010. DEFINITIONS (A THROUGH L)

Administrative Code Provisions | Idaho Admin. Code r. 16.03.01.010 | 2018

For the purposes of this chapter, the following terms apply. Effective Date (3-20-14)

01. Advanced Payment of Premium Tax Credit. Payment of federal tax credits specified in 26 U.S.C. Part 36B (as added by section 1401 of the Affordable Care Act) which are provided on an advance basis to an eligible individual enrolled in a Qualified Health Plan (QHP) through an exchange in accordance with sections 1402 and 1412 of the Affordable Care Act. Effective Date (3-20-14)

02. Adult. Any individual who has passed the month of his nineteenth birthday. Effective Date (3-20-14)

03. Affordable Care Act. The Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152). Effective Date (3-20-14)

04. Applicant. A person applying for public assistance from the Department, including individuals referred to the Department from a Health Insurance Exchange or Marketplace. Effective Date (3-20-14)

05. Application. An application for benefits including an Application for Assistance (AFA) or other application recognized by the Department, including referrals from a Health Insurance Exchange or Marketplace. Effective Date (3-20-14)

06. Application Date. The date the Application for Assistance (AFA) is received by the Department or by the Health Insurance Exchange or Marketplace electronically, telephonically, in person, or the date the application is postmarked, if mailed. Effective Date (3-20-14)

07. Caretaker Relative. A caretaker relative is a relative of a dependent child by full- or half-blood, adoption, or marriage with whom the child is living and who assumes primary responsibility for the child's care. A caretaker relative is one of the following: Effective Date (3-20-14)

a. A child's natural, adoptive, or step-parents; Effective Date (3-20-14)

b. A child's natural, adoptive, or step-grandparents; Effective Date (3-20-14)

c. A child's natural, adoptive, half- or step-siblings; Effective Date (3-20-14)

d. A child's natural, adoptive, half- or step-uncle, aunt, first cousin, nephew, niece; first cousin once removed; or Effective Date (3-20-14)

e. A current or former spouse of a qualified relative listed above. Effective Date (3-20-14)

08. Child. Any individual from birth through the end of the month of his nineteenth birthday. Effective Date (3-20-14)

09. Citizen. A person having status as a "national of the United States" defined in 8 U.S.C. 1101(a)(22) that includes both citizens of the United States and non-citizen nationals of the United States. Effective Date (3-20-14)

10. Cost-Sharing. A participant payment for a portion of Medicaid service costs such as deductibles, co-insurance, or co-payment amounts. Effective Date (3-20-14)

11. Creditable Health Insurance. Creditable health insurance is coverage that provides benefits for inpatient and outpatient hospital services and physicians' medical and surgical services. Creditable coverage excludes liability, limited scope dental, vision, specified disease, or other supplemental-type benefits. Effective Date (3-20-14)

12. Department. The Idaho Department of Health and Welfare. Effective Date (3-20-14)

13. Disenrollment. The end of an individual's participation in a Health Care Assistance program. Effective Date (3-20-14)

14. Electronic Account. An electronic file that includes all information collected and generated by the state regarding each individual's Health Care Assistance eligibility and enrollment, including all documentation required and information collected as part of an eligibility review, or during the course of an appeal. Effective Date (3-20-14)

15. Eligibility. The determination of whether or not an individual is eligible for participation in a Health Care Assistance program. Effective Date (3-20-14)

16. Enrollment. The process of adding eligible individuals to a Health Care Assistance program. Effective Date (3-20-14)

17. Extended Medicaid. Extended Medicaid is four (4) additional months of medical assistance for a parent or relative caretaker who becomes ineligible for Title XIX Medicaid due to an increase in spousal support payments. Effective Date (3-20-14)

18. Federal Poverty Guidelines (FPG). The federal poverty guidelines issued annually by the Department of Health and Human Services (HHS).The Federal Poverty Guidelines (FPG) are available on the U.S.
Health and Human Services website at http://aspe.hhs.gov/poverty. Effective Date (3-20-14)

19. Health Assessment. Health Assessment is an examination performed by a primary care provider in order to determine the appropriate health plan for a Medicaid-eligible individual. Effective Date (3-20-14)

20. Health Care Assistance (HCA). Health coverage, including Title XIX or Title XXl benefits granted by the Department for persons or families under the authority of Title 56, Chapter 2, Idaho Code, as well as private health insurance plans purchased with a Premium Tax Credit described in Subsection 010.01 of this rule. Effective Date (3-20-14)

21. Health Insurance Exchange or Marketplace. A resource where individuals, families, and small businesses can: Effective Date (3-20-14)

a. Learn about their health coverage options; Effective Date (3-20-14)

b. Compare health insurance plans based on costs, benefits, and other important features: Effective Date (3-20-14)

c. Choose a health coverage plan; and Effective Date (3-20-14)

d. Enroll in health coverage. Effective Date (3-20-14)

22. Health Insurance Premium Program (HIPP). The Premium Assistance program in which Title XIX and Title XXI participants may participate. Effective Date (3-20-14)

23. Health Plan. A set of health services paid for by Idaho Medicaid, or health insurance coverage obtained through the Health Insurance Exchange or Marketplace. Effective Date (3-20-14)

24. Health Questionnaire. A tool used to assist Health and Welfare staff in determining the correct Health Plan for the Medicaid applicant. Effective Date (3-20-14)

25. Internal Revenue Code. The federal tax law used to determine eligibility under Title 26 U.S.C. for individual income and self-employment income. Effective Date (3-20-14)

26. Internal Revenue Service (IRS). The U.S. government agency in charge of tax laws. These laws are used to determine income eligibility. The IRS website is at http://www.irs.gov. Effective Date (3-20-14)

27. Insurance Affordability Programs. Insurance affordability programs include Title XIX title XXI and all insurance programs available in the Health Insurance Exchange or Marketplace. Effective Date (3-20-14)

28. Lawfully Present. An individual who is a qualified non-citizen as described in Section 221 of these rules. Effective Date (3-20-14)

29. Lawfully Residing. An individual who is lawfully present in the United States and is a resident of the state in which they are applying for health care coverage. Effective Date (3-20-14)