100–360, title II, § 204(d)(3), title III, §§ 301(a)(1), (e)(2), 302(a), (b)(1), (c)(1), (2), (d)–(e)(3), 303(d), (e), title IV, § 411(k)(5)(B), (17)(B), (l)(3)(E), (6)(C), (D), July 1, 1988, 102 Stat. 729, 748–753, 762, 763, 792, 800, 803, 804; Pub. L. 100–485, title II, § 202(c)(4), title III, § 303(a)(2), (b)(1), (d), title IV, § 401(d)(1), title VI, § 608(d)(15)(B), (16)(C), Oct. 13, 1988, 102 Stat. 2378, 2391, 2392, 2396, 2416, 2418; Pub. L. 100–647, title VIII, § 8434(b)(1), (2), Nov. 10, 1988, 102 Stat. 3805; Pub. L. 101–234, title II, § 201(a), Dec. 13, 1989, 103 Stat. 1981; Pub. L. 101–239, title VI, §§ 6115(c), 6401(a), 6402(a), (c)(2), 6403(b), (d)(1), 6404(c), 6405(b), 6406(a), 6408(c)(1), (d)(1), (4)(C), 6411(a)(1), (d)(3)(B), (e)(2), Dec. 19, 1989, 103 Stat. 2219, 2258, 2260, 2261, 2263–2265, 2268–2271; Pub. L. 101–508, title IV, §§ 4401(a)(2), 4402(a)(1), (c), (d)(1), 4501(b), (e)(2), 4601(a)(1), 4602(a), 4603(a), 4604(a), (b), 4701(b)(1), 4704(a), (e)(1), 4708(a), 4711(c)(1), (d), 4713(a), 4715(a), 4723(b), 4724(a), 4732(b)(1), 4751(a), 4752(a)(1)(A), (c)(1), 4754(a), 4755(a)(2), (c)(1), 4801(e)(1)(A), (11)(A), Nov. 5, 1990, 104 Stat. 1388–143, 1388–161, 1388–163 to 1388–173, 1388–186, 1388–187, 1388–190, 1388–192, 1388–194, 1388–195, 1388–204, 1388–206, 1388–208 to 1388–210, 1388–215, 1388–217; Pub. L. 102–234, §§ 2(b)(1), 3(a), Dec. 12, 1991, 105 Stat. 1799; Pub. L. 103–66, title XIII, § 13581(b)(2), 13601(b), 13602(c), 13603(a)–(c), 13611(d)(1), 13622(a)(1), (b), (c), 13623(a), 13625(a), 13631(a), (e)(1), (f)(1), Aug. 10, 1993, 107 Stat. 611, 613, 619, 620, 626, 632, 633, 636, 643, 644; Pub. L. 103–296, title I, § 108(d)(1), Aug. 15, 1994, 108 Stat. 1486; Pub. L. 103–448, title II, § 204(w)(2)(E), Nov. 2, 1994, 108 Stat. 4746; Pub. L. 104–193, title I, §§ 108(k), 114(b)–(d)(1), title IX, § 913, Aug. 22, 1996, 110 Stat. 2169, 2180, 2354; Pub. L. 104–226, § 1(b)(2), Oct. 2, 1996, 110 Stat. 3033; Pub. L. 104–248, § 1(a)(1), Oct. 9, 1996, 110 Stat. 3148; Pub. L. 105–12, § 9(b)(2), Apr. 30, 1997, 111 Stat. 26; Pub. L. 105–33, title IV, §§ 4106(c), 4454(b)(1), 4701(b)(2)(A)(i)–(iv), (d)(1), 4702(b)(2), 4709, 4711(a), 4712(a), (b)(1), (c)(1), 4714(a)(1), 4715(a), 4724(c)(1), (d), (f), (g)(1), 4731(a), (b), 4732(a), 4733, 4741(a), 4751(a), (b), 4752(a), 4753(b), 4911(b), 4912(b)(1), 4913(a), Aug. 5, 1997, 111 Stat. 368, 431, 493, 495, 506–510, 516, 517, 519, 520, 522–525, 571, 573; Pub. L. 106–113, div. B, § 1000(a)(6) [title VI, §§ 603(a)(1), 604(a)(1), (2)(A), (b)(1), 608(a)–(d), (y)(2), (aa)(1)], Nov. 29, 1999, 113 Stat. 1536, 1501A–394 to 1501A–398; Pub. L. 106–169, title I, § 121(a)(1), (c)(4), title II, §§ 205(c), 206(b), Dec. 14, 1999, 113 Stat. 1829, 1830, 1834, 1837; Pub. L. 106–170, title II, § 201(a)(1), (2)(A), Dec. 17, 1999, 113 Stat. 1891, 1892; Pub. L. 106–354, § 2(a)(1)–(3), (b)(2)(A), Oct. 24, 2000, 114 Stat. 1381–1383; Pub. L. 106–554, § 1(a)(6) [title VII, §§ 702(a)–(c)(1), 707(b)], Dec. 21, 2000, 114 Stat. 2763, 2763A–572 to 2763A–574, 2763A–577; Pub. L. 107–121, § 2(a), (b)(1), (2), Jan. 15, 2002, 115 Stat. 2384; Pub. L. 108–40, § 7(b), June 30, 2003, 117 Stat. 837; Pub. L. 108–89, title IV, § 401(a), Oct. 1, 2003, 117 Stat. 1134; Pub. L. 108–173, title I, § 103(a)(1), (f)(1), title II, § 236(b)(1), Dec. 8, 2003, 117 Stat. 2154, 2160, 2211; Pub. L. 108–265, title I, § 105(b), June 30, 2004, 118 Stat. 744; Pub. L. 108–448, § 1(a), Dec. 8, 2004, 118 Stat. 3467; Pub. L. 109–91, title I, § 101(a), Oct. 20, 2005, 119 Stat. 2091; Pub. L. 109–171, title VI, §§ 6032(a), 6034(b), 6035(a), (b), 6062(a), 6065(a), 6083(a), Feb. 8, 2006, 120 Stat. 73, 76, 78, 79, 96, 101, 120; Pub. L. 109–432, div. B, title IV, § 405(c)(2)(A)(iv), Dec. 20, 2006, 120 Stat. 3000; Pub. L. 110–90, § 3(a), Sept. 29, 2007, 121 Stat. 984; Pub. L. 110–173, title II, § 203(a), Dec. 29, 2007, 121 Stat. 2513; Pub. L. 110–252, title VII, § 7001(d)(2), June 30, 2008, 122 Stat. 2394; Pub. L. 110–275, title I, § 111(a), July 15, 2008, 122 Stat. 2503; Pub. L. 111–3, title I, § 113(b)(1), title II, §§ 203(a)(1), (c), (d)(3), 211(a)(1)(A), (b)(3)(B), title V, § 501(d)(1), (e)(1), Feb. 4, 2009, 123 Stat. 34, 40, 47, 49, 54, 87; Pub. L. 111–5, div. B, title V, §§ 5004(a)(1), 5005(a), 5006(b)(1), (e)(2)(A), Feb. 17, 2009, 123 Stat. 503, 505, 506, 510; Pub. L. 111–148, title II, §§ 2001(a)(1), (2)(A), (4)(A), (5)(A), (B), (b), (d)(1), (e)(1), 2002(a), (b), 2004(a), 2202(a), 2301(b), 2303(a)(1)–(3), (b)(2)(A), 2402(d)(1), 2901(c), title III, § 3021(b), title IV, § 4302(b)(1)(A), title VI, §§ 6103(d)(2), 6401(b)(1), (3), 6411(a)(1), 6501–6503, 6505, title VIII, § 8002(a)(2), (b), title X, § 10201(a)(1), (2), (b), Mar. 23, 2010, 124 Stat. 271, 274, 275, 277–279, 282, 283, 291–294, 296, 303, 333, 394, 581, 710, 751, 753, 773, 776, 777, 846, 917, 918; Pub. L. 111–152, title I, §§ 1004(b)(1), (e), 1202(a)(1), Mar. 30, 2010, 124 Stat. 1034, 1036, 1052; Pub. L. 111–255, § 3(c), (e), Oct. 5, 2010, 124 Stat. 2641; Pub. L. 111–296, title I, § 103(c)(1), Dec. 13, 2010, 124 Stat. 3191; Pub. L. 111–309, title I, §§ 110(a), 111, title II, §§ 205(a), (b), (f)(1), Dec. 15, 2010, 124 Stat. 3288–3290; Pub. L. 112–78, title III, §§ 310(a), 311, Dec. 23, 2011, 125 Stat. 1286; Pub. L. 112–96, title III, §§ 3101(a), 3102, Feb. 22, 2012, 126 Stat. 191; Pub. L. 112–240, title VI, §§ 621(a), 622, 623, 642(b)(2), Jan. 2, 2013, 126 Stat. 2352, 2358; Pub. L. 113–67, div. A, title II, § 202(a), (b)(1), div. B, title II, §§ 1201(a), 1202, Dec. 26, 2013, 127 Stat. 1177, 1198, 1199; Pub. L. 113–93, title II, §§ 201(a), 202, 203, Apr. 1, 2014, 128 Stat. 1045, 1046; Pub. L. 114–10, title II, §§ 211(a), 212(b), title III, § 302, Apr. 16, 2015, 129 Stat. 151, 152, 158; Pub. L. 114–63, § 2, Oct. 7, 2015, 129 Stat. 549; Pub. L. 114–198, title VII, § 706(b)(1), July 22, 2016, 130 Stat. 754; Pub. L. 114–255, div. A, title V, §§ 5005(a)(1), (3), (6), (b)(1), (c)(2), 5006(a), (b), div. C, title XVII, § 17004(b)(1)(B), (C), (2)(B), Dec. 13, 2016, 130 Stat. 1191–1196, 1332, 1333; Pub. L. 115–120, div. C, §§ 3002(e), (f)(2), 3004(c), Jan. 22, 2018, 132 Stat. 34, 35, 37; Pub. L. 115–123, div. E, title I, § 50101(e), (f)(2), title XII, §§ 53102(a)(1), (b)(1), (d)(2), 53103(a), Feb. 9, 2018, 132 Stat. 174, 175, 298–300; Pub. L. 115–271, title I, §§ 1001(a), 1002(a)(1), 1004(a)(1), (2), 1006(b)(1), 1007(a), (b), Oct. 24, 2018, 132 Stat. 3900, 3902, 3909, 3914, 3915; Pub. L. 116–16, § 7(a), Apr. 18, 2019, 133 Stat. 864; Pub. L. 116–94, div. N, title I, § 202(e)(1), (2), (f)(4), Dec. 20, 2019, 133 Stat. 3108–3110; Pub. L. 116–127, div. F, § 6004(a)(3)(A)–(C), Mar. 18, 2020, 134 Stat. 205, 206; Pub. L. 116–136, div. A, title III, §§ 3715, 3716, Mar. 27, 2020, 134 Stat. 424, 425; Pub. L. 116–260, div. CC, title II, §§ 209(a)(1), (b)(4)(A), 210(b), title IV, § 402(f)(2), Dec. 27, 2020, 134 Stat. 2986, 2988, 2991, 3001; Pub. L. 117–2, title IX, §§ 9811(a)(2), 9812(a), Mar. 11, 2021, 135 Stat. 208, 212; Pub. L. 117–103, div. P, title II, § 202(a), Mar. 15, 2022, 136 Stat. 803; Pub. L. 117–169, title I, § 11405(a)(1), Aug. 16, 2022, 136 Stat. 1900; Pub. L. 117–328, div. FF, title V, §§ 5111(d), 5112(a), 5121(a), 5122(a)(2), 5123(b), 5131(b), Dec. 29, 2022, 136 Stat. 5939–5941, 5944, 5945, 5950; Pub. L. 118–42, div. G, title I, §§ 203(a), 205(a)(1), (c)(1), (2), Mar. 9, 2024, 138 Stat. 403, 405, 406; Pub. L. 119–21, title VII, §§ 71103(a)(1), 71104, 71105, 71107(a), 71108(b), 71112(a), 71119(a), (b), 71120(b)(1), July 4, 2025, 139 Stat. 291, 293–295, 297, 298, 306, 314, 316.)

