us/statute/42/1396b/v/5

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us/statute/42/1396b/v/5 · Axiom

Notwithstanding the preceding paragraphs of this subsection, beginning on October 1, 2026 , except as provided in paragraphs (2) and (4), in no event shall payment be made to a State under this section for medical assistance furnished to an individual unless such individual is—

(A) a resident of 1 of the 50 States, the District of Columbia, or a territory of the United States; and

(B) either— (i) a citizen or national of the United States; (ii) an alien lawfully admitted for permanent residence as an immigrant as defined by sections 1101(a)(15) and 1101(a)(20) of title 8, excluding, among others, alien visitors, tourists, diplomats, and students who enter the United States temporarily with no intention of abandoning their residence in a foreign country; (iii) an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the Refugee Education Assistance Act of 1980 ( Public Law 96–422 ); or (iv) an individual who lawfully resides in the United States in accordance with a Compact of Free Association referred to in section 1612(b)(2)(G) of title 8 .

in view

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statutes/42/1396b/v.yaml

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Rules

pregnancy_postpartum_period_days

Parameter

source: 42 U.S.C. 1396b(v)(4)(A)(i)

- name: pregnancy_postpartum_period_days
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396b(v)(4)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: during the 60-day period beginning on the last day of the pregnancy
  versions:
    - effective_from: '2024-01-01'
      formula: '60'

child_age_ceiling_years

Parameter

source: 42 U.S.C. 1396b(v)(4)(A)(ii)

- name: child_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396b(v)(4)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: Individuals under 21 years of age
  versions:
    - effective_from: '2024-01-01'
      formula: '21'

alien_described_in_payment_bar

Derived

source: 42 U.S.C. 1396b(v)(1)

- name: alien_described_in_payment_bar
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(1)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: predicate
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        not alien_lawfully_admitted_for_permanent_residence
        and not alien_otherwise_permanently_residing_in_united_states_under_color_of_law

emergency_medical_condition

Derived

source: 42 U.S.C. 1396b(v)(3)

- name: emergency_medical_condition
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(3)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: definition
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_place_health_in_serious_jeopardy

        or medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_seriously_impair_bodily_functions

        or medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_cause_serious_dysfunction_of_bodily_organ_or_part

is_emergency_medicaid_eligible

Derived

source: 42 U.S.C. 1396b(v)(2)

- name: is_emergency_medicaid_eligible
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(2)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#alien_described_in_payment_bar
            output: alien_described_in_payment_bar
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#emergency_medical_condition
            output: emergency_medical_condition
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        alien_described_in_payment_bar
        and emergency_medical_condition
        and care_and_services_are_necessary_for_treatment_of_emergency_medical_condition
        and alien_otherwise_meets_medicaid_state_plan_eligibility_requirements
        and not care_and_services_related_to_organ_transplant_procedure

state_lawfully_residing_pregnancy_category_election_applies

Derived

source: 42 U.S.C. 1396b(v)(4)(A)(i)

- name: state_lawfully_residing_pregnancy_category_election_applies
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(4)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        state_elected_plan_amendment_for_lawfully_residing_pregnant_women
        and individual_lawfully_residing_in_united_states
        and individual_otherwise_eligible_for_medical_assistance
        and individual_is_during_pregnancy_or_within_postpartum_period

state_lawfully_residing_child_category_election_applies

Derived

source: 42 U.S.C. 1396b(v)(4)(A)(ii)

- name: state_lawfully_residing_child_category_election_applies
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(4)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#child_age_ceiling_years
            output: child_age_ceiling_years
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        state_elected_plan_amendment_for_lawfully_residing_children
        and individual_lawfully_residing_in_united_states
        and individual_otherwise_eligible_for_medical_assistance
        and age < child_age_ceiling_years

payment_status_requirement_satisfied

Derived

source: 42 U.S.C. 1396b(v)(5)

- name: payment_status_requirement_satisfied
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(5)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: effective_period
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: beginning on October 1, 2026
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2026-10-01'
      formula: |-
        individual_is_resident_of_state_district_of_columbia_or_united_states_territory
        and (individual_is_citizen_or_national_of_united_states
        or alien_lawfully_admitted_for_permanent_residence_as_immigrant
        or alien_has_cuban_and_haitian_entrant_status
        or individual_lawfully_resides_in_united_states_under_compact_of_free_association)

▸citations (1)

References

This rule cites 1 other rule.

42 USC § 1101 (a)(15)inferredUS Federal › Statutes › Title 42 › § 1101 › (a)(15)

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Official source

(A) a resident of 1 of the 50 States, the District of Columbia, or a territory of the United States; and

in view

Whole section

▸rulespec code

Shown source

statutes/42/1396b/v.yaml

Displaying the canonical repository encoding.

