Supporting Families in Transition: A Guide to Expanding Health Coverage in the Post-Welfare Reform World. A. Mandatory Eligibility Policies


  • Section 1931 group. Medicaid eligibility is no longer tied to or based on eligibility for welfare. Nor can states limit Medicaid eligibility only to families receiving TANF benefits. Section 1931 of the Social Security Act establishes rules for Medicaid eligibility for low-income families based on the income and resources of the family. Under Section 1931, states must provide Medicaid coverage to families who:

    ¨ have a dependent child living with them;

    ¨ have income and resources that would have qualified them for AFDC under the State plan in effect on July 16, 1996; and

    ¨ meet certain deprivation requirements (e.g., absent parent) that were in the state's AFDC plan as of July 16, 1996. Most states have amended their Medicaid state plans to add the new Section 1931 eligibility group for low-income families to replace the former AFDC recipient eligibility group.

  • Comparable standards. Section 1902 (a) (17) of the Social Security Act requires states to establish eligibility standards for a given Medicaid group that are the same for all members of that group. This means that, generally, the eligibility rules must be the same for all Medicaid applicants and recipients within the Section 1931 group.
  • Statewide application. Medicaid statute requires states to apply their policies through all subdivisions of the state. Accordingly, a state's Section 1931 eligibility rules must be the same throughout the state.

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