Amendment of Section

Pub. L. 119–21, title VII, § 71112(a), (d), July 4, 2025, 139 Stat. 298, 299, provided that, applicable to medical assistance, child health assistance, and pregnancy-related assistance with respect to individuals whose eligibility for such assistance is based on an application made on or after the first day of the first quarter that begins after Dec. 31, 2026, subsection (a)(34) of this section is amended to read as follows:

“(34) provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan and—

“(A) is enrolled under paragraph (10)(A)(i)(VIII), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the month before the month in which the individual made application (or application was made on the individual’s behalf in the case of a deceased individual) for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished; or

“(B) is not described in subparagraph (A), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the second month before the month in which the individual made application (or application was made on the individual’s behalf in the case of a deceased individual) for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished;”.

See 2025 Amendment note below.

Pub. L. 118–42, div. G, title I, § 203, Mar. 9, 2024, 138 Stat. 403, provided that, effective on the date that is 24 months after Mar. 9, 2024, subsection (oo)(1)(B) of this section is amended as follows:

(1) in the subparagraph heading, by striking “by children”;

(2) by striking “children enrolled” and inserting “children generally, children in foster care specifically, individuals over the age of 18 receiving home and community-based services (as defined in section 9817(a)(2)(B) of Public Law 117–2), and individuals over the age of 18 residing in institutional care settings (including nursing facilities, intermediate care facilities for individuals with intellectual disabilities, institutions for mental diseases, inpatient psychiatric hospitals, and other such institutional care settings) enrolled”; and

(3) by striking “not more than the age of 18 years” through the period at the end and inserting “subject to the program, including information with respect to each such category of children and individuals over the age of 18.”

See 2024 Amendment note below.

Pub. L. 101–508, title IV, § 4801(e)(11), Nov. 5, 1990, 104 Stat. 1388–217, provided that, effective on the date on which the Secretary promulgates standards regarding the qualifications of nursing facility administrators under section 1396r(f)(4) of this title, subsection (a)(29) of this section is repealed.

Editorial Notes

References in Text

The Child Nutrition Act of 1966, referred to in subsecs. (a)(7) and (e)(13)(F)(ii)(I)(hh), is Pub. L. 89–642, Oct. 11, 1966, 80 Stat. 885, which is classified generally to chapter 13A (§ 1771 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 1771 of this title and Tables.

The Richard B. Russell National School Lunch Act, referred to in subsecs. (a)(7) and (e)(13)(F)(ii)(I)(gg), is act June 4, 1946, ch. 281, 60 Stat. 230, which is classified generally to chapter 13 (§ 1751 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 1751 of this title and Tables.

Section 602 of this title, referred to in subsecs. (a)(10)(A)(i)(I) and (e)(10), was repealed and a new section 602 enacted by Pub. L. 104–193, title I, § 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted, no longer contains subsec. (a)(37) or (a)(43).

Section 606 of this title, referred to in subsec. (a)(10)(A)(i)(I), was repealed and a new section 606 enacted by Pub. L. 104–193, title I, § 103(a)(1), Aug. 22, 1996, 110 Stat. 2112, and, as so enacted, no longer contains a subsec. (h).

Section 682 of this title, referred to in subsec. (a)(10)(A)(i)(I), was repealed by Pub. L. 104–193, title I, § 108(e), Aug. 22, 1996, 110 Stat. 2167.

The date of the enactment of section 211(a) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, referred to in subsec. (a)(10)(A)(i)(II)(aa), is the date of enactment of Pub. L. 104–193, which was approved Aug. 22, 1996. Section 211(a) of the Act amended section 1382c of this title.

Section 303(a)(4)(A) of this title, referred to in subsec. (a)(20)(C), was amended generally by Pub. L. 97–35, title XXIII, § 2353(a)(1)(A), Aug. 13, 1981, 95 Stat. 871, and, as so amended, no longer contained cls. (i) and (ii). Section 303(a)(4) was amended by Pub. L. 103–66, title XIII, § 13741(b), Aug. 10, 1993, 107 Stat. 663, and, as so amended, no longer contains subparagraphs.