This encoding covers the parent provision us/statute/42/1396b/v; no dedicated encoding exists for this exact provision yet.

View on GitHub

Rules

pregnancy_postpartum_period_days

Parameter

source: 42 U.S.C. 1396b(v)(4)(A)(i)

- name: pregnancy_postpartum_period_days
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396b(v)(4)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: during the 60-day period beginning on the last day of the pregnancy
  versions:
    - effective_from: '2024-01-01'
      formula: '60'

child_age_ceiling_years

Parameter

source: 42 U.S.C. 1396b(v)(4)(A)(ii)

- name: child_age_ceiling_years
  kind: parameter
  dtype: Count
  source: 42 U.S.C. 1396b(v)(4)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: parameter
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: Individuals under 21 years of age
  versions:
    - effective_from: '2024-01-01'
      formula: '21'

alien_described_in_payment_bar

Derived

source: 42 U.S.C. 1396b(v)(1)

- name: alien_described_in_payment_bar
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(1)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: predicate
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        not alien_lawfully_admitted_for_permanent_residence
        and not alien_otherwise_permanently_residing_in_united_states_under_color_of_law

emergency_medical_condition

Derived

source: 42 U.S.C. 1396b(v)(3)

- name: emergency_medical_condition
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(3)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: definition
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: >-
        medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_place_health_in_serious_jeopardy

        or medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_seriously_impair_bodily_functions

        or medical_condition_manifested_by_acute_symptoms_of_sufficient_severity

        and
        absence_of_immediate_medical_attention_could_reasonably_be_expected_to_cause_serious_dysfunction_of_bodily_organ_or_part

is_emergency_medicaid_eligible

Derived

source: 42 U.S.C. 1396b(v)(2)

- name: is_emergency_medicaid_eligible
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(2)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#alien_described_in_payment_bar
            output: alien_described_in_payment_bar
            hash: sha256:local
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#emergency_medical_condition
            output: emergency_medical_condition
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        alien_described_in_payment_bar
        and emergency_medical_condition
        and care_and_services_are_necessary_for_treatment_of_emergency_medical_condition
        and alien_otherwise_meets_medicaid_state_plan_eligibility_requirements
        and not care_and_services_related_to_organ_transplant_procedure

state_lawfully_residing_pregnancy_category_election_applies

Derived

source: 42 U.S.C. 1396b(v)(4)(A)(i)

- name: state_lawfully_residing_pregnancy_category_election_applies
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(4)(A)(i)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        state_elected_plan_amendment_for_lawfully_residing_pregnant_women
        and individual_lawfully_residing_in_united_states
        and individual_otherwise_eligible_for_medical_assistance
        and individual_is_during_pregnancy_or_within_postpartum_period

state_lawfully_residing_child_category_election_applies

Derived

source: 42 U.S.C. 1396b(v)(4)(A)(ii)

- name: state_lawfully_residing_child_category_election_applies
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(4)(A)(ii)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
        - path: versions[0].formula
          kind: import
          import:
            target: us:statutes/42/1396b/v#child_age_ceiling_years
            output: child_age_ceiling_years
            hash: sha256:local
  versions:
    - effective_from: '2024-01-01'
      formula: |-
        state_elected_plan_amendment_for_lawfully_residing_children
        and individual_lawfully_residing_in_united_states
        and individual_otherwise_eligible_for_medical_assistance
        and age < child_age_ceiling_years

payment_status_requirement_satisfied

Derived

source: 42 U.S.C. 1396b(v)(5)

- name: payment_status_requirement_satisfied
  kind: derived
  entity: Person
  dtype: Judgment
  period: Month
  source: 42 U.S.C. 1396b(v)(5)
  metadata:
    proof:
      atoms:
        - path: versions[0].formula
          kind: effective_period
          source:
            corpus_citation_path: us/statute/42/1396b/v
            excerpt: beginning on October 1, 2026
        - path: versions[0].formula
          kind: formula
          source:
            corpus_citation_path: us/statute/42/1396b/v
  versions:
    - effective_from: '2026-10-01'
      formula: |-
        individual_is_resident_of_state_district_of_columbia_or_united_states_territory
        and (individual_is_citizen_or_national_of_united_states
        or alien_lawfully_admitted_for_permanent_residence_as_immigrant
        or alien_has_cuban_and_haitian_entrant_status
        or individual_lawfully_resides_in_united_states_under_compact_of_free_association)

▸citations (1)

References

This rule cites 1 other rule.

42 USC § 1101 (a)(15)inferredUS Federal › Statutes › Title 42 › § 1101 › (a)(15)