A State plan for medical assistance must--
(1) provide that it shall be in effect
in all political subdivisions of the State, and, if administered
by them, be mandatory upon them;
(2) provide for financial participation
by the State equal to not less than 40 per centum of the non-Federal
share of the expenditures under the plan with respect to which
payments under section 1396b of this title are authorized
by this subchapter; and, effective July 1, 1969, provide for
financial participation by the State equal to all of such
non-Federal share or provide for distribution of funds from
Federal or State sources, for carrying out the State plan,
on an equalization or other basis which will assure that the
lack of adequate funds from local sources will not result
in lowering the amount, duration, scope, or quality of care
and services available under the plan;
(3) provide for granting an opportunity
for a fair hearing before the State agency to any individual
whose claim for medical assistance under the plan is denied
or is not acted upon with reasonable promptness;
(4) provide (A) such methods of administration
(including methods relating to the establishment and maintenance
of personnel standards on a merit basis, except that the Secretary
shall exercise no authority with respect to the selection,
tenure of office, and compensation of any individual employed
in accordance with such methods, and including provision for
utilization of professional medical personnel in the administration
and, where administered locally, supervision of administration
of the plan) as are found by the Secretary to be necessary
for the proper and efficient operation of the plan, (B) for
the training and effective use of paid subprofessional staff,
with particular emphasis on the full-time or part-time employment
of recipients and other persons of low income, as community
service aides, in the administration of the plan and for the
use of nonpaid or partially paid volunteers in a social service
volunteer program in providing services to applicants and
recipients and in assisting any advisory committees established
by the State agency, (C) that each State or local officer,
employee, or independent contractor who is responsible for
the expenditure of substantial amounts of funds under the
State plan, each individual who formerly was such an officer,
employee, or contractor and each partner of such an officer,
employee, or contractor shall be prohibited from committing
any act, in relation to any activity under the plan, the commission
of which, in connection with any activity concerning the United
States Government, by an officer or employee of the United
States Government, an individual who was such an officer or
employee, or a partner of such an officer or employee is prohibited
by section 207 or 208 of Title 18, and (D) that each State
or local officer, employee, or independent contractor who
is responsible for selecting, awarding, or otherwise obtaining
items and services under the State plan shall be subject to
safeguards against conflicts of interest that are at least
as stringent as the safeguards that apply under section 27
of the Office of Federal Procurement Policy Act (41 U.S.C.
423) to persons described in subsection (a)(2) of such section
of that Act;
(5) either provide for the establishment
or designation of a single State agency to administer or to
supervise the administration of the plan; or provide for the
establishment or designation of a single State agency to administer
or to supervise the administration of the plan, except that
the determination of eligibility for medical assistance under
the plan shall be made by the State or local agency administering
the State plan approved under subchapter I or XVI of this
chapter (insofar as it relates to the aged) if the State is
eligible to participate in the State plan program established
under subchapter XVI of this chapter, or by the agency or
agencies administering the supplemental security income program
established under subchapter XVI or the State plan approved
under part A of subchapter IV of this chapter if the State
is not eligible to participate in the State plan program established
under subchapter XVI of this chapter;
(6) provide that the State agency will
make such reports, in such form and containing such information,
as the Secretary may from time to time require, and comply
with such provisions as the Secretary may from time to time
find necessary to assure the correctness and verification
of such reports;
(7) provide safeguards which restrict
the use or disclosure of information concerning applicants
and recipients to purposes directly connected with the administration
of the plan;
(8) provide that all individuals wishing
to make application for medical assistance under the plan
shall have opportunity to do so, and that such assistance
shall be furnished with reasonable promptness to all eligible
individuals;
(9) provide--
(A) that the State health agency, or other
appropriate State medical agency (whichever is utilized by
the Secretary for the purpose specified in the first sentence
of section 1395aa(a) of this title), shall be responsible
for establishing and maintaining health standards for private
or public institutions in which recipients of medical assistance
under the plan may receive care or services,
(B) for the establishment or designation