Section 1383(a)(4)(A)(i) and (ii) of this title, referred to in subsec. (a)(20)(C), is a reference to section 1383(a)(4)(A)(i) and (ii) existing prior to the general revision of subchapter XVI of this chapter by Pub. L. 92–603, title III, § 301, Oct. 30, 1972, 86 Stat. 1465, eff. Jan. 1, 1974. The prior section (which is set out as a note under section 1383 of this title) continues in effect for Puerto Rico, Guam, and the Virgin Islands. Subsec. (a)(4) of the prior section was amended generally by Pub. L. 97–35, title XXIII, § 2353(m)(2)(B), Aug. 13, 1981, 95 Stat. 973, and, as so amended, no longer contained clauses in subpar. (A). Subsec. (a)(4) of the prior section was also amended by Pub. L. 103–66, title XIII, § 13741(b), Aug. 10, 1993, 107 Stat. 663, and, as so amended, no longer contains subparagraphs.

Section 6401(b)(2) of the Patient Protection and Affordable Care Act, referred to in subsecs. (a)(39) and (ll), is section 6401(b)(2) of Pub. L. 111–148, which is set out as a note under section 1395cc of this title.

Public Law 92–336, referred to in provisions following subsec. (a)(81), is Pub. L. 92–336, July 1, 1972, 86 Stat. 406, which amended sections 401, 403, 409, 411, 415, 427, 428, and 430 of this title and sections 165, 1401, 1402, 3101, 3111, 3121, 3122, 3125, 6413, and 6654 of Title 26, Internal Revenue Code, and enacted provisions set out as notes under sections 403, 409, 415, and 428 of this title and sections 165 and 1401 of Title 26.

The Food and Nutrition Act of 2008, referred to in subsecs. (e)(13)(F)(ii)(I)(ee) and (xx)(9)(A)(ii)(VI)(bb), is Pub. L. 88–525, Aug. 31, 1964, 78 Stat. 703, which is classified generally to chapter 51 (§ 2011 et seq.) of Title 7, Agriculture. For complete classification of this Act to the Code, see Short Title note set out under section 2011 of Title 7 and Tables.

The Head Start Act, referred to in subsec. (e)(13)(F)(ii)(I)(ff), is subchapter B (§ 635 et seq.) of chapter 8 of subtitle A of title VI of Pub. L. 97–35, Aug. 13, 1981, 95 Stat. 499, which is classified generally to subchapter II (§ 9831 et seq.) of chapter 105 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 9801 of this title and Tables.

The Child Care and Development Block Grant Act of 1990, referred to in subsec. (e)(13)(F)(ii)(I)(ii), is subchapter C (§ 658A et seq.) of chapter 8 of subtitle A of title VI of Pub. L. 97–35, as added by Pub. L. 101–508, title V, § 5082(2), Nov. 5, 1990, 104 Stat. 1388–236, which is classified generally to subchapter II–B (§ 9857 et seq.) of chapter 105 of this title. For complete classification of this Act to the Code, see section 9857(a) of this title and Tables.

The Stewart B. McKinney Homeless Assistance Act, referred to in subsec. (e)(13)(F)(ii)(I)(jj), was Pub. L. 100–77, July 22, 1987, 101 Stat. 482. Pub. L. 100–77 was renamed the McKinney-Vento Homeless Assistance Act by Pub. L. 106–400, § 1, Oct. 30, 2000, 114 Stat. 1675, and is classified principally to chapter 119 (§ 11301 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 11301 of this title and Tables.

The United States Housing Act of 1937, referred to in subsec. (e)(13)(F)(ii)(I)(kk), is act Sept. 1, 1937, ch. 896, as revised generally by Pub. L. 93–383, title II, § 201(a), Aug. 22, 1974, 88 Stat. 653, which is classified generally to chapter 8 (§ 1437 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 1437 of this title and Tables.

The Native American Housing Assistance and Self-Determination Act of 1996, referred to in subsec. (e)(13)(F)(ii)(I)(ll), is Pub. L. 104–330, Oct. 26, 1996, 110 Stat. 4016, which is classified principally to chapter 43 (§ 4101 et seq.) of Title 25, Indians. For complete classification of this Act to the Code, see Short Title note set out under section 4101 of Title 25 and Tables.

The Internal Revenue Code of 1986, referred to in subsecs. (e)(14)(G), (K)(iv)(I)(aa), (v), (L)(i)(II), (u)(3), (ss)(2), (tt)(1)(D)(i), (ii), and (xx)(2)(G), (7)(B), (9)(A)(i)(II)(aa), is classified generally to Title 26, Internal Revenue Code.

The Patient Protection and Affordable Care Act, referred to in subsecs. (e)(14)(K)(iv)(I)(aa) and (tt)(1)(D)(i), (ii), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. Title I of the Act enacted chapter 157 of Title 42, The Public Health and Welfare, and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables.

Section 1397gg(e)(1)(J) of this title, referred to in subsec. (e)(16)(C), was redesignated section 1397gg(e)(1)(K) by Pub. L. 119–21, title VII, § 71103(b)(1)(A), July 4, 2025, 139 Stat. 293.

The Public Health Service Act, referred to in subsecs. (u)(3) and (aa)(3), is act July 1, 1944, ch. 373, 58 Stat. 682. Titles XV and XXII of the Act are classified generally to subchapters XIII (§ 300k et seq.) and XX (§ 300bb–1 et seq.), respectively, of chapter 6A of this title. For complete classification of this Act to the Code, see Short Title note set out under section 201 of this title and Tables.

The Employee Retirement Income Security Act of 1974, referred to in subsec. (u)(3), is Pub. L. 93–406, Sept. 2, 1974, 88 Stat. 829. Title VI of the Act probably means part 6 of subtitle B of title I of the Act which is classified generally to part 6 (§ 1161 et seq.) of subtitle B of subchapter I of chapter 18 of Title 29, Labor, because the Act has no title VI. For complete classification of this Act to the Code, see Short Title note set out under section 1001 of Title 29 and Tables.

Section 2701 of the Public Health Service Act, referred to in subsec. (aa)(4), is section 2701 of act July 1, 1944, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title.

Section 1710(1) of the Government Paperwork Elimination Act, referred to in subsec. (dd), is section 1710(1) of Pub. L. 105–277, which is set out in a note under section 3504 of Title 44, Public Printing and Documents.

The Alaska Native Claims Settlement Act, referred to in subsec. (ff)(1), is Pub. L. 92–203, Dec. 18, 1971, 85 Stat. 688, which is classified generally to chapter 33 (§ 1601 et seq.) of Title 43, Public Lands. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 43 and Tables.

Section 1395cc(j)(7) of this title, referred to in subsec. (kk)(5), was redesignated section 1395cc(j)(9) by Pub. L. 111–152, title I, § 1304(1), Mar. 30, 2010, 124 Stat. 1058 and Pub. L. 114–255, div. C, title XVII, § 17004(b)(2)(A)(ii), Dec. 13, 2016, 130 Stat. 1333.

The Families First Coronavirus Response Act, referred to in subsec. (tt), is Pub. L. 116–127, Mar. 18, 2020, 134 Stat. 178. For complete classification of this Act to the Code, see Short Title note set out under section 2601 of Title 29, Labor, and Tables.

The National Emergencies Act, referred to in subsec. (xx)(3)(B)(ii)(II)(aa), is Pub. L. 94–412, Sept. 14, 1976, 90 Stat. 1255, which is classified principally to chapter 34 (§ 1601 et seq.) of Title 50, War and National Defense. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 50 and Tables.

The Robert T. Stafford Disaster Relief and Emergency Assistance Act, referred to in subsec. (xx)(3)(B)(ii)(II)(aa), is Pub. L. 93–288, May 22, 1974, 88 Stat. 143, which is classified principally to chapter 68 (§ 5121 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5121 of this title and Tables.

