Which states are designated 209(b) states under Medicaid and where can their state plan documents be found?
Executive summary
Section 209(b) of the Social Security Act lets certain states retain older, more restrictive Medicaid eligibility rules for people who are aged, blind or disabled; authoritative guidance on how that group is reviewed is found in HHS and CMS implementation materials [1] [2]. A single, up‑to‑date federal roster of which states currently operate under Section 209(b) is maintained in federal policy documents (not fully reproduced in the reporting provided), while the legally binding Medicaid state plan language that establishes each state's eligibility rules is available through CMS’s state plan and state plan amendment (SPA) repositories [3] [4].
1. What “209(b)” means and why it matters
Section 209(b) allows states to apply Medicaid eligibility criteria for the aged, blind and disabled that are different — and historically in some cases more restrictive — than Supplemental Security Income (SSI) criteria, meaning approval for SSI does not automatically produce Medicaid in those states unless state rules also qualify a recipient [5] [6]. HHS and CMS have produced implementation guidance explaining how reviewable units should treat individuals in 209(b) states and how eligibility groups are defined for administrative and appeals purposes [1] [2].
2. Where to find the authoritative list and why the sources differ
The Social Security Administration’s Program Operations Manual System (POMS) and related SSA materials historically maintain lists and operational guidance identifying which states have 209(b) authority, but the excerpted POMS cite in the reporting does not include the list text itself and must be consulted directly for a current roster [7] [8]. Policy analysts such as MACPAC and Congressional Research Service explain the statutory framework and note that states’ choices about using SSI criteria or 209(b) rules affect automatic enrollment and “1634” relationships with SSA, which is why different secondary sources sometimes report slightly different state lists unless cross‑checked against federal repositories [5] [4] [6].
3. Commonly cited states and caveats about completeness
Some publicly available legal‑help and advocacy writeups identify specific states that make separate Medicaid determinations or otherwise do not automatically grant Medicaid with SSI; one consumer‑facing source lists Alaska, Idaho, Kansas, Nebraska, Nevada, Oklahoma, Oregon and Utah as examples that make state determinations or use their own criteria [9]. That list is illustrative but not definitive for the present date; the reporting at hand does not include a single federal table enumerating all 209(b) states, so any specific roster should be verified against SSA POMS or CMS records [7] [8].
4. Where the state plan documents live — how to find the legal text
The legally enforceable description of a state's Medicaid eligibility standards is contained in its Medicaid state plan and in state plan amendments (SPAs), which CMS hosts and indexes; researchers should use CMS’s Medicaid State Plan Amendments and CHIP SPA portals to retrieve the approved state plan language and amendments that reflect whether a state applies SSI criteria, operates under 209(b), or uses alternative rules [3] [10]. MACPAC’s state‑plan primer explains that the state plan is the authoritative document CMS must approve for federal matching funds and is the correct place to confirm historical 1972 plan provisions relied upon by some 209(b) states [4].
5. How to verify a state’s current 209(b) status and practical tips
To confirm whether a specific state is a 209(b) state today, consult SSA POMS page SI 01715.020 and related SSA guidance for operational designations [7] [8], and that state’s current Medicaid state plan and recent SPAs on Medicaid.gov to read the eligibility provisions themselves [3] [10]. Policy observers should beware of secondary lists that are not routinely updated and should cross‑reference SSA/CMS primary sources; stakeholders (advocates, attorneys, state agencies) may frame the issue differently depending on whether their focus is administrative burden, benefit access, or historical program design, which can introduce implicit agendas into summaries found outside federal repositories [4] [11].