PURPOSE: The purpose of this rule is to define terms that are used in determining eligibility for Family MO HealthNet programs and the Children’s Health Insurance Program (CHIP).

1. (1) For purposes of this chapter, the following definitions shall apply:

   1. (A) “Applicant” is the adult who completes and submits an application for a Family MO HealthNet Program or CHIP program, whether for themselves or on behalf of someone else;
   2. (B) “Child” or “Children” means a person or persons who are under nineteen (19) years of age;
   3. (C) “Children’s Health Insurance Program” or “CHIP” means the health assistance provided to uninsured, low income children under Title XXI of the Social Security Act and established in sections 208.631 through 208.658, RSMo;
   4. (D) “Division” means the Family Support Division, Department of Social Services;
   5. (E) “Electronic data hub” means any electronic service established by the Secretary of the United States Department of Health and Human Services, through which the division may verify certain information with, or obtain such information from, federal agencies and other data sources;
   6. (F) “Family Mo HealthNet programs” means MO HealthNet benefits provided to participants under the MO HealthNet for Families (MHF) program, MO HealthNet for Kids

2. (MHK) program, MO HealthNet for Pregnant Women (MPW) program, and Uninsured Woman’s Health Services (UWHS) program. Family MO HealthNet programs also include presumptive eligibility for any of the above programs;

   1. (G) “Non-custodial parent” means the parent who does not have physical custody of the child.

      1. 1. If physical custody is questioned, a

court order, judgment, decree, or any legally enforceable separation, divorce, or custody agreement establishing which party has physical custody shall control who is the custodial parent;

1. 2. If there is no such order or agree-

ment, or the order or agreement is silent, or in the event of joint custody, the custodial parent is the parent with whom the child expects to spend more than fifty percent (50%) of his or her overnight visits in the year for which eligibility is being determined; or

1. 3. In the case of true joint physical cus-

tody where the child spends an equal amount of overnight visits with both parents, the noncustodial parent is the parent who does not claim the child as part of their tax household;

1. (H) “Parent” means a natural or biological, adopted, or stepparent;
2. (I) “Participant” means any individual who has applied for, is receiving, or has been denied Family MO HealthNet benefits or CHIP benefits;
3. (J) “Sibling” means a natural or biological, adopted, half, or step sibling;
4. (K) “Reasonable Compatibility” means the information received by the division, is not in conflict with other information known by the division. Income information is “reasonably compatible” if the sources of information are above or both are at or below the applicable income standard or other relevant income threshold limit, or the difference between the sources of the income information is ten percent (10%) or less and the sources of income are similar;
5. (L) “Tax Dependent” means an individual for whom another individual claims a deduction for a personal exemption under Internal Revenue Code, section 151 for a taxable year; and
6. (M) “Taxpayer” means an individual who expects to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made and who does not expect to be claimed as a tax dependent by another individual.

AUTHORITY: section 207.020, RSMo 2000, and section 208.991, RSMo Supp. 2013.* Original rule filed July 31, 2013, effective Feb. 28, 2014.

*Original authority: 207.020, RSMo 1945, amended 1961, 1965, 1977, 1981, 1982, 1986, 1993 and 208.991, RSMo 2013.