Section 2 of the RAISE Family Caregivers Act, referred to in subsec. (xx)(9)(A)(ii)(III), is section 2 of Pub. L. 115–119, which is set out in a note under section 3030s of this title.

Codification

In subsec. (a)(4)(D), “chapter 21 of title 41” substituted for “section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423)” and “section 2102(a)(3) of title 41” substituted for “subsection (a)(2) of such section of that Act” on authority of Pub. L. 111–350, § 6(c), Jan. 4, 2011, 124 Stat. 3854, which Act enacted Title 41, Public Contracts.

Amendments

2025—Subsec. (a)(10)(A)(i)(VIII). Pub. L. 119–21, § 71119(b), substituted “subject to subsections (k) and (xx)” for “subject to subsection (k)”.

Subsec. (a)(14). Pub. L. 119–21, § 71120(b)(1), inserted “and provide for imposition of such deductions, cost sharing, or similar charges for care, items, or services furnished to specified individuals (as defined in paragraph (3) of section 1396o(k) of this title) in accordance with paragraph (2) of such section” after “section 1396o of this title”.

Subsec. (a)(34). Pub. L. 119–21, § 71112(a), amended par. (34) generally. Prior to amendment, par. (34) read as follows: “provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan, such assistance will be made available to him for care and services included under the plan and furnished in or after the third month before the month in which he made application (or application was made on his behalf in the case of a deceased individual) for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished;”.

Subsec. (a)(88). Pub. L. 119–21, § 71103(a)(1)(A), added par. (88).

Subsec. (a)(89). Pub. L. 119–21, § 71104(1), added par. (89).

Subsec. (e)(14)(D)(iv). Pub. L. 119–21, § 71108(b)(2), designated existing provisions as subcl. (I), inserted heading, and added subcl. (II).

Subsec. (e)(14)(L). Pub. L. 119–21, § 71107(a), added subpar. (L).

Subsec. (r)(2)(C). Pub. L. 119–21, § 71108(b)(1), added subpar. (C).

Subsec. (kk)(1). Pub. L. 119–21, § 71105, designated existing provisions as subpar. (A), inserted heading, and added subpar. (B).

Subsecs. (uu), (vv). Pub. L. 119–21, § 71103(a)(1)(B), added subsecs. (uu) and (vv).

Subsec. (ww). Pub. L. 119–21, § 71104(2), added subsec. (ww).

Subsec. (xx). Pub. L. 119–21, § 71119(a), added subsec. (xx).

2024—Subsec. (a)(84)(A). Pub. L. 118–42, § 205(a)(1)(B)–(F), struck out “who is an eligible juvenile (as defined in subsection (nn)(2))” after “under the State plan (or waiver of such plan) for an individual”, substituted “because the individual” for “because the juvenile”, “during the period the individual” for “during the period the juvenile”, and “the last numbered paragraph” for “paragraph (31)”, and inserted “such an individual who is an eligible juvenile (as defined in subsection (nn)(2)) and” after “or in the case of”.

Pub. L. 118–42, § 205(a)(1)(A), substituted “under the State plan (or waiver of such plan)” for “under the State plan”.

Subsec. (nn)(2)(A). Pub. L. 118–42, § 205(c)(1), substituted “State plan (or waiver of such plan)” for “State plan”.

Subsec. (nn)(3). Pub. L. 118–42, § 205(c)(2), substituted “the last numbered paragraph” for “paragraph (31)”.

Subsec. (oo)(1)(B). Pub. L. 118–42, § 203(a), in heading, struck out “by children” after “antipsychotic medications” and, in text, substituted “children generally, children in foster care specifically, individuals over the age of 18 receiving home and community-based services (as defined in section 9817(a)(2)(B) of Public Law 117–2), and individuals over the age of 18 residing in institutional care settings (including nursing facilities, intermediate care facilities for individuals with intellectual disabilities, institutions for mental diseases, inpatient psychiatric hospitals, and other such institutional care settings) enrolled” for “children enrolled” and “subject to the program, including information with respect to each such category of children and individuals over the age of 18.” for “not more than the age of 18 years generally and children in foster care specifically.”

2022—Subsec. (a)(10)(A). Pub. L. 117–169, § 11405(a)(1)(A), inserted “(13)(B),” after “(5),” in introductory provisions.

Subsec. (a)(10)(C)(iv). Pub. L. 117–169, § 11405(a)(1)(B), inserted “, (13)(B),” after “(5)”.

Subsec. (a)(25)(I)(ii). Pub. L. 117–103, § 202(a)(1), amended cl. (ii) generally. Prior to amendment, cl. (ii) read as follows: “accept the State’s right of recovery and the assignment to the State of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the State plan;”.

Subsec. (a)(25)(I)(iii). Pub. L. 117–103, § 202(a)(2), substituted “not later than 60 days after receiving any inquiry” for “respond to any inquiry” and “, respond to such inquiry; and” for “; and”.

Subsec. (a)(25)(I)(iv). Pub. L. 117–103, § 202(a)(3), substituted “a failure” for “or a failure” and inserted “, or in the case of a responsible third party (other than the original medicare fee-for-service program under parts A and B of subchapter XVIII, a Medicare Advantage plan offered by a Medicare Advantage organization under part C of such subchapter, a reasonable cost reimbursement plan under section 1395mm of this title, a health care prepayment plan under section 1395l of this title, or a prescription drug plan offered by a PDP sponsor under part D of such subchapter) a failure to obtain a prior authorization for the item or service for which the claim is being submitted” after “the basis of the claim”.

Subsec. (a)(83). Pub. L. 117–328, § 5123(b)(1), added par. (83) and struck out former par. (83) which required a State to publish a directory of physicians for a State plan providing medical assistance on a fee-for-service basis or through a primary care case-management system, and certain other providers at State option, on the public website of the State agency administering the State plan.

Subsec. (a)(84)(A). Pub. L. 117–328, § 5122(a)(2), inserted “(or in the case of a State electing the option described in the subdivision (A) following paragraph (31) of section 1396d(a) of this title, during such period beginning after the disposition of charges with respect to such individual)” after “is such an inmate”.

Pub. L. 117–328, § 5121(a)(1)(A), inserted “, subject to subparagraph (D),” after “but”.

Subsec. (a)(84)(D). Pub. L. 117–328, § 5121(a)(1)(B)–(D), added subpar. (D).

Subsec. (e)(12). Pub. L. 117–328, § 5112(a), added par. (12) and struck out former par. (12) which read as follows: “At the option of the State, the plan may provide that an individual who is under an age specified by the State (not to exceed 19 years of age) and who is determined to be eligible for benefits under a State plan approved under this subchapter under subsection (a)(10)(A) shall remain eligible for those benefits until the earlier of—

“(A) the end of a period (not to exceed 12 months) following the determination; or

“(B) the time that the individual exceeds that age.”

Subsec. (e)(13)(I). Pub. L. 117–328, § 5111(d)(1), substituted “2029” for “2027”.

Subsec. (gg)(2). Pub. L. 117–328, § 5111(d)(2), substituted “through September 30, 2029” for “through September 30, 2027” in heading and “2029,” for “2027” in two places in text.

Subsec. (mm). Pub. L. 117–328, § 5123(b)(2), added subsec. (mm) and struck out former subsec. (mm) which related to directory physician or provider described.

Subsec. (nn)(3). Pub. L. 117–328, § 5121(a)(2), substituted “(31)” for “(30)”.

Subsec. (tt). Pub. L. 117–328, § 5131(b), added subsec. (tt).

2021—Subsec. (a)(10). Pub. L. 117–2, § 9811(a)(2)(F), inserted before semicolon at end of concluding provisions “, and (XIX) medical assistance shall be made available during the period described in section 1396d(a)(4)(E) of this title for vaccines described in such section and the administration of such vaccines, for any individual who is eligible for and receiving medical assistance under the State plan or under a waiver of such plan (other than an individual who is eligible for medical assistance consisting only of payment of premiums pursuant to subparagraph (E) or (F) or section 1396u–3 of this title), notwithstanding any provision of this subchapter or waiver under section 1315 of this title impacting such individual’s eligibility for medical assistance under such plan or waiver to coverage for a limited type of benefits and services that would not otherwise include coverage of a COVID–19 vaccine and its administration”.