of a State authority or authorities which shall be responsible
for establishing and maintaining standards, other than those
relating to health, for such institutions, and
(C) that any laboratory services paid for
under such plan must be provided by a laboratory which meets
the applicable requirements of section 1395x(e)(9) of this
title or paragraphs (16) and (17) of section 1395x(s) of this
title, or, in the case of a laboratory which is in a rural
health clinic, of section 1395x(aa)(2)(G) of this title;
(10) provide--
(i) all individuals--
(I) who are receiving aid or assistance under
any plan of the State approved under subchapter I, X, XIV,
or XVI of this chapter, or part A or part E of subchapter
IV of this chapter (including individuals eligible under this
subchapter by reason of section 602(a)(37), 606(h), or 673(b)
of this title, or considered by the State to be receiving
such aid as authorized under section 682(e)(6) of this title),
(II) with respect to whom supplemental security
income benefits are being paid under subchapter XVI of this
chapter (or were being paid as of the date of the enactment
of section 211(a) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (P.L. 104-193)) and
would continue to be paid but for the enactment of that section
or who are qualified severely impaired individuals (as defined
in section 1396d(q) of this title),
(III) who are qualified pregnant women or
children as defined in section 1396d(n) of this title,
(IV) who are described in subparagraph (A)
or (B) of subsection (l)(1) of this section and whose family
income does not exceed the minimum income level the State
is required to establish under subsection (l)(2)(A) of this
section for such a family; (V) who are qualified family members
as defined in section 1396d(m)(1) of this title; (VI) who
are described in subparagraph (C) of subsection (l)(1) of
this section and whose family income does not exceed the income
level the State is required to establish under subsection
(l)(2)(B) of this section for such a family, or
(VII) who are described in subparagraph (D)
of subsection (l)(1) of this section and whose family income
does not exceed the income level the State is required to
establish under subsection (l)(2)(C) of this section for such
a family;
(ii) at the option of the State, to any group
or groups of individuals described in section 1396d(a) of
this title (or, in the case of individuals described in section
1396d(a)(i) of this title, to any reasonable categories of
such individuals) who are not individuals described in clause
(i) of this subparagraph but--
(I) who meet the income and resources requirements
of the appropriate State plan described in clause (i) or the
supplemental security income program (as the case may be),
(II) who would meet the income and resources
requirements of the appropriate State plan described in clause
(i) if their work-related child care costs were paid from
their earnings rather than by a State agency as a service
expenditure,
(III) who would be eligible to receive aid
under the appropriate State plan described in clause (i) if
coverage under such plan was as broad as allowed under Federal
law,
(IV) with respect to whom there is being
paid, or who are eligible, or would be eligible if they were
not in a medical institution, to have paid with respect to
them, aid or assistance under the appropriate State plan described
in clause (i), supplemental security income benefits under
subchapter XVI of this chapter, or a State supplementary payment;
(V) who are in a medical institution for
a period of not less than 30 consecutive days (with eligibility
by reason of this subclause beginning on the first day of
such period), who meet the resource requirements of the appropriate
State plan described in clause (i) or the supplemental security
income program, and whose income does not exceed a separate
income standard established by the State which is consistent
with the limit established under section 1396b(f)(4)(C) of
this title,
(VI) who would be eligible under the State
plan under this subchapter if they were in a medical institution,
with respect to whom there has been a determination that but
for the provision of home or community-based services described
in subsection (c), (d), or (e) of section 1396n of this title
they would require the level of care provided in a hospital,
nursing facility or intermediate care facility for the mentally
retarded the cost of which could be reimbursed under the State
plan, and who will receive home or community-based services
pursuant to a waiver granted by the Secretary under subsection
(c), (d), or (e) of section 1396n of this title,
(VII) who would be eligible under the State
plan under this subchapter if they were in a medical institution,
who are terminally ill, and who will receive hospice care
pursuant to a voluntary election described in section 1396d(o)
of this title;
(VIII) who is a child described in section
1396d(a)(i) of this title--
(aa) for whom there is in effect an adoption
assistance agreement (other than an agreement under part E
of subchapter IV of this chapter) between the State and an
adoptive parent or parents,
(bb) who the State agency responsible for
adoption assistance has determined cannot be placed with adoptive
parents without medical assistance because such child has
special needs for medical or rehabilitative care, and
(cc) who was eligible for medical assistance
