“The term `applicable individual' means an individual (other than a specified excluded individual (as defined in clause (ii)))--”
The section defines an applicable individual as someone who is not a specified excluded individual and who is eligible for or enrolled under the expansion group in section 1902(a)(10)(A)(i)(VIII), or who is eligible for or enrolled under a waiver giving coverage equivalent to minimum essential coverage and is aged 19 to 64, not pregnant, and not entitled to or enrolled for Medicare. State here means one of the 50 States or the District of Columbia.
What the document actually says
“The term `applicable individual' means an individual (other than a specified excluded individual (as defined in clause (ii)))--”
That sentence, in plain words
The term covers a person who is not on the excluded list. The tests that follow narrow it further.
What this is about
The person must be in the Medicaid expansion group. Under a waiver they must be aged 19 to 64. They must not be pregnant or on Medicare.
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Provide for reconciliation pursuant to title II of H. Con. Res. 14, Public Law 119-21, sec. 71119, 139 Stat. 306 (2025). https://www.govinfo.gov/content/pkg/PLAW-119publ21/html/PLAW-119publ21.htm
This page
“An applicable individual is an expansion adult aged 19 to 64,” Provide for reconciliation pursuant to title II of H. Con. Res. 14, section 71119, Sec. 71119. Read the Mandate, https://readthemandate.org/pl-119-21/proposal/sec71119-applicable-individual/ (retrieved October 10, 2026).
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