Title 16
16000 Federal Poverty Level Related Programs
16110 Adult Expansion Population
Section 1902(a)(10)(A)(i) of the Social Security Act requires states to provide medical assistance to certain mandatory categories of individuals and allows states to cover optional categories. On May 17, 1995, HCFA approved a Section 1115 Demonstration Project, entitled Diamond State Health Plan. This demonstration waiver extends Medicaid coverage to uninsured individuals age 19 or over with income at or below 100% of the FPL who are not categorically eligible. Individuals who receive long term care services (nursing facility and home and community based waivers), who have comprehensive health insurance as defined in this section, who are entitled to or eligible to enroll in Medicare, or who have coverage through Military Health Insurance for Active Duty, Retired Military, and their dependents, are excluded from this category of assistance created under the demonstration waiver. Medicaid coverage for this new group is effective March 1, 1996. Adults are not eligible for Medicaid benefits they are enrolled in a Managed Care Organization (MCO). (See DSSM 16220.5) Enrollment in a MCO is a technical eligibility requirement for these adults under the demonstration waiver. Adults will not receive Medicaid services until they are enrolled in a MCO.