under the State plan prior to the adoption assistance agreement
being entered into, or who would have been eligible for medical
assistance at such time if the eligibility standards and methodologies
of the State's foster care program under part E of subchapter
IV of this chapter were applied rather than the eligibility
standards and methodologies of the State's aid to families
with dependent children program under part A of subchapter
IV of this chapter;
(IX) who are described in subsection (l)(1)
of this section and are not described in clause (i)(IV), clause
(i)(VI), or clause (i)(VII);
(X) who are described in subsection (m)(1)
of this section;
(XI) who receive only an optional State supplementary
payment based on need and paid on a regular basis, equal to
the difference between the individual's countable income and
the income standard used to determine eligibility for such
supplementary payment (with countable income being the income
remaining after deductions as established by the State pursuant
to standards that may be more restrictive than the standards
for supplementary security income benefits under subchapter
XVI of this chapter), which are available to all individuals
in the State (but which may be based on different income standards
by political subdivision according to cost of living differences),
and which are paid by a State that does not have an agreement
with the Commissioner of Social Security under section 1382e
or 1383c of this title;
(XII) who are described in subsection (z)(1)
of this section (relating to certain TB-infected individuals);
(XIII) who are in families whose income is
less than 250 percent of the income official poverty line
(as defined by the Office of Management and Budget, and revised
annually in accordance with section 9902(2) of this title)
applicable to a family of the size involved, and who but for
earnings in excess of the limit established under section
1396d(q)(2)(B) of this title, would be considered to be receiving
supplemental security income (subject, notwithstanding section
1396o of this title, to payment of premiums or other cost-sharing
charges (set on a sliding scale based on income) that the
State may determine);
(XIV) who are optional targeted low-income
children described in section 1396d(u)(2)(B) of this title;
or
(XV) who are independent foster care adolescents
(as defined in section 1396d(v)(1) of this title), or who
are within any reasonable categories of such adolescents specified
by the State;
(B) that the medical assistance made available
to any individual described in subparagraph (A)--
(i) shall not be less in amount, duration,
or scope than the medical assistance made available to any
other such individual, and
(ii) shall not be less in amount, duration,
or scope than the medical assistance made available to individuals
not described in subparagraph (A);
(C) that if medical assistance is included
for any group of individuals described in section 1396d(a)
of this title who are not described in subparagraph (A) or
(E), then--
(i) the plan must include a description of
(I) the criteria for determining eligibility of individuals
in the group for such medical assistance, (II) the amount,
duration, and scope of medical assistance made available to
individuals in the group, and (III) the single standard to
be employed in determining income and resource eligibility
for all such groups, and the methodology to be employed in
determining such eligibility, which shall be no more restrictive
than the methodology which would be employed under the supplemental
security income program in the case of groups consisting of
aged, blind, or disabled individuals in a State in which such
program is in effect, and which shall be no more restrictive
than the methodology which would be employed under the appropriate
State plan (described in subparagraph (A)(i)) to which such
group is most closely categorically related in the case of
other groups;
(ii) the plan must make available medical
assistance--
(I) to individuals under the age of 18 who
(but for income and resources) would be eligible for medical
assistance as an individual described in subparagraph (A)(i),
and
(II) to pregnant women, during the course
of their pregnancy, who (but for income and resources) would
be eligible for medical assistance as an individual described
in subparagraph (A);
(iii) such medical assistance must include
(I) with respect to children under 18 and individuals entitled
to institutional services, ambulatory services, and (II) with
respect to pregnant women, prenatal care and delivery services;
and
(iv) if such medical assistance includes
services in institutions for mental diseases or in an intermediate
care facility for the mentally retarded (or both) for any
such group, it also must include for all groups covered at
least the care and services listed in paragraphs (1) through
(5) and (17) of section 1396d(a) of this title or the care
and services listed in any 7 of the paragraphs numbered (1)
through (24) of such section;
(D) for the inclusion of home health services
for any individual who, under the State plan, is entitled
to nursing facility services; and
(E)(i) for making medical assistance available
for medicare cost-sharing (as defined in section 1396d(p)(3)
of this title) for qualified medicare beneficiaries described
in section 1396d(p)(1) of this title;
(ii) for making medical assistance available
