13 CSR 40-7.010 - Scope and Definitions
(1)
Definitions.
(A) "Applicant" is a participant
as listed in 13 CSR 40-7.015 who completes
and submits an application for a Family MO HealthNet Program or CHIP program,
whether for themselves or on behalf of someone else.
(B) "Authorized Representative" means an
individual as defined in
13 CSR
40-2.015(2)(B).
(C) "Child" or "Children" means a person or
persons who are under nineteen (19) years of age.
(D) "Children's Health Insurance Program" or
"CHIP" means the health assistance provided to uninsured, low income children
under Title XXI of the Social Security Act and established in sections
208.631 through
208.658, RSMo.
(E) "Deductions" means an allowable amount
that is deducted from earned income and claimed on the participant's federal
income taxes.
(F) "Division" means
the Family Support Division, Department of Social Services.
(G) "Earned Income" means-
1. Wages, salaries, tips, commissions, and
other taxable employee pay;
2.
Union strike benefits;
3. Long-term
disability benefits received prior to minimum retirement age;
4. Net earnings from self-employment if-
A. The participant or household member owns
or operates a business or a farm;
B. The participant or household member is a
minister or member of a religious order; or
C. The participant or household member meets
the definition of a "statutory employee" under section 3121(d) of the
Internal Revenue Code and has income;
5. Compensation in lieu of
wages/bar-tering.
(H)
"Electronic data hub" means any electronic service established by the Secretary
of the United States Department of Health and Human Services, through which the
division may verify certain information with, or obtain such information from,
federal agencies and other data sources.
(I) "Emancipated minor" means a minor who-
1. Has been declared emancipated by a court
of competent jurisdiction; or
2.
Meets all of the following criteria:
A. The
minor is sixteen (16) or seventeen (17) years of age; and
B. The minor is self-supporting, such that
the minor is without the physical or financial support of a parent or legal
guardian; and
C. The minor's parent
or legal guardian has consented to the minor living independent of the parents'
or guardians' control. Consent may be expressed or implied, such that-
(I) Expressed consent is any verbal or
written statement made by the parent(s) or guardian(s) of the minor displaying
approval or agreement that the minor may live independently of the parent's or
guardian's control;
(II) Implied
consent is any action made by the parent or guardian of the minor that
indicates the parent or guardian is unwilling or unable to adequately care for
the minor. Such actions may include, but are not limited to:
(a) Barring the minor from the home or
otherwise indicating that the minor is not welcome to stay;
(b) Refusing to provide any or all financial
support for the minor; or
(c)
Abusing or neglecting the minor, as defined in section
210.110, RSMo, or committing an
act or acts of domestic violence against the minor, as defined in section
455.010,
RSMo.
(J) "Family member" means a person who meets
the following relationship criteria: father, mother, grandfather, grandmother,
brother, sister, stepfather or stepmother (but not step-grandparents),
stepbrother, stepsister, uncle, aunt, first cousin, first cousin of a parent,
nephew, niece, adoptive father or adoptive mother, grandfather-in-law or
grandmother-in-law (meaning the spouse of a second marriage of one (1) of the
child's biological grandparents), great-grandfather or great-grandmother
(including great-great grandfather or great-great grandmother), brother or
sister of half-blood, adoptive brother or adoptive sister, brother-in-law or
sister-in-law, uncle or aunt of the half-blood, uncle-in-law or aunt-in-law,
great-uncle, or great-aunt (including great-great uncle or great-great aunt).
Relatives by adoption not specifically mentioned in this subsection are treated
in the same way as blood relatives.
(K) "Family MO HealthNet programs" means MO
HealthNet benefits provided to participants under the MO HealthNet for Families
(MHF) program, the Adult Expansion Group (AEG) pursuant to Article IV, Section
36(c) of the Missouri Constitution, MO HealthNet for Kids
(MHK) program, MO HealthNet for Pregnant Women (MPW) program, and Uninsured
Women's Health Services (UWHS) program. Family MO HealthNet programs also
include presumptive eligibility for any of the above programs.
(L) "Household" means individuals who make up
an eligibility group under 42 CFR 45.603(f) and
13 CSR
40-7.020.
(M) "Non-custodial parent" means the parent
who does not have physical custody of the child.
1. If physical custody is questioned, a court
order, judgment, decree, or any legally enforceable separation, divorce, or
custody agreement establishing which party has physical custody shall control
who is the custodial parent.
2. If
there is no such order or agreement, or the order or agreement is silent, or in
the event of joint custody, the custodial parent is the parent with whom the
child expects to spend more than fifty percent (50%) of his or her overnight
visits in the year for which eligibility is being determined.
3. In the case of true joint physical custody
where the child spends an equal amount of overnight visits with both parents,
the noncustodial parent is the parent who does not claim the child as part of
their tax household.
(N)
"Non-Filer" means an individual who is not expected to file a tax return or be
claimed as a tax-dependent.
(O)
"Parent" means a natural or biological, adopted, or stepparent.
(P) "Participant" means any individual who
has applied for, is receiving, or has been denied Family MO HealthNet benefits
or CHIP benefits.
(Q) "Sibling"
means a natural or biological, adopted, half, or step sibling.
(R) "Reasonable Compatibility" means the
information received by the division, is not in conflict with other information
known by the division. Income information is "reasonably compatible" if the
sources of information are above or both are at or below the applicable income
standard or other relevant income threshold limit, or the difference between
the sources of the income information is ten percent (10%) or less and the
sources of income are similar.
(S)
"Tax Dependent" means an individual for whom another individual claims a
deduction for a personal exemption under Internal Revenue
Code, section 151 for a taxable year.
(T) "Taxpayer" means an individual who
expects to file a tax return for the taxable year in which an initial
determination or renewal of eligibility is being made and who does not expect
to be claimed as a tax dependent by another individual.
(U) "Unearned Income" means-
1. Pay received for work while an inmate is
in a penal institution;
2. Interest
and dividends;
3. Retirement
income;
4. Social
Security;
5. Unemployment
benefits;
6. Alimony; and
7. Child support.
Notes
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