State Plan Amendment - Title XIX of the Social Security Act
Supplement 1 - Mandatory and Excluded Populations
Mandatory populations
Section 1931 Children and Related Poverty Level Populations (TANF/AFDC)
Section 1931 Adults and Related Poverty Level Populations, including pregnant women (TANF/AFDC)
Blind/Disabled Adults and Related Populations (SSI)
Title XXI CHIP
Excluded populations
Medicare recipients
Nursing home residents
Recipients residing in an Intermediate Care Facility for the Mentally Retarded (ICF/MR)
Participants in a home and community-based waiver program
Have an eligibility period that is only retroactive
Enrollees under age 19 with special needs that are
Eligible for SSI
Determined to be Children with Special Health Care Needs (CSHCN) through Title V
Eligible under a Maternal Child Health Services Block Grant
Foster care children
Subsidized adoption
Optional populations (State approval for exemption required)
Full-time students residing out-of-state and other recipients where the State determines that access to care is severally limited through PCCM participation.
Recipients currently receiving care within a case management system
Institutionalized recipients including Adjustment Training Center residents