Pub. L. 117–2, § 9811(a)(2)(E), in concluding provisions, substituted “, any service described in section 1396o(a)(2)(G) of this title that is furnished during any such portion, any vaccine described in section 1396d(a)(4)(E) of this title (and the administration of such vaccine) that is furnished during any such portion, and testing and treatments for COVID–19, including specialized equipment and therapies (including preventive therapies), and, in the case of an individual who is diagnosed with or presumed to have COVID–19, during the period such individual has (or is presumed to have) COVID–19, the treatment of a condition that may seriously complicate the treatment of COVID–19, if otherwise covered under the State plan (or waiver of such plan)” for “and any visit described in section 1396o(a)(2)(G) of this title that is furnished during any such portion”.

Pub. L. 117–2, § 9811(a)(2)(D), in concluding provisions, inserted “and medical assistance for vaccines described in section 1396d(a)(4)(E) of this title and the administration of such vaccines during the period described in such section” after “family planning setting”.

Pub. L. 117–2, § 9811(a)(2)(C), in concluding provisions, inserted “and medical assistance for vaccines described in section 1396d(a)(4)(E) of this title and the administration of such vaccines during the period described in such section” after “described in subsection (k)(1)”.

Pub. L. 117–2, § 9811(a)(2)(B), in concluding provisions, inserted “and medical assistance for vaccines described in section 1396d(a)(4)(E) of this title and the administration of such vaccines during the period described in such section” after “(described in subsection (z)(2))”.

Pub. L. 117–2, § 9811(a)(2)(A), in concluding provisions, substituted “, medical assistance for services related to other conditions which may complicate pregnancy, and medical assistance for vaccines described in section 1396d(a)(4)(E) of this title and the administration of such vaccines during the period described in such section, (VIII)” for “and to other conditions which may complicate pregnancy, (VIII)”.

Subsec. (e)(16). Pub. L. 117–2, § 9812(a), added par. (16).

2020—Subsec. (a)(4)(A). Pub. L. 116–260, § 209(a)(1), substituted “including provision for utilization” for “and including provision for utilization” and inserted “, and, subject to section 1396b(i) of this title, including a specification that the single State agency described in paragraph (5) will ensure necessary transportation for beneficiaries under the State plan to and from providers and a description of the methods that such agency will use to ensure such transportation” after “supervision of administration of the plan”.

Subsec. (a)(10). Pub. L. 116–127, § 6004(a)(3)(A)(ii), in concluding provisions, substituted “, (XVII)” for “and (XVII)” and inserted before semicolon at end “, and (XVIII) the medical assistance made available to an uninsured individual (as defined in subsection (ss)) who is eligible for medical assistance only because of subparagraph (A)(ii)(XXIII) shall be limited to medical assistance for any in vitro diagnostic product described in section 1396d(a)(3)(B) of this title that is administered during any portion of the emergency period described in such section beginning on or after March 18, 2020 (and the administration of such product) and any visit described in section 1396o(a)(2)(G) of this title that is furnished during any such portion”.

Subsec. (a)(10)(A). Pub. L. 116–260, § 210(b), substituted “(29), and (30)” for “and (29)” in introductory provisions.

Subsec. (a)(10)(A)(ii)(XXIII). Pub. L. 116–127, § 6004(a)(3)(A)(i), added subcl. (XXIII).

Subsec. (a)(10)(E)(iii), (iv). Pub. L. 116–260, § 402(f)(2), inserted “(including such individuals enrolled under section 1395o(b) of this title)” after “section 1396d(p)(1) of this title”.

Subsec. (a)(55). Pub. L. 116–127, § 6004(a)(3)(B), substituted “(a)(10)(A)(ii)(IX), or (a)(10)(A)(ii)(XXIII)” for “or (a)(10)(A)(ii)(IX)” in introductory provisions.

Subsec. (a)(87). Pub. L. 116–260, § 209(b)(4)(A), added par. (87).

Subsec. (h). Pub. L. 116–136, § 3715, designated existing provisions as par. (1), inserted “, home and community-based services provided under subsection (c), (d), or (i) of section 1396n of this title or under a waiver or demonstration project under section 1315 of this title, self-directed personal assistance services provided pursuant to a written plan of care under section 1396n(j) of this title, and home and community-based attendant services and supports under section 1396n(k) of this title” before period at end, and added par. (2).

Subsec. (ss). Pub. L. 116–127, § 6004(a)(3)(C), added subsec. (ss).

Subsec. (ss)(1). Pub. L. 116–136, § 3716(1), inserted “(excluding subclause (VIII) of such subsection if the individual is a resident of a State which does not furnish medical assistance to individuals described in such subclause)” after “subsection (a)(10)(A)(i)”.

Subsec. (ss)(2). Pub. L. 116–136, § 3716(2), inserted before period at end “, except that individuals who are eligible for medical assistance under subsection (a)(10)(A)(ii)(XII), subsection (a)(10)(A)(ii)(XVIII), subsection (a)(10)(A)(ii)(XXI), or subsection (a)(10)(C) (but only to the extent such an individual is considered to not have minimum essential coverage under section 5000A(f)(1) of the Internal Revenue Code of 1986), or who are described in subsection (l)(1)(A) and are eligible for medical assistance only because of subsection (a)(10)(A)(i)(IV) or (a)(10)(A)(ii)(IX) and whose eligibility for such assistance is limited by the State under clause (VII) in the matter following subsection (a)(10)(G), shall not be treated as enrolled in a Federal health care program for purposes of this paragraph”.

2019—Subsec. (a)(25)(F)(i). Pub. L. 116–16, § 7(a), amended Pub. L. 113–67, § 202(a)(2). See 2013 Amendment note below.

Subsec. (j). Pub. L. 116–94, § 202(e)(2), substituted “, the requirement” for “or the requirement” and inserted “, or the requirement under subsection (qq)(1) (relating to data reporting)” before period at end.

Subsec. (qq). Pub. L. 116–94, § 202(e)(1), added subsec. (qq).

Subsec. (rr). Pub. L. 116–94, § 202(f)(4), added subsec. (rr).

2018—Subsec. (a)(10)(A). Pub. L. 115–271, § 1006(b)(1), substituted “(28), and (29)” for “and (28)” in introductory provisions.

Subsec. (a)(10)(A)(i)(IX)(bb). Pub. L. 115–271, § 1002(a)(1)(A), substituted “are not described in and are not enrolled under” for “are not described in or enrolled under”.

Subsec. (a)(10)(A)(i)(IX)(cc). Pub. L. 115–271, § 1002(a)(1)(B), substituted “responsibility of a State” for “responsibility of the State”.

Subsec. (a)(10)(A)(i)(IX)(dd). Pub. L. 115–271, § 1002(a)(1)(C), substituted “a State plan under this subchapter or under a waiver of such a” for “the State plan under this subchapter or under a waiver of the”.

Subsec. (a)(17). Pub. L. 115–123, § 53103(a)(1), substituted “(e)(14), (e)(15)” for “(e)(14), (e)(14)”.

Subsec. (a)(25)(B). Pub. L. 115–123, § 53102(b)(1), repealed Pub. L. 113–67, § 202(b)(1)(A), and provided that the provisions amended by section 202(b) shall be applied and administered as if such amendment had never been enacted. See 2013 Amendment note below.

Subsec. (a)(25)(E). Pub. L. 115–123, § 53102(a)(1), struck out “prenatal or” after “in the case of” in introductory provisions.

Subsec. (a)(25)(H). Pub. L. 115–123, § 53102(b)(1), repealed Pub. L. 113–67, § 202(b)(1)(B), and provided that the provisions amended by section 202(b) shall be applied and administered as if such amendment had never been enacted. See 2013 Amendment note below.

Subsec. (a)(25)(I)(i). Pub. L. 115–123, § 53102(d)(2), substituted “medical assistance under a State plan (or under a waiver of the plan) under this subchapter and child health assistance under subchapter XXI” for “medical assistance under the State plan under this subchapter (and, at State option, child health assistance under subchapter XXI)”.

