Utah Admin. Code R414-301-2 - Definitions

The definitions in Section 26-18-2 apply in this rule. In addition, the following definitions apply in Rules R414-301 through R414-308:

(1) "Aged" means an individual who is 65 years of age or older.

(2) "Agency" means the Department of Health and Human Services.

(3) "CHEC" means Child Health Evaluation and Care and is the Utah specific term for the federally mandated program of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children under 21 years old.

(4) "Cost-of-care" means the amount of income after allowable deductions an individual must pay for their long-term care services either in a medical institution or for home and community-based waiver services.

(5) "Deemed newborn" means a child who receives one year of continuous eligibility because at the time of the child's birth, the child's mother was a Medicaid member or was receiving coverage under the Children's Health Insurance Program in a state that provides deemed newborn coverage to infants born to a CHIP eligible mother.

(6) "Department" means the Department of Health and Human Services.

(7) "Eligibility agency" means any state office or outreach location of the Department of Workforce Services (DWS) that accepts and processes applications for medical assistance programs under contract with the Department.

(8) "Federal poverty guideline" means the United States (U.S.) federal poverty measure issued annually by the Department to determine financial eligibility for certain means-tested federal programs.

(9) "Federally facilitated marketplace (FFM) means the entity that individuals can access to enroll in health insurance and apply for assistance from insurance affordability programs such as Advanced Premium Tax Credits, Medicaid, and CHIP.

(10) "Medically needy" means medical assistance coverage under 42 CFR 435.301 that uses the Basic Maintenance Standard as the income limit for eligibility.

(11) "Modified adjusted gross income" means the income that is determined using the methodology defined in 42 CFR 435.603(e).

(12) "Outreach location" means any site other than a state office where state workers are located to accept applications for medical assistance programs. Locations include sites such as hospitals, clinics, and homeless shelters.

(13) "QI" means the Qualifying Individuals program, a Medicare cost-sharing program.

(14) "QMB" means Qualified Medicare Beneficiary program, a Medicare cost-sharing program.

(15) "Reportable change" means any change in circumstances that could affect a member's eligibility for Medicaid, including the following changes:

(a) the source of income;

(b) gross income of $25 or more;

(c) household size;

(d) residence;

(e) gain of a vehicle;

(f) resources;

(g) total allowable deductions of $25 or more;

(h) marital status, deprivation, or living arrangements;

(i) pregnancy or termination of a pregnancy; (j) onset of a disabling condition;

(k) change in health insurance coverage including changes in the cost of coverage;

(l) tax filing status;

(m) number of dependents claimed as tax dependents;

(n) earnings of a child; and

(o) student status of a child.

(16) "Resident of a medical institution" means a single individual who is a resident of a medical institution from the month after entry into a medical institution until the month before discharge from the institution. Death in a medical institution is not considered a discharge from the institution and does not change the member's status as a resident of the medical institution. Married individuals are residents of an institution in the month of entry into the institution and in the month they leave the institution.

(17) "SLMB" means Specified Low-Income Medicare Beneficiary program, a Medicare cost-sharing program.

(18) "Spenddown" means an amount of income in excess of the allowable income standard that must be paid in cash to the eligibility agency or incurred through the medical services not paid by Medicaid or other health insurance coverage, or some combination of these.

(19) "Spouse" means any individual who has been married to an applicant or member and has not legally terminated the marriage.

(20) "Verification" means the proof needed to decide whether an individual meets the eligibility criteria to be enrolled in the applicable medical assistance program. Verification may include documents in paper format, electronic records from computer match systems, and collateral contacts with third parties who have information needed to determine the eligibility of the individual.

(21) "Worker" means a state employee who determines eligibility for medical assistance programs.

Notes

Utah Admin. Code R414-301-2

Amended by Utah State Bulletin Number 2023-08, effective 3/30/2023