1. (1) "American Indian and Alaska Native” means a person who:

   1. (a) is an Indian or an Urban Indian as defined in paragraphs (13) or (28) of section 4 of the Indian Health Care Improvement Act;
   2. (b) is a California Indian as described in section 809(a) of the Indian Health Care Improvement Act; or
   3. (c) has otherwise been determined eligible as an Indian for the Indian Health Service under U.S. Health and Human Services regulations.
2. (2) “Caregiver” means a parent, guardian, relative, or family caregiver of either a dependent child who is 13 years of age or younger or a disabled individual. “Family caregiver” has the same meaning as defined in section 2 of the RAISE Family Caregivers Act, Pub. L. No. 115-119.
3. (3) "Department" means the Department of Public Health and Human Services.
4. (4) "Federal poverty level” or “FPL” means the income level published each year by the United States Department of Health and Human Services to determine poverty guidelines.
5. (5) "Health and Economic Livelihood Partnership program" or “HELP program” means a Medicaid coverage program for persons as authorized at Title 53, chapter 6, part 13, MCA, 42 U.S.C. 1315, 42 U.S.C. 1396d(y), and other applicable state and federal authorities for those persons who are eligible for the HELP program as authorized under 42 U.S.C. 1396a(a)(10)(A)(i)(VIII).
6. (6) "Medicaid alternative benefit plan" means the health services offered to HELP program participants, which are identical to regular Medicaid benefits.

7. (7) "Medically frail" means a person who has special medical needs, including an individual:

   1. (a) who is blind or disabled as defined in section 1614 of the Social Security Act;
   2. (b) with a substance use disorder;
   3. (c) with a disabling mental disorder;
   4. (d) with a physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living; or
   5. (e) with a serious or complex medical condition.
8. (8) "Member" means an individual enrolled in Montana Medicaid under 53-6-131, MCA, or receiving Medicaid-funded services under 53-6-1304, MCA.
9. (9) "Modified adjusted gross income" or “MAGI” means income determined in accordance with 42 U.S.C. 1396a(e)(14) and 42 CFR 435.603.
10. (10) "Participant" means a HELP program member whose MAGI is at or below 138% of the federal poverty level.

11. (11) “Work program” means:

    1. (a) a program under Title I of the Workforce Innovation and Opportunity Act, Pub. L. No. 113-128;
    2. (b) a program under section 236 of the Trade Act of 1974, Pub. L. No. 93-618;
    3. (c) a program of employment and training operated or supervised by a state or political subdivision of a state that meets standards approved by the governor of the state, including a program under section 6, subsection (d)(4) of the Food and Nutrition Act of 2008, other than a supervised job search program or job search training program;
    4. (d) a program of employment and training for veterans operated by the United States Department of Labor or the United States Department of Veterans Affairs, and approved by the relevant department secretary; or
    5. (e) a workforce partnership under section 6, subsection (d)(4)(N), of the Food and Nutrition Act of 2008.

Authorizing statute(s): 53-2-215, 53-6-113, 53-6-1309, 53-6-1318, MCA

Implementing statute(s): 53-2-215, 53-6-101, 53-6-113, 53-6-1304, 53-6-1305, 53-6-1306, 53-6-1307, 53-6-1308, 53-6-1309, MCA

History: NEW, 2015 MAR p. 2294, Eff. 1/1/16; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 2438, Eff. 1/1/21; AMD, 2026 MAR, Notice No. 2026-514, Eff. 7/1/26.