for payment of medicare cost- sharing described in section
1396d(p)(3)(A)(i) of this title for qualified disabled and
working individuals described in section 1396d(s) of this
title;
(iii) for making medical assistance available
for medicare cost sharing described in section 1396d(p)(3)(A)(ii)
of this title subject to section 1396d(p)(4) of this title,
for individuals who would be qualified medicare beneficiaries
described in section 1396d(p)(1) of this title but for the
fact that their income exceeds the income level established
by the State under section 1396d(p)(2) of this title but is
less than 110 percent in 1993 and 1994, and 120 percent in
1995 and years thereafter of the official poverty line (referred
to in such section) for a family of the size involved; and
(iv) subject to sections 1396u-3 and 1396d(p)(4)
of this title, for making medical assistance available (but
only for premiums payable with respect to months during the
period beginning with January 1998, and ending with December
2002)--
(I) for medicare cost-sharing described in
section 1396d(p)(3)(A)(ii) of this title for individuals who
would be qualified medicare beneficiaries described in section
1396d(p)(1) of this title but for the fact that their income
exceeds the income level established by the State under section
1396d(p)(2) of this title and is at least 120 percent, but
less than 135 percent, of the official poverty line (referred
to in such section) for a family of the size involved and
who are not otherwise eligible for medical assistance under
the State plan, and
(II) for the portion of medicare cost-sharing
described in section 1396d(p)(3)(A)(ii) of this title that
is attributable to the operation of the amendments made by
(and subsection (e)(3) of) section 4611 of the Balanced Budget
Act of 1997 for individuals who would be described in subclause
(I) if "135 percent" and "175 percent"
were substituted for "120 percent" and "135
percent" respectively;
(F) at the option of a State, for making
medical assistance available for COBRA premiums (as defined
in subsection (u)(2) of this section) for qualified COBRA
continuation beneficiaries described in subsection (u)(1)
of this section; and
(G) that, in applying eligibility criteria
of the supplemental security income program under subchapter
XVI of this chapter [42 U.S.C.A. § 1381 et seq.] for purposes
of determining eligibility for medical assistance under the
State plan of an individual who is not receiving supplemental
security income, the State will disregard the provisions of
subsections (c) and (e) of section 1382b of this title; except
that (I) the making available of the services described in
paragraph (4), (14), or (16) of section 1396d(a) of this title
to individuals meeting the age requirements prescribed therein
shall not, by reason of this paragraph (10), require the making
available of any such services, or the making available of
such services of the same amount, duration, and scope, to
individuals of any other ages, (II) the making available of
supplementary medical insurance benefits under part B of subchapter
XVIII of this chapter to individuals eligible therefor (either
pursuant to an agreement entered into under section 1395v
of this title or by reason of the payment of premiums under
such subchapter by the State agency on behalf of such individuals),
or provision for meeting part or all of the cost of deductibles,
cost sharing, or similar charges under part B of subchapter
XVIII of this chapter for individuals eligible for benefits
under such part, shall not, by reason of this paragraph (10),
require the making available of any such benefits, or the
making available of services of the same amount, duration,
and scope, to any other individuals, (III) the making available
of medical assistance equal in amount, duration, and scope
to the medical assistance made available to individuals described
in clause (A) to any classification of individuals approved
by the Secretary with respect to whom there is being paid,
or who are eligible, or would be eligible if they were not
in a medical institution, to have paid with respect to them,
a State supplementary payment shall not, by reason of this
paragraph (10), require the making available of any such assistance,
or the making available of such assistance of the same amount,
duration, and scope, to any other individuals not described
in clause (A), (IV) the imposition of a deductible, cost sharing,
or similar charge for any item or service furnished to an
individual not eligible for the exemption under section 1396o(a)(2)
or (b)(2) of this title shall not require the imposition of
a deductible, cost sharing, or similar charge for the same
item or service furnished to an individual who is eligible
for such exemption, (V) the making available to pregnant women
covered under the plan of services relating to pregnancy (including
prenatal, delivery, and postpartum services) or to any other
condition which may complicate pregnancy shall not, by reason
of this paragraph (10), require the making available of such
services, or the making available of such services of the
same amount, duration, and scope, to any other individuals,
provided such services are made available (in the same amount,
duration, and scope) to all pregnant women covered under the
State plan, (VI) with respect to the making available of medical
