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

1. (1) Applicant--A person seeking assistance under Pregnant Women's Medicaid who:

   1. (A) has never received Medicaid and is not currently receiving Medicaid; or
   2. (B) previously received Medicaid but subsequently was denied and reapplies for Medicaid.
2. (2) Authorized representative--A person whom a budget group authorizes to apply for Medicaid benefits on behalf of a certified group but who is not included in the certified group.
3. (3) Budget group--Members of a household whose needs, income, resources, and medical expenses are considered in determining eligibility for Medicaid. The budget group may include both members who are eligible for Medicaid and those who are not. For Pregnant Women's Medicaid, the needs of the applicant's unborn child are included in the budget group.
4. (4) Certified group--Members of a budget group who are eligible for and receiving Medicaid.
5. (5) CFR--Code of Federal Regulations.
6. (6) Child--Any household member under 19 years of age unless the child is married or legally emancipated.
7. (7) Continuous coverage--Uninterrupted eligibility for the extent of the certification period.
8. (8) Countable income--The receipt of cash or its equivalent, either earned or unearned, that a person may directly or indirectly use to meet basic needs (such as food, clothing, and shelter), including TANF cash payments.
9. (9) Earned income--Compensation received from employment or job training, including military and flight pay, allowances for housing and food, and receipts from self-employment (but not receipts from ownership of property involving less than 20 hours of work per week, which are unearned income).
10. (10) Eligible group--A category of people who are eligible for Pregnant Women's Medicaid. In other Medicaid programs, an eligible group may be called a coverage group.
11. (11) Federal Poverty Income Limit (FPIL)--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 Pregnant Women's Medicaid and certain other public assistance programs. In other programs, the FPIL may be referred to as the Federal Poverty Level or the Federal Poverty Guidelines.
12. (12) 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.
13. (13) Person acting responsibly--A person, other than a provider, who may apply for Medicaid on behalf of an individual who is incompetent or incapacitated if the person is determined by the Texas Health and Human Services Commission (HHSC) to be acting responsibly on behalf of the applicant.
14. (14) Recipient--A person receiving Pregnant Women's Medicaid services.
15. (15) Retroactive coverage--Payment for Medicaid-reimbursable medical services received up to three months before the month of application.
16. (16) Temporary Assistance for Needy Families (TANF)--A program that provides temporary benefits (cash assistance) and work opportunities to families with needy dependent children, authorized under Title IV of the Social Security Act.
17. (17) Texas Works Handbook--An HHSC manual containing policies and procedures used to determine eligibility for SNAP food benefits, TANF, 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. (18) Unearned income--Income that is not earned income, including dividends and withdrawals from excluded resources.
19. (19) U.S.C.--United States Code.

Source Note:The provisions of this §366.303 adopted to be effective June 9, 2010, 35 TexReg 4661.