Section 436.224 - Individuals under age 21 who are under State adoption assistance agreements(a) The agency may provide Medicaid to individuals under the age of 21 (or, at State option, age 20, 19, or 18)- (1) For whom an adoption agreement (other than an agreement under title IV-E) between the State and adoptive parent(s) is in effect;(2) Who, the State agency responsible for adoption assistance has determined, cannot be placed with adoptive parents without Medicaid because the child has special needs for medical or rehabilitative care; and(3) Who meet either of the following: (i) Were eligible for Medicaid under the State plan before the adoption agreement was entered into; or(ii) Would have been eligible for Medicaid before the adoption agreement was entered into, if the eligibility standards and methodologies of the foster care program were used without employing the threshold title IV-A eligibility determination.(b) For adoption assistance agreements entered into before April 7, 1986-(1) The agency must deem the requirements of paragraph (a)(1) and (2) of this section to be met if the State adoption assistance agency determines that- (i) At the time of the adoption placement, the child had special needs for medical or rehabilitative care that made the child difficult to place; and(ii) There is in effect an adoption assistance agreement between the State and the adoptive parent(s).(2) The agency must deem the requirements of paragraph (a)(3) of this section to be met if the child was found by the State to be eligible for Medicaid before the adoption assistance agreement was entered into.55 FR 48610, Nov. 21, 1990