Subsec. (a)(84). Pub. L. 115–271, § 1001(a)(1), added par. (84).

Subsec. (a)(85). Pub. L. 115–271, § 1004(a)(1), added par. (85).

Subsec. (a)(86). Pub. L. 115–271, § 1007(a), added par. (86).

Subsec. (e)(13)(I). Pub. L. 115–123, § 50101(e), substituted “2027” for “2023”.

Pub. L. 115–120, § 3002(e), substituted “2023” for “2017”.

Subsec. (e)(14). Pub. L. 115–120, § 3004(c)(2), redesignated par. (14), relating to exclusion of compensation for participation in a clinical trial for testing of treatments for a rare disease or condition, as (15).

Subsec. (e)(14)(J). Pub. L. 115–120, § 3004(c)(1), which directed addition of subpar. (J) to “first” par. (14), relating to income determined using modified adjusted gross income, was executed by making the addition to what had been the second par. (14) to reflect the probable intent of Congress.

Subsec. (e)(14)(K). Pub. L. 115–123, § 53103(a)(2), added subpar. (K).

Subsec. (e)(15). Pub. L. 115–120, § 3004(c)(2), redesignated first par. (14), relating to exclusion of compensation for participation in a clinical trial for testing of treatments for a rare disease or condition, as (15). As redesignated, par. (15) was moved to appear after par. (14), to reflect the probable intent of Congress.

Subsec. (gg)(2). Pub. L. 115–123, § 50101(f)(2)(B), which directed amendment of par. (2) by substituting “2027” for “2023,” wherever appearing, was executed by substituting “2027 (but during” for “2023 (but during” and “2027 only with” for “2023, only with” to reflect the probable intent of Congress.

Pub. L. 115–123, § 50101(f)(2)(A), substituted “through september 30, 2027” for “through September 30, 2023” in heading.

Pub. L. 115–120, § 3002(f)(2), substituted “through September 30, 2023” for “until October 1, 2019” in heading and “September 30, 2023 (but during the period that begins on October 1, 2019, and ends on September 30, 2023, only with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 1397jj(c)(5) of this title) applicable to a family of the size involved)” for “September 30, 2019,” in text.

Subsec. (nn). Pub. L. 115–271, § 1001(a)(2), added subsec. (nn).

Subsec. (oo). Pub. L. 115–271, § 1004(a)(2), added subsec. (oo).

Subsec. (pp). Pub. L. 115–271, § 1007(b), added subsec. (pp).

2016—Subsec. (a)(39). Pub. L. 114–255, § 5005(c)(2), substituted “subchapter XVIII, any other State plan under this subchapter (or waiver of the plan), or any State child health plan under subchapter XXI (or waiver of the plan) and such termination is included by the Secretary in any database or similar system developed pursuant to section 6401(b)(2) of the Patient Protection and Affordable Care Act” for “subchapter XVIII or any other State plan under this subchapter”.

Subsec. (a)(41). Pub. L. 114–255, § 5005(a)(6), substituted “provide, in accordance with subsection (kk)(8) (as applicable), that whenever” for “provide that whenever”.

Subsec. (a)(78). Pub. L. 114–255, § 5005(b)(1), added par. (78).

Subsec. (a)(82). Pub. L. 114–198 added par. (82).

Subsec. (a)(83). Pub. L. 114–255, § 5006(a), added par. (83).

Subsec. (kk)(1), (2). Pub. L. 114–255, § 17004(b)(2)(B)(i), (ii), made technical amendment to reference in original act which appears in text as reference to section 1395cc of this title.

Subsec. (kk)(3). Pub. L. 114–255, § 17004(b)(2)(B)(iii), made technical amendment to reference in original act which appears in text as reference to section 1395cc of this title and substituted “(j)(5)” for “(j)(4)”.

Subsec. (kk)(4)(A)(i). Pub. L. 114–255, § 17004(b)(2)(B)(iv), made technical amendment to reference in original act which appears in text as reference to section 1395cc of this title and substituted “(j)(7)” for “(j)(6)”.

Subsec. (kk)(4)(A)(ii). Pub. L. 114–255, § 17004(b)(1)(B), amended cl. (ii) generally. Prior to amendment, text read as follows: “A State shall not be required to comply with a temporary moratorium described in clause (i) if the State determines that the imposition of such temporary moratorium would adversely impact beneficiaries’ access to medical assistance.”

Subsec. (kk)(4)(A)(iii). Pub. L. 114–255, § 17004(b)(1)(C), added cl. (iii).

Subsec. (kk)(8), (9). Pub. L. 114–255, § 5005(a)(1), added par. (8) and redesignated former par. (8) as (9).

Subsec. (ll). Pub. L. 114–255, § 5005(a)(3), added subsec. (ll).

Subsec. (mm). Pub. L. 114–255, § 5006(b), added subsec. (mm).

2015—Subsec. (a)(10)(E)(iv). Pub. L. 114–10, § 211(a), struck out “(but only for premiums payable with respect to months during the period beginning with January 1998, and ending with March 2015)” after “available”.

Subsec. (a)(17). Pub. L. 114–63, § 2, repealed Pub. L. 111–255, § 3(e). See 2010 Amendment note and Effective Date of 2015 Amendment note below.

Subsec. (e)(1). Pub. L. 114–10, § 212(b), amended par. (1) generally. Prior to amendment, par. (1) read as follows:

“(A) Notwithstanding any other provision of this subchapter, effective January 1, 1974, subject to subparagraph (B) each State plan approved under this subchapter must provide that each family which was receiving aid pursuant to a plan of the State approved under part A of subchapter IV of this chapter in at least 3 of the 6 months immediately preceding the month in which such family became ineligible for such aid because of increased hours of, or increased income from, employment, shall, while a member of such family is employed, remain eligible for assistance under the plan approved under this subchapter (as though the family was receiving aid under the plan approved under part A of subchapter IV of this chapter) for 4 calendar months beginning with the month in which such family became ineligible for aid under the plan approved under part A of subchapter IV of this chapter because of income and resources or hours of work limitations contained in such plan.

“(B) Subparagraph (A) shall not apply with respect to families that cease to be eligible for aid under part A of subchapter IV of this chapter during the period beginning on April 1, 1990, and ending on March 31, 2015. During such period, for provisions relating to extension of eligibility for medical assistance for certain families who have received aid pursuant to a State plan approved under part A of subchapter IV of this chapter and have earned income, see section 1396r–6 of this title.”

Subsec. (e)(13)(I). Pub. L. 114–10, § 302, substituted “2017” for “2015”.

Subsec. (e)(14). Pub. L. 114–63, § 2, repealed Pub. L. 111–255, § 3(e). See 2010 Amendment note and Effective Date of 2015 Amendment note below.

2014—Subsec. (a)(10)(E)(iv). Pub. L. 113–93, § 201(a), substituted “March 2015” for “March 2014”.

Subsec. (e)(1)(B). Pub. L. 113–93, § 202, substituted “March 31, 2015” for “March 31, 2014”.

Subsec. (e)(13)(I). Pub. L. 113–93, § 203, substituted “September 30, 2015” for “September 30, 2014”.

2013—Subsec. (a)(10)(E)(iv). Pub. L. 113–67, § 1201(a), substituted “March 2014” for “December 2013”.

Pub. L. 112–240, § 621(a), substituted “2013” for “2012”.

Subsec. (a)(25)(B). Pub. L. 113–67, § 202(b)(1)(A), which directed striking out “to the extent of such legal liability” before semicolon at end, was repealed by Pub. L. 115–123, § 53102(b)(1).

Subsec. (a)(25)(E)(i). Pub. L. 113–67, § 202(a)(1), which directed amendment of cl. (i) by inserting before semicolon at end “, except that the State may, if the State determines doing so is cost-effective and will not adversely affect access to care, only make such payment if a third party so liable has not made payment within 90 days after the date the provider of such services has initially submitted a claim to such third party for payment for such services”, was executed by making the insertion before “; and” to reflect the probable intent of Congress.

