Administrative Code Provisions | Idaho Admin. Code r. 16.03.01.011 | 2018

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

01. MAGI-Based Income. Income calculated using the same financial methodologies used by the IRS to determine modified adjusted gross income for federal tax filers, with the exception that: Effective Date (3-20-14)

a. Educational income is excluded in Section 382 of these rules; Effective Date (3-20-14)

b. Indian monies excluded by federal law are not included in MAGI-based income; Effective Date (3-20-14)

c. Lump sum income is counted only in the month received in Section 384 of these rules; and Effective Date (3-20-14)

d. For Medicaid applicants, MAGI-based income is calculated based on income received in the month of application. Effective Date (3-20-14)

02. Medicaid. Idaho's Medical Assistance Program administered by the Department and funded with federal and state funds according to Title XIX of the Social Security Act that provides medical care for eligible individuals. Effective Date (3-20-14)

03. Modified Adjusted Gross Income (MAGI). Modified Adjusted Gross Income (MAGI), is Adjusted Gross Income as defined by the IRS, plus certain tax-exempt income. Effective Date (3-20-14)

04. Newborn Deemed Eligible. A child born to a woman who is eligible for and receiving medical assistance on the date of the child's birth, including during a month of retroactive eligibility for the mother. A child so born is eligible for Medicaid for the first year of his life. Effective Date (3-20-14)

05. Non-Citizen. Same as "alien" defined in Section 101(a)(3) of the Immigration and Nationality Act (INA) (8 U.S.C. 1101 (a)(3)), and includes any individual who is not a citizen or national of the United States. Effective Date (3-20-14)

06. Parent. For a household with a MAGI-based eligibility determination a parent can be: Effective Date (3-20-14)

a. Natural; Effective Date (3-20-14)

b. Biological; Effective Date (3-20-14)

c. Adoptive; or Effective Date (3-20-14)

d. Step-parent. Effective Date (3-20-14)

07. Participant. An individual who is eligible for, and enrolled in, a Health Care Assistance program. Effective Date (3-20-14)

08. Pregnant Woman Coverage. Medical assistance for a pregnant woman that is limited to pregnancy-related services for the period of the pregnancy and sixty (60) days after the pregnancy ends. Effective Date (3-20-14)

09. Premium. A regular, periodic charge or payment for health coverage. Effective Date (3-20-14)

10. Qualified Hospital. A qualified hospital has a Memorandum of Understanding (MOU) with the Department, participates as a provider under the Medicaid state plan, may assist individuals in completing and submitting applications for Health coverage, and has not been disqualified from doing presumptive eligibility determinations. Effective Date (3-20-14)

11. Qualified Non-Citizen. Same as "qualified alien" defined at 8 U.S. C.164(b) and (c). Effective Date (3-20-14)

12. Reasonable Opportunity Period. A period of time allowed for an individual to provide requested proof of citizenship or identity. A reasonable opportunity period extends for ninety (90) days beginning on the 5th day after the notice requesting the proof has been mailed to the applicant. This period may be extended if the Department determines that the individual is making a "good faith" effort to obtain necessary documentation. Effective Date (3-20-14)

13. Sibling. For household with MAGI-based eligibility determination: Is a natural or biological, adopted, half- or step-sibling. Effective Date (3-20-14)

14. SSI. Supplemental Security Income. Effective Date (3-20-14)

15. SSN. Social Security Number. Effective Date (3-20-14)

16. State. The state of Idaho. Effective Date (3-20-14)

17. TAFI. Temporary Assistance for Families in Idaho. Effective Date (3-20-14)

18. TANF. Temporary Assistance to Needy Families. Effective Date (3-20-14)

19. Tax Dependent. A person, who is a related child, or other qualifying relative or person, according to federal IRS standards for whom another individual can claim a deduction for a personal exemption when filing a federal income tax for a taxable year. Effective Date (3-20-14)

20. Third Party. Includes a person, institution, corporation, public or private agency that is liable to pay all or part of the medical cost of injury, disease, or disability of a medical assistance participant. Effective Date (3-20-14)

21. Title XIX. Title XIX of the Social Security Act, known as Medicaid, is a medical benefits program jointly financed by the federal and state governments and administered by the States. This program pays for medical assistance for certain individuals and families with low income, and for some program types, limited resources. Effective Date (3-20-14)

22. Title XXI. Title XXI of the Social Security Act, known as the Children's Health Insurance Program (CHIP), is a federal and state partnership similar to Medicaid, that expands health insurance to targeted, low-income children. Effective Date (3-20-14)

23. Working Day. A calendar day when regular office hours are observed by the state of Idaho.
Weekends and state holidays are not considered working days. Effective Date (3-20-14)