assistance for hospice care to terminally ill individuals
who have made a voluntary election described in section 1396d(o)
of this title to receive hospice care instead of medical assistance
for certain other services, such assistance may not be made
available in an amount, duration, or scope less than that
provided under subchapter XVIII of this chapter, and the making
available of such assistance shall not, by reason of this
paragraph (10), require the making available of medical assistance
for hospice care to other individuals or the making available
of medical assistance for services waived by such terminally
ill individuals, (VII) the medical assistance made available
to an individual described in subsection (l)(1)(A) of this
section who is eligible for medical assistance only because
of subparagraph (A)(i)(IV) or (A)(ii)(IX) shall be limited
to medical assistance for services related to pregnancy (including
prenatal, delivery, postpartum, and family planning services)
and to other conditions which may complicate pregnancy, (VIII)
the medical assistance made available to a qualified medicare
beneficiary described in section 1396d(p)(1) of this title
who is only entitled to medical assistance because the individual
is such a beneficiary shall be limited to medical assistance
for medicare cost- sharing (described in section 1396d(p)(3)
of this title), subject to the provisions of subsection (n)
of this section and section 1396o(b) of this title, (IX) the
making available of respiratory care services in accordance
with subsection (e)(9) of this section shall not, by reason
of this paragraph (10), require the making available of such
services, or the making available of such services of the
same amount, duration, and scope, to any individuals not included
under subsection (e)(9)(A) of this section, provided such
services are made available (in the same amount, duration,
and scope) to all individuals described in such subsection,
(X) if the plan provides for any fixed durational limit on
medical assistance for inpatient hospital services (whether
or not such a limit varies by medical condition or diagnosis),
the plan must establish exceptions to such a limit for medically
necessary inpatient hospital services furnished with respect
to individuals under one year of age in a hospital defined
under the State plan, pursuant to section 1396r-4(a)(1)(A)
of this title, as a disproportionate share hospital and subparagraph
(B) (relating to comparability) shall not be construed as
requiring such an exception for other individuals, services,
or hospitals, (XI) the making available of medical assistance
to cover the costs of premiums, deductibles, coinsurance,
and other cost-sharing obligations for certain individuals
for private health coverage as described in section 1396e
of this title shall not, by reason of paragraph (10), require
the making available of any such benefits or the making available
of services of the same amount, duration, and scope of such
private coverage to any other individuals, (XII) the medical
assistance made available to an individual described in subsection
(u)(1) of this section who is eligible for medical assistance
only because of subparagraph (F) shall be limited to medical
assistance for COBRA continuation premiums (as defined in
subsection (u)(2) of this section), and (XIII) the medical
assistance made available to an individual described in subsection
(z)(1) of this section who is eligible for medical assistance
only because of subparagraph (A)(ii)(XII) shall be limited
to medical assistance for TB-related services (described in
subsection (z)(2) of this section);
(11) (A) provide for entering into
cooperative arrangements with the State agencies responsible
for administering or supervising the administration of health
services and vocational rehabilitation services in the
State looking toward maximum utilization of such services
in the provision of medical assistance under the plan, (B)
provide, to the extent prescribed by the Secretary, for entering
into agreements, with any agency, institution, or organization
receiving payments under (or through an allotment under) subchapter
V of this chapter, (i) providing for utilizing such agency,
institution, or organization in furnishing care and services
which are available under such subchapter or allotment and
which are included in the State plan approved under this section
(ii) making such provision as may be appropriate for reimbursing
such agency, institution, or organization for the cost of
any such care and services furnished any individual for which
payment would otherwise be made to the State with respect
to the individual under section 1396b of this title, and (iii)
providing for coordination of information and education on
pediatric vaccinations and delivery of immunization services,
and (C) provide for coordination of the operations under this
subchapter, including the provision of information and education
on pediatric vaccinations and the delivery of immunization
services, with the State's operations under the special supplemental
nutrition program for women, infants, and children under section
1786 of this title;
(12) provide that, in determining whether
an individual is blind, there shall be an examination by a
physician skilled in the diseases of the eye or by an optometrist,
whichever the individual may select;
(13) provide--
SNIP, SNIP
