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 the Medically Needy Program 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) Applied income--A portion of a legal parent's income applied or counted to meet the needs of a minor applicant.
3. (3) 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.
4. (4) 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.
5. (5) Caretaker--A person who supervises and cares for a dependent child. A caretaker must be related to the child.
6. (6) Certified group--Members of a budget group who are eligible for and receiving Medicaid.
7. (7) CFR--Code of Federal Regulations.
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) Disqualified member--A person who normally would be considered a participating member of a household but whose needs are not considered because the person failed to meet or comply with a program requirement.
10. (10) 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).
11. (11) Eligible group--A category of people who are eligible for the Medically Needy Program. In other Medicaid programs, an eligible group may be called a coverage group.
12. (12) Fair market value--The amount of money an item would bring if sold in the current local market.
13. (13) Good cause--An acceptable reason that exempts an applicant or recipient from a Medicaid requirement.
14. (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. (15) Medically Needy (MN) Program--A program the Texas Health and Human Services Commission (HHSC) administers that provides Medicaid benefits to pregnant women, children, and parents or caretakers of children whose income is too high to qualify for other Medicaid programs and who have high medical expenses.
16. (16) Newborn--A child from birth through 12 months of age.
17. (17) 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 HHSC to be acting responsibly on behalf of the applicant.
18. (18) Provider--A health care practitioner, institution, or other entity that is enrolled with the state Medicaid claims administrator to provide Medicaid services in Texas and is authorized to submit claims for payment or reimbursement of medical assistance.
19. (19) Recipient--A person receiving Medically Needy Program services, including a person who is renewing eligibility for the Medically Needy Program.

20. (20) Resources--Cash (or its equivalent) and property that is convertible to cash (or its equivalent). Resources include:

    1. (A) cash from income that is not obligated in the month of receipt; and
    2. (B) lump sum payments that may be received intermittently and no more often than once annually.
21. (21) Retroactive coverage--Payment for Medicaid-reimbursable medical services received up to three months before the month of application.
22. (22) Spend down--The amount of income that an applicant must apply toward incurred medical bills before the applicant can be certified for the Medically Needy Program.
23. (23) 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.
24. (24) 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.hhsc.state.tx.us/Programs/Programs.shtml#handbooks.
25. (25) Third-party resource--A person or organization, other than HHSC or a person living with the applicant, who may be liable as a source of payment of the applicant's medical expenses (for example, a health insurance company).
26. (26) Unearned income--Income that is not earned income, including dividends and withdrawals from excluded resources.
27. (27) U.S.C.--United States Code.

Source Note:The provisions of this §366.803 adopted to be effective June 9, 2010, 35 TexReg 4661.