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Rule §366.803 Definitions

Published: 2015

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The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
  (1) Applicant--A person seeking assistance under the
Medically Needy Program who:
    (A) has never received Medicaid and is not currently
receiving Medicaid; or
    (B) previously received Medicaid but subsequently was
denied and reapplies for Medicaid.
  (2) Authorized representative--A person or organization
whom an applicant authorizes to apply for Medicaid benefits on behalf
of the applicant.
  (3) Caretaker--A person who supervises and cares for
a child. A caretaker must be related to the child.
  (4) Child--An adoptive, step, or natural child who
is under age 19.
  (5) CFR--Code of Federal Regulations.
  (6) Eligible group--A category of people who are eligible
for the Medically Needy Program.
  (7) HHSC--The Texas Health and Human Services Commission
or its designee.
  (8) Household composition--The group of individuals
who are considered in determining eligibility for an applicant or
recipient for certain medical programs based on tax status, tax relationships,
living arrangements, and family relationships, referenced in 42 CFR §435.603(f)
as "household."
  (9) MAGI--Modified adjusted gross income.
  (10) Medicaid--A state and federal cooperative program,
authorized under Title XIX of the Social Security Act (42 U.S.C. §1396
et seq.) and Texas Human Resources Code chapter 32, that pays for
certain medical and health care costs for people who qualify. Also
known as the medical assistance program.
  (11) Medically Needy (MN) Program--A program HHSC administers
that provides Medicaid benefits to pregnant women and children whose
income is too high to qualify for other Medicaid programs and who
have high medical expenses.
  (12) Newborn--A child from birth through 12 months
of age.
  (13) Person acting responsibly--A person, other than
a provider, who may apply for Medicaid on behalf of an applicant who
is incompetent or incapacitated if the person is determined by HHSC
to be acting responsibly on behalf of the applicant.
  (14) Provider--A health care practitioner, institution,
or other entity that is enrolled with the state Medicaid claims administrator
to provide Medicaid services in Texas and is authorized to submit
claims for payment or reimbursement of medical assistance.
  (15) Recipient--A person receiving Medically Needy
Program services.
  (16) Retroactive coverage--Payment for Medicaid-reimbursable
medical services received up to three months before the month of application.

  (17) Spend down--The amount of income that an applicant
must apply toward incurred medical bills before the applicant can
be certified for the Medically Needy Program.
  (18) Texas Works Handbook --An
HHSC manual containing policies and procedures used to determine eligibility
for Supplemental Assistance Nutrition Program (SNAP) food benefits,
Temporary Assistance for Needy Families (TANF), the Children's Health
Insurance Program (CHIP), and Medicaid programs for children and families.
The Texas Works Handbook is found
on the Internet at

  (19) Third-party resource--A person or organization,
other than HHSC or a person living with the applicant or recipient,
who may be liable as a source of payment of the applicant's or recipient's
medical expenses (for example, a health insurance company).
  (20) U.S.C.--United States Code.