The Medicaid eligibility final rule at 435.110, 435.116 and 435.118 set forth the mechanism for consolidating certain federal eligibility categories into four main groupings: adults, children, pregnant women and parents/caretaker relatives. The table provided below lays out the consolidation of mandatory and optional eligibility groups (a version of this table was also included as part of the preamble to the proposed rule).
Realignment of Medicaid Eligibility Groups
| Before | After Affordable Care Act Final Rule | ||
| Mandatory Medicaid Eligibility Groups (Pre-Affordable Care Act) |
Parents/Caretaker Relatives (section 435.110) |
Pregnant Women (section 435.116) |
Children <19 (section 435.118) |
| Low-Income Families - 1902(a)(10)(A)(i)(I) and 1931 Former AFDC - 435.110 | x | x | x |
|
Qualified Pregnant Women & Children<19 -1902="" a="" 10="" a="" i="" iii="" -="" 435="" 116="" p=""> |
x | x | |
| Poverty-Level Related Pregnant Women & Infants - 1902(a)(10)(A)(i)(IV) - No rule | x | x | |
| Poverty-Level Related Children Ages 1-5 - 1902(a)(10)(A)(i)(VI) - No rule | x | ||
| Poverty-Level Related Children Ages 6-18 - 1902(a)(10)(A)(i)(VII) - No rule | x |
| Optional Medicaid Eligibility Groups (Pre-Affordable Care Act) |
Parents/Caretaker Relatives (435.110) |
Pregnant Women (435.116) |
Children <19 (435.118) |
| Families & Children Financially Eligible for AFDC - 1902(a)(10)(A)(ii)(I) - 435.210 | x | ||
| Families & children Who Would be Eligible for AFDC if Not Institutionalized - 1902(a)(10)(A)(ii)(IV) - 435.211 | x | x | |
| Poverty-Level Related Pregnant Women & Infants - 1902(a)(10)(A)(ii)(IX) - No rule | x | x |