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RULE §361.103Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

  (1) Applicant--A person seeking Medicaid benefits under MBIC who is not currently receiving Medicaid services.

  (2) Authorized representative--An individual:

    (A) who assists and represents a person in the application or eligibility redetermination process, and who is familiar with that person and that person's financial affairs; or

    (B) who is a representative payee for an applicant or recipient for another federal benefit.

  (3) CFR--Code of Federal Regulations.

  (4) Child--An unmarried person under 19 years of age.

  (5) Child with disabilities--A child who meets the Supplemental Security Income (SSI) program's definition of disability for children, as explained in 20 CFR §416.906.

  (6) Eligibility certification month--Month in which MBIC eligibility is established.

  (7) Family--A unit consisting of an applicant or recipient and the applicant's or recipient's parents and siblings who live in the same household as the applicant or recipient.

  (8) Federal Poverty Level (FPL)--The household income guidelines issued annually and published in the Federal Register by the U.S. Department of Health and Human Services. Percentages of these guidelines are used to determine income eligibility for MBIC and certain other public assistance programs. In other programs, the FPL may be referred to as the Federal Poverty Income Level or the Federal Poverty Guidelines.

  (9) HHSC--The Texas Health and Human Services Commission.

  (10) Income--Funds a person receives that can be used to meet his or her need for food or shelter.

  (11) In-kind support and maintenance--The value of food or shelter furnished to an applicant's or recipient's family.

  (12) Intermediate care facility for persons with mental retardation (ICF/MR)--A Medicaid-certified facility that provides care in a 24-hour specialized residential setting for persons with mental retardation or a related condition. An ICF/MR includes a state supported living center and a state center.

  (13) MBIC--Medicaid Buy-In for Children. A Medicaid buy-in program that provides Medicaid benefits to children with disabilities who are not eligible for SSI for reasons other than disability.

  (14) Medicaid--A state and federal cooperative program, authorized under Title XIX of the Social Security Act and the Texas Human Resources Code, that pays for certain medical and health care costs for people who qualify. Also known as the medical assistance program.

  (15) Parent--A child's natural or adoptive parent or the spouse of the natural or adoptive parent.

  (16) Premium--A monthly payment to be made by a family to HHSC or its designee to buy MBIC coverage.

  (17) Recipient--A person receiving Medicaid benefits under MBIC, including a person whose Medicaid eligibility is being redetermined.

  (18) Sibling--A child's unmarried brother or sister (natural, adoptive, or step).

  (19) U.S.C.--United States Code.

Source Note: The provisions of this §361.103 adopted to be effective January 1, 2011, 35 TexReg 11572

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