The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

1. (1) "Administrative Contractor" means the entity that performs administrative services for the CHIP under contract with the Commission.

2. (2) "Applicant" means an individual who lives with the child and applies for health insurance coverage on behalf of the child. An applicant can only be:

   1. (A) a child's custodial parent, whether natural or adoptive;
   2. (B) a child's grandparent, relative or other adult who provides care for the child;
   3. (C) an emancipated minor applying for himself/herself; or
   4. (D) a child's step-parent.
3. (3) "Application" means the standardized, written document issued by TexCare that an applicant must complete to apply for health care benefits or coverage through CHIP.
4. (4) "Application completion date" means the calendar date a completed CHIP application is entered into the TexCare database.

5. (5) "Budget Group" means the group of individuals who live in the home with the child for whom an application for health insurance is submitted and whose information is used to establish family size and calculate income. Individuals receiving Supplemental Security Income payments are not included in the Budget group. Budget group members include only:

   1. (A) the child seeking health insurance benefits;
   2. (B) the child's siblings who live with the child (biological, adopted, or step-siblings);
   3. (C) the child's natural or adoptive parents; or
   4. (D) the child's step-parent.
6. (6) "Children's Health Insurance Program" or "CHIP" means the Texas State Children's Health Insurance Program established under Title XXI of the federal Social Security Act (42 U.S.C, §§1397aa, et seq.) and chapters 62 and 63, Health and Safety Code.
7. (7) "Children's Health Insurance Program Service Area" or "CSA" means one of the designated areas in the state that is served by one or more of the CHIP Health Plans or the CHIP Exclusive Provider Organization.
8. (8) "Commission" or "HHSC" means the Health and Human Services Commission.
9. (9) "Community-based Organization" or "CBO" means an organization that contracts with the Commission to provide outreach services to applicants for CHIP coverage.
10. (10) "Completed application" means an application entered into the TexCare database that includes all information required under §370.23.
11. (11) "Countable income" means any type of payment that is a regular and predictable gain or a benefit to a budget group that is not specifically exempted. Regular and predictable income is income received in one month that is either likely to be received in the next month and/or was received on a regular and predictable basis in past months. It does not include income that is not received on a regular and predictable basis in past months, or is received by the child or sibling member of the budget group who is enrolled in school.

12. (12) "Countable liquid assets" means resources that an applicant can readily convert to cash to meet immediate needs and whose values are used in calculating a child's eligibility for CHIP.

    1. (A) Countable liquid assets include the balances, as of the last day of the month prior to the date of submission of an application (either initial or renewal), of the following:

       1. (i) cash on hand;
       2. (ii) cash in the bank;
       3. (iii) cash in a TANF (Temporary Assistance to Needy Families) Electronic Benefit Transfer account;
       4. (iv) money remaining from the sale of a homestead; and
       5. (v) accessible trust funds.

    2. (B) Countable liquid assets do not include:

       1. (i) any resource exempted by federal law from consideration for purposes of determining eligibility or benefit levels for any federally funded program, such as TANF and Assets for Independence Act (AFIA) Individual Development Accounts; or
       2. (ii) any financial instrument subject to rules limiting use of its proceeds, including penalties and/or tax liabilities incurred for early liquidation, such as individual retirement accounts and Keogh plans; or
       3. (iii) the cash value of any insurance policy; or
       4. (iv) Internal Revenue Code 529 qualified college savings program accounts, such as Texas Tomorrow Fund accounts; or
       5. (v) funds received as educational grants or scholarships.
13. (13) "Enrollment" means the process by which a child determined to be eligible for CHIP is enrolled in a CHIP health plan serving the CHIP Service Area in which the child resides.
14. (14) "Entrant" means a person who is not a native born or naturalized citizen of the United States of America.
15. (15) "Excess vehicle value" means a vehicle's wholesale value minus any allowable exemption.
16. (16) "Exempt income" means income received by the budget group that is not counted in determining income eligibility.
17. (17) "FPL" means Federal Poverty Level Income Guidelines.
18. (18) "Gross budget group income" means monthly countable income before any payroll deductions.
19. (19) "Health Plan" means a licensed health maintenance organization, indemnity carrier, or authorized exclusive provider organization that contracts with the Commission to provide health benefits coverage to CHIP members.

20. (20) "Household" means the budget group plus any SSI recipient who is

    1. (A) the child's sibling who lives with the child (biological, adopted, or step-sibling);
    2. (B) the child's natural or adoptive parent; or
    3. (C) the child's step-parent.
21. (21) "Income eligibility standard" means monthly gross budget group income at or below 200% of current (FPL). A child meets the CHIP income eligibility standard if the budget group's monthly gross income exceeds the income eligibility standard applied to the child in the Texas Medicaid Program and is at or below the 200% of FPL CHIP monthly income standard.
22. (22) "Member" means a child enrolled in a CHIP Health Plan.
23. (23) "Qualified Entrant" means an alien who applies for CHIP coverage and who, at the time of such application, satisfies the criteria established under 8 U.S.C. §1641(b).
24. (24) "SSI" means Supplemental Security Income.
25. (25) "State fiscal year" means the 12-month period beginning September 1 of each calendar year and ending August 31 of the following calendar year.
26. (26) "TDHS" means the Texas Department of Human Services.
27. (27) "TexCare" means the name designated to publicly identify the operational entity that provides administrative services for the CHIP program.

Source Note:The provisions of this §370.4 adopted to be effective April 4, 2001, 26 TexReg 2519; amended to be effective September 1, 2003, 28 TexReg 7337; amended to be effective August 24, 2004, 29 TexReg 4448.