The following words and terms, when used in this subchapter,
have the following meanings, unless the context clearly indicates
otherwise:
(1) Applicant--A person seeking assistance under Children's
Medicaid who:
(A) has never received Medicaid and is not currently
receiving Medicaid; or
(B) previously received Medicaid but subsequently was
denied and reapplies for Medicaid.
(2) Authorized representative--A person or organization
whom an applicant authorizes to apply for Medicaid benefits on behalf
of the applicant.
(3) Caretaker--An adult who is present in the home,
who supervises and cares for a child, and who meets relationship requirements
in §366.519(b) of this subchapter (relating to Relationship and
Domicile).
(4) CFR--Code of Federal Regulations.
(5) Child--An adoptive, step, or natural child who
is under 19 years of age.
(6) Continuous coverage--Uninterrupted eligibility
for the extent of the certification period regardless of any changes
in circumstances, unless:
(A) the recipient attains the maximum age for that
specific program;
(B) the recipient dies;
(C) the recipient disenrolls voluntarily;
(D) the recipient changes state residence;
(E) the state has erred in the eligibility determination;
or
(F) the recipient or the recipient's representative
has committed fraud, abuse, or perjury.
(7) Eligible group--A category of people who are eligible
for Children's Medicaid.
(8) Federal Poverty Level (FPL)--The household income
guidelines issued annually and published in the Federal Register by
the United States Department of Health and Human Services.
(9) HHSC--The Texas Health and Human Services Commission
or its designee.
(10) Household composition--The group of individuals
who are considered in determining eligibility for an applicant or
recipient for certain medical programs based on tax status, tax relationships,
living arrangements, and family relationships, referenced in 42 CFR §435.603(f)
as "household."
(11) Medicaid--A state and federal cooperative program,
authorized under Title XIX of the Social Security Act (42 U.S.C. §1396
et seq.) and Texas Human Resources Code chapter 32, that pays for
certain medical and health care costs for people who qualify. Also
known as the medical assistance program.
(12) Newborn--A child from birth through 12 months
of age.
(13) Person acting responsibly--A person, other than
a provider, who may apply for Medicaid on behalf of an applicant who
is incompetent or incapacitated if the person is determined by HHSC
to be acting responsibly on behalf of the applicant.
(14) Recipient--A person receiving Children's Medicaid
services, including a person who is renewing eligibility for Children's
Medicaid.
(15) Retroactive coverage--Payment for Medicaid-reimbursable
medical services received up to three months before the month of application.
(16) Texas Health Steps--Federally mandated Medicaid
services that provide medical and dental check-ups, diagnosis, and
treatment to eligible clients from birth through age 20. Federally,
this program is known as the Early Periodic Screening, Diagnostic,
and Treatment (EPSDT) Program.
(17) Texas Works Handbook --An
HHSC manual containing policies and procedures used to determine eligibility
for Supplemental Nutrition Assistance Program (SNAP) food benefits,
Temporary Assistance for Needy Families (TANF), the Children's Health
Insurance Program (CHIP), and Medicaid programs for children and families.
The Texas Works Handbook is found
on the Internet at www.dads.state.tx.us/handbooks/TexasWorks.
(18) Third-party resource--A person or organization,
other than HHSC or a person living with the applicant or recipient,
who may be liable as a source of payment of the applicant's or recipient's
medical expenses (for example, a health insurance company).
(19) U.S.C.--United States Code.
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