Subsec. (a)(25)(F)(i). Pub. L. 113–67, § 202(a)(2), as amended by Pub. L. 116–16, § 7(a), substituted “100 days after the date the provider of such services has initially submitted a claim to such third party for payment for such services, except that the State may make such payment within 30 days after such date if the State determines doing so is cost-effective and necessary to ensure access to care.” for “30 days after such services are furnished”.

Subsec. (a)(25)(H). Pub. L. 113–67, § 202(b)(1)(B), which directed substituting “any payments by such third party” for “payment by any other party for such health care items or services”, was repealed by Pub. L. 115–123, § 53102(b)(1).

Subsec. (a)(81) to (83). Pub. L. 112–240, § 642(b)(2), redesignated par. (83) as (81) and struck out former pars. (81) and (82) which required States to comply with regulations relating to payor rules with respect to beneficiaries under both the Medicaid and CLASS programs and to take certain actions relating to workers who provide personal care services to individuals under the CLASS program.

Subsec. (e)(1)(B). Pub. L. 113–67, § 1202, substituted “March 31, 2014” for “December 31, 2013”.

Pub. L. 112–240, § 622, substituted “2013” for “2012”.

Subsec. (e)(13)(I). Pub. L. 112–240, § 623, substituted “2014” for “2013”.

2012—Subsec. (a)(10)(E)(iv). Pub. L. 112–96, § 3101(a), substituted “December 2012” for “February 2012”.

Subsec. (e)(1)(B). Pub. L. 112–96, § 3102, substituted “December 31” for “February 29”.

2011—Subsec. (a)(10)(E)(iv). Pub. L. 112–78, § 310(a), substituted “February 2012” for “December 2011”.

Subsec. (e)(1)(B). Pub. L. 112–78, § 311, substituted “February 29, 2012” for “December 31, 2011”.

2010—Subsec. (a)(7). Pub. L. 111–296, § 103(c)(1), amended par. (7) generally. Prior to amendment, par. (7) read as follows: “provide safeguards which restrict the use or disclosure of information concerning applicants and recipients to purposes directly connected with—

“(A) the administration of the plan; and

“(B) at State option, the exchange of information necessary to verify the certification of eligibility of children for free or reduced price breakfasts under the Child Nutrition Act of 1966 and free or reduced price lunches under the Richard B. Russell National School Lunch Act, in accordance with section 9(b) of that Act, using data standards and formats established by the State agency;”.

Subsec. (a)(9)(D). Pub. L. 111–148, § 6103(d)(2), added subpar. (D).

Subsec. (a)(10). Pub. L. 111–309, § 205(f)(1)(A), in concluding provisions, struck out “and” before “(XVI) the medical” and substituted “(XVII) if” for “(XVI) if”.

Pub. L. 111–148, § 10201(a)(2), which directed amendment of par. (10) in the matter following subparagraph (G) by substituting “(XV)” for “and (XV)” and inserting “and (XVI) if an individual is described in subclause (IX) of subparagraph (A)(i) and is also described in subclause (VIII) of that subparagraph, the medical assistance shall be made available to the individual through subclause (IX) instead of through subclause (VIII)” before the semicolon, was executed by making the insertion only, to reflect the probable intent of Congress. The substitution could not be executed because “and (XV)” did not appear after amendment by Pub. L. 111–148, § 2303(a)(3). See below.

Pub. L. 111–148, § 2303(a)(3), in concluding provisions, substituted “(XV)” for “and (XV)” and inserted before semicolon at end “, and (XVI) the medical assistance made available to an individual described in subsection (ii) shall be limited to family planning services and supplies described in section 1396d(a)(4)(C) of this title including medical diagnosis and treatment services that are provided pursuant to a family planning service in a family planning setting”.

Pub. L. 111–148, § 2001(a)(5)(A), in concluding provisions, substituted “(XIV)” for “and (XIV)” and inserted before semicolon at end “and (XV) the medical assistance made available to an individual described in subparagraph (A)(i)(VIII) shall be limited to medical assistance described in subsection (k)(1)”.

Subsec. (a)(10)(A). Pub. L. 111–148, § 2301(b), substituted “, (21), and (28)” for “and (21)” in introductory provisions.

Subsec. (a)(10)(A)(i)(VIII). Pub. L. 111–148, § 2001(a)(1), added subcl. (VIII).

Subsec. (a)(10)(A)(i)(IX). Pub. L. 111–148, § 10201(a)(1), amended subcl. (IX) generally. Prior to amendment, subcl. (IX) read as follows: “who were in foster care under the responsibility of a State for more than 6 months (whether or not consecutive) but are no longer in such care, who are not described in any of subclauses (I) through (VII) of this clause, and who are under 25 years of age;”.

Pub. L. 111–148, § 2004(a), added subcl. (IX).

Subsec. (a)(10)(A)(ii)(XX). Pub. L. 111–148, § 2001(e)(1)(A), added subcl. (XX).

Subsec. (a)(10)(A)(ii)(XXI). Pub. L. 111–148, § 2303(a)(1), added subcl. (XXI).

Subsec. (a)(10)(A)(ii)(XXII). Pub. L. 111–148, § 2402(d)(1), added subcl. (XXII).

Subsec. (a)(10)(E)(iv). Pub. L. 111–309, § 110(a), substituted “December 2011” for “December 2010”.

Subsec. (a)(13)(C). Pub. L. 111–152, § 1202(a)(1)(A), added subpar. (C).

Subsec. (a)(17). Pub. L. 111–255, § 3(e), which directed the repeal of the amendment made by Pub. L. 111–255, § 3(c)(2), effective 5 years after Oct. 5, 2010, was itself repealed by Pub. L. 114–63, § 2, effective as if included in Pub. L. 111–255.

Pub. L. 111–255, § 3(c)(2), inserted “(e)(14),” before “(l)(3)”.

Pub. L. 111–148, § 2002(b), inserted “(e)(14),” before “(l)(3)”.

Subsec. (a)(23). Pub. L. 111–309, § 205(f)(1)(B), which directed amendment by substituting “(kk)” for “(ii)”, was executed by substituting “(kk)(4)” for “(ii)(4)”, to reflect the probable intent of Congress.

Pub. L. 111–148, § 6401(b)(3), inserted before semicolon at end “or by a provider or supplier to which a moratorium under subsection (ii)(4) is applied during the period of such moratorium”.

Subsec. (a)(39). Pub. L. 111–148, § 6501, inserted “terminate the participation of any individual or entity in such program if (subject to such exceptions as are permitted with respect to exclusion under sections 1320a–7(c)(3)(B) and 1320a–7(d)(3)(B) of this title) participation of such individual or entity is terminated under subchapter XVIII or any other State plan under this subchapter,” after “1320a–7a of this title,”.

Subsec. (a)(42). Pub. L. 111–148, § 6411(a)(1), substituted “provide that—” for “provide that”, inserted subpar. (A) designation before “the records” and “and” after semicolon at end, and added subpar. (B).

Subsec. (a)(47). Pub. L. 111–148, § 2202(a), substituted “provide—” for “at the option of the State, provide”, inserted subpar. (A) designation and “at the option of the State,” before “for making ambulatory” and “and” after semicolon at end, and added subpar. (B).

Subsec. (a)(47)(A). Pub. L. 111–148, § 2303(b)(2)(A)(i), inserted before semicolon at end “and provide for making medical assistance available to individuals described in subsection (a) of section 1396r–1c of this title during a presumptive eligibility period in accordance with such section”.

Subsec. (a)(47)(B). Pub. L. 111–148, § 2303(b)(2)(A)(ii), substituted “1396r–1b, or 1396r–1c of this title” for “or 1396r–1b of this title”.

Subsec. (a)(74). Pub. L. 111–148, § 4302(b)(1)(A)(i), which directed amendment of “paragraph 4)” by striking “and” at the end, was executed to par. (74) to reflect the probable intent of Congress.

Pub. L. 111–148, § 2001(b)(1), added par. (74).

Subsec. (a)(75). Pub. L. 111–148, § 4302(b)(1)(A)(ii), substituted “; and” for period at end.

Pub. L. 111–148, § 2001(d)(1), added par. (75).

