Medicaid Law Outline

By David L. McGuffey, Certified Elder Law Attorney

The following is a list of statutes, regulations, cases, and other sources with links. The laws relating to Medicaid are massive to this will be an on-going project. We do not pretend that this page is complete or that it will be complete anytime soon. If you have questions about a Medicaid issue, you should consult with an attorney.

General Concepts
Federal Statutes
Federal Regulations
Georgia Issues
Tennessee Issues
Other States
Nursing Home Medicaid: Eligibility
Spousal Impoverishment
Estate Recovery
Miscellaneous

General Concepts:

The Medicaid program was enacted in 1965 as Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., as a jointly financed federal and state program designed to provide health care to needy individuals. A state is not required to participate in the Medicaid program, but if a state elects to participate, the federal government shares the cost if the state's plan complies with the requirements of the Act and the related regulations of the Secretary of Health and Human Services. 42 U.S.C. § 1396a

Federal Statutes:

Cornell Code Collection	U.S. House website	Section Heading
42 U.S.C. § 1396	42 U.S.C. § 1396	Appropriations
42 U.S.C. § 1396a	42 U.S.C. § 1396a	State plans for medical assistance
42 U.S.C. § 1396b	42 U.S.C. § 1396b	Payment to States
42 U.S.C. § 1396c	42 U.S.C. § 1396c	Operation of State plans
42 U.S.C. § 1396d	42 U.S.C. § 1396d	Definitions
42 U.S.C. § 1396e	42 U.S.C. § 1396e	Enrollment of individuals under group health plans
42 U.S.C. § 1396f	42 U.S.C. § 1396f	Observance of religious beliefs
42 U.S.C. § 1396g	42 U.S.C. § 1396g	State programs for licensing of administrators of nursing homes
42 U.S.C. § 1396g-1	42 U.S.C. § 1396g-1	Required laws relating to medical child support
42 U.S.C. § 1396h	42 U.S.C. § 1396h	Transferred
42 U.S.C. § 1396i	42 U.S.C. § 1396i	Certification and approval of rural health clinics and intermediate care facilities for mentally retarded
42 U.S.C. § 1396j	42 U.S.C. § 1396j	Indian health service facilities
42 U.S.C. § 1396k	42 U.S.C. § 1396k	Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures pursuant to State plan; amounts retained by State
42 U.S.C. § 1396l	42 U.S.C. § 1396l	Hospital providers of nursing facility services
42 U.S.C. § 1396m	42 U.S.C. § 1396m	Withholding of Federal share of payments for certain medicare providers
42 U.S.C. § 1396n	42 U.S.C. § 1396n	Compliance with State plan and payment provisions
42 U.S.C. § 1396o	42 U.S.C. § 1396o	Use of enrollment fees, premiums, deductions, cost sharing, and similar charges
42 U.S.C. § 1396p	42 U.S.C. § 1396p	Liens, adjustments and recoveries, and transfers of assets
42 U.S.C. § 1396q	42 U.S.C. § 1396q	Application of provisions of subchapter II relating to subpoenas
42 U.S.C. § 1396r	42 U.S.C. § 1396r	Requirements for nursing facilities
42 U.S.C. § 1396r-1	42 U.S.C. § 1396r-1	Presumptive eligibility for pregnant women
42 U.S.C. § 1396r-1a	42 U.S.C. § 1396r-1a	Presumptive eligibility for children
42 U.S.C. § 1396r-1b	42 U.S.C. § 1396r-1b	Presumptive eligibility for certain breast or cervical cancer patients
42 U.S.C. § 1396r-2	42 U.S.C. § 1396r-2	Information concerning sanctions taken by State licensing authorities against health care practitioners and providers
42 U.S.C. § 1396r-3	42 U.S.C. § 1396r-3	Correction and reduction plans for intermediate care facilities for mentally retarded
42 U.S.C. § 1396r-4	42 U.S.C. § 1396r-4	Adjustment in payment for inpatient hospital services furnished by disproportionate share hospitals
42 U.S.C. § 1396r-5	42 U.S.C. § 1396r-5	Treatment of income and resources for certain institutionalized spouses
42 U.S.C. § 1396r-6	42 U.S.C. § 1396r-6	Extension of eligibility for medical assistance
42 U.S.C. § 1396r-7	42 U.S.C. § 1396r-7	Repealed. Pub. L. 105–33, title IV, § 4713(a), Aug. 5, 1997, 111 Stat. 509
42 U.S.C. § 1396r-8	42 U.S.C. § 1396r-8	Payment for covered outpatient drugs
42 U.S.C. § 1396s	42 U.S.C. § 1396s	Program for distribution of pediatric vaccines
42 U.S.C. § 1396t	42 U.S.C. § 1396t	Home and community care for functionally disabled elderly individuals
42 U.S.C. § 1396u	42 U.S.C. § 1396u	Community supported living arrangements services
42 U.S.C. § 1396u-1	42 U.S.C. § 1396u-1	Assuring coverage for certain low-income families
42 U.S.C. § 1396u-2	42 U.S.C. § 1396u-2	Provisions relating to managed care
42 U.S.C. § 1396u-3	42 U.S.C. § 1396u-3	State coverage of medicare cost-sharing for additional low-income medicare beneficiaries
42 U.S.C. § 1396u-4	42 U.S.C. § 1396u-4	Program of all-inclusive care for elderly (PACE)
42 U.S.C. § 1396u-5	42 U.S.C. § 1396u-5	Special provisions relating to medicare prescription drug benefit
42 U.S.C. § 1396v	42 U.S.C. § 1396v	References to laws directly affecting medicaid program

• Deficit Reduction Act of 2005; P.L. 109-171 (Signed into law on February 8, 2006).
• CBO Cost Estimate of Senate version of Deficit Reduction Act of 2005