Subsec. (a)(76). Pub. L. 111–148, § 4302(b)(1)(A)(iii), added par. (76).

Subsec. (a)(77). Pub. L. 111–309, § 205(f)(1)(C), substituted “(kk)” for “(ii)”.

Pub. L. 111–148, § 6401(b)(1)(A), added par. (77).

Subsec. (a)(78). Pub. L. 111–309, § 205(a), struck out par. (78). Text read as follows: “provide that the State agency described in paragraph (9) exclude, with respect to a period, any individual or entity from participation in the program under the State plan if such individual or entity owns, controls, or manages an entity that (or if such entity is owned, controlled, or managed by an individual or entity that)—

“(A) has unpaid overpayments (as defined by the Secretary) under this subchapter during such period determined by the Secretary or the State agency to be delinquent;

“(B) is suspended or excluded from participation under or whose participation is terminated under this subchapter during such period; or

“(C) is affiliated with an individual or entity that has been suspended or excluded from participation under this subchapter or whose participation is terminated under this subchapter during such period;”.

Pub. L. 111–148, § 6502, added par. (78).

Subsec. (a)(79). Pub. L. 111–148, § 6503, added par. (79).

Subsec. (a)(80). Pub. L. 111–148, § 6505, added par. (80).

Subsec. (a)(81). Pub. L. 111–148, § 8002(a)(2), added par. (81).

Subsec. (a)(82). Pub. L. 111–148, § 8002(b), added par. (82).

Subsec. (a)(83). Pub. L. 111–148, § 3021(b), added par. (83).

Subsec. (e)(1)(B). Pub. L. 111–309, § 111, substituted “December 31, 2011” for “December 31, 2010”.

Subsec. (e)(13)(F)(ii). Pub. L. 111–148, § 2901(c), inserted “and indian tribes and tribal organizations” after “agencies” in heading and added subcl. (IV).

Subsec. (e)(14). Pub. L. 111–255, § 3(e), which directed the repeal of the amendment made by Pub. L. 111–255, § 3(c)(1), effective 5 years after Oct. 5, 2010, was itself repealed by Pub. L. 114–63, § 2, effective as if included in Pub. L. 111–255.

Pub. L. 111–255, § 3(c)(1), added par. (14) related to exclusion of compensation for participation in a clinical trial for testing of treatments for a rare disease or condition.

Pub. L. 111–152, § 1004(b)(1)(A), substituted “modified adjusted gross income” for “modified gross income” wherever appearing in headings and text.

Pub. L. 111–148, § 2002(a), added par. (14) related to income determined using modified gross income.

Subsec. (e)(14)(B). Pub. L. 111–152, § 1004(e)(1), substituted “Subject to subparagraph (I), no type” for “No type”.

Subsec. (e)(14)(I). Pub. L. 111–152, § 1004(e)(2), added subpar. (I).

Subsec. (k). Pub. L. 111–148, § 2001(a)(4)(A), added pars. (2) and (3).

Pub. L. 111–148, § 2001(a)(2)(A), added subsec. (k).

Subsec. (k)(2). Pub. L. 111–148, § 10201(b), substituted “April 1, 2010” for “January 1, 2011”.

Subsec. (l)(2)(C). Pub. L. 111–309, § 205(b), substituted “100 percent (or, beginning January 1, 2014, 133 percent)” for “133 percent”.

Pub. L. 111–148, § 2001(a)(5)(B), substituted “133” for “100”.

Subsec. (gg). Pub. L. 111–148, § 2001(b)(2), added subsec. (gg).

Subsec. (gg)(4)(A). Pub. L. 111–152, § 1004(b)(1)(B), substituted “modified adjusted gross income” for “modified gross income” in heading.

Subsec. (hh). Pub. L. 111–148, § 2001(e)(1)(B), added subsec. (hh).

Subsec. (ii). Pub. L. 111–309, § 205(f)(1)(E), redesignated subsec. (ii) relating to provider and supplier screening, oversight, and reporting requirements as (kk).

Pub. L. 111–148, § 6401(b)(1)(B), added subsec. (ii) relating to provider and supplier screening, oversight, and reporting requirements.

Pub. L. 111–148, § 2303(a)(2), added subsec. (ii) relating to State eligibility option for family planning services.

Subsec. (ii)(2). Pub. L. 111–309, § 205(f)(1)(D), substituted “(XVI)” for “(XV)”.

Subsec. (jj). Pub. L. 111–152, § 1202(a)(1)(B), added subsec. (jj).

Subsec. (kk). Pub. L. 111–309, § 205(f)(1)(E), redesignated subsec. (ii) relating to provider and supplier screening, oversight, and reporting requirements as (kk).

2009—Subsec. (a)(10)(E)(iv). Pub. L. 111–5, § 5005(a), substituted “December 2010” for “December 2009”.

Subsec. (a)(25)(I)(i). Pub. L. 111–3, § 203(d)(3), inserted “(and, at State option, individuals who apply or whose eligibility for medical assistance is being evaluated in accordance with section 1396a(e)(13)(D) of this title)” after “with respect to individuals who are eligible” and “under this subchapter (and, at State option, child health assistance under subchapter XXI)” after “the State plan”.

Subsec. (a)(43)(D)(iii). Pub. L. 111–3, § 501(e)(1), inserted “and other information relating to the provision of dental services to such children described in section 1397hh(e) of this title” after “receiving dental services,”.

Subsec. (a)(46). Pub. L. 111–3, § 211(a)(1)(A)(i), designated existing provisions as subpar. (A) and added subpar. (B).

Subsec. (a)(72). Pub. L. 111–3, § 501(d)(1), added par. (72).

Subsec. (a)(73). Pub. L. 111–5, § 5006(e)(2)(A), added par. (73).

Subsec. (e)(1)(B). Pub. L. 111–5, § 5004(a)(1), substituted “December 31, 2010” for “September 30, 2003”.

Subsec. (e)(4). Pub. L. 111–3, § 211(b)(3)(B), inserted at end “Notwithstanding the preceding sentence, in the case of a child who is born in the United States to an alien mother for whom medical assistance for the delivery of the child is made available pursuant to section 1396b(v) of this title, the State immediately shall issue a separate identification number for the child upon notification by the facility at which such delivery occurred of the child’s birth.”

Pub. L. 111–3, § 113(b)(1), struck out “so long as the child is a member of the woman’s household and the woman remains (or would remain if pregnant) eligible for such assistance” before period at end of first sentence.

Subsec. (e)(13). Pub. L. 111–3, § 203(a)(1), added par. (13).

Subsec. (dd). Pub. L. 111–3, § 203(c), added subsec. (dd).

Subsec. (ee). Pub. L. 111–3, § 211(a)(1)(A)(ii), added subsec. (ee).

Subsec. (ff). Pub. L. 111–5, § 5006(b)(1), added subsec. (ff).

2008—Subsec. (a)(10)(E)(iv). Pub. L. 110–275 substituted “December 2009” for “June 2008”.

Subsec. (a)(71). Pub. L. 110–252 added par. (71).

2007—Subsec. (a)(10)(E)(iv). Pub. L. 110–173 substituted “June 2008” for “December 2007”.

Pub. L. 110–90 substituted “December 2007” for “September 2007”.

2006—Subsec. (a)(10)(A)(i)(II). Pub. L. 109–171, § 6065(a), inserted “(aa)” after “(II)”, substituted “and” for “) and” after “P.L. 104–193)”, substituted “section), (bb) who are” for “section or who are”, and inserted before comma at end “, or (cc) who are under 21 years of age and with respect to whom supplemental security income benefits would be paid under subchapter XVI if subparagraphs (A) and (B) of section 1382(c)(7) of this title were applied without regard to the phrase ‘the first day of the month following’ ”.

Subsec. (a)(10)(A)(ii)(XIX). Pub. L. 109–171, § 6062(a)(1)(A), added subcl. (XIX).

Subsec. (a)(25)(A). Pub. L. 109–171, § 6035(a)(1), in introductory provisions, inserted “, self-insured plans” after “health insurers” and substituted “managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service” for “and health maintenance organizations”.