Section 210-RICR-30-00-1.4 - DefinitionsA. For the purposes of Medicaid MACC and non-MAGI eligibility groups covered under this Part, the following definitions apply:1. "ACA expansion adults" means the eligibility pathway established by the Federal Patient Protection and Affordable Care Act (ACA), Pub. Law No. 111-148, and by R.I. Gen. Laws Chapter 40-8.12, for persons between the ages of nineteen (19) and sixty-four (64) who are not eligible for or enrolled in Medicare and do not qualify for Medicaid in any other eligibility group.2. "Dependent child" means a child under the age of eighteen (18) or under the age of nineteen (19), if enrolled full-time in school.3. "Extended Medicaid" means Medicaid eligibility granted to certain individuals who previously qualified for benefits pursuant to §1931 of the Social Security Act, 42 U.S.C. § 1396u-1, but no longer qualify due to excess income.4. "Hospital presumptive eligibility" means the temporary and time-limited Medicaid eligibility pathway for persons who meet certain requirements and are receiving care in a hospital pending submission of a complete application.5. "Managed care organization" or "MCO" means a health plan system that integrates an efficient financing mechanism with quality service delivery and a "medical home" to assure appropriate preventive care and deter unnecessary services.6. "Medicaid Affordable Care Coverage Group" or "MACC" means a classification of persons eligible to receive Medicaid based on similar characteristics who are subject to the MAGI standard for determining income eligibility.7. "Rhode Island Code of Regulations" or "RICR" means the compilation of Rules governing the Rhode Island Medicaid program promulgated in accordance with the State's Administrative Procedures Act (R.I. Gen. Laws Chapter 42-35).8. "Medicaid member" means a Medicaid beneficiary enrolled in a managed care plan.9. "Modified adjusted gross income" or "MAGI" means income, adjusted by any amount excluded from gross income under 26 U.S.C. § 911, and any interest accrued.10. "Navigator" means a person working for a State-contracted organization that provides certified assisters who have expertise in Medicaid eligibility and enrollment.11. "Non-citizen" means anyone who is not a U.S. citizen at the time of application including lawfully present immigrants and persons born in other countries who are present in the U.S. without documentation.12. "Non-MAGI coverage group" means a Medicaid coverage group that is not subject to the modified adjusted gross income eligibility determination. For the purposes of this Part, it includes Medicaid for persons who qualify for Medicaid based on their eligibility for another publicly funded program, including children in the substitute care under the auspices of the DCYF such as current, and some instances, former foster care recipients and anyone receiving Supplemental Security Income (SSI).13. "Qualified non-citizen" means a person legally present in the United States based on immigration status who, if otherwise eligible for Medicaid, is prohibited or "barred" under Federal law from receiving Medicaid coverage for a period of five (5) years from the date the immigration status was secured from the United States Citizenship and Immigration services (USCIS). Certain qualified non-citizens are exempt from the five (5) year Medicaid ban.14. "Rhody Health Partners" means the Medicaid managed care delivery system for ACA expansion adults (see Subchapter 05 Part 2 of this Chapter) and adults with disabilities (See Chapter 40 of this Title).15. "RIte Care" means the Medicaid managed care delivery system for eligible families, pregnant people, children up to age nineteen (19), and young adults older than age nineteen (19) (see Subchapter 05 Part 2 of this Chapter).16. "RIte Share" means the Medicaid premium assistance program for eligible individuals and families who have access to cost-effective commercial health insurance plans coverage.17. "Section 1115 W aiver" means the waiver authorized pursuant to §1115 of the Social Security Act, 42 U.S.C. § 1315.18. "Section 1931" or "§1931" means §1931 of Title XIX of the Social Security Act, 42 U.S.C. § 1396u-1.19. "Self-attestation" means the act of a person affirming through an electronic or written signature that the statements the person made when applying for Medicaid eligibility are truthful and correct.20. "Title IV-E" means Title IV-E of the Social Security Act, 42 U.S.C. §§ 670- 679c.21. "Title XIX" means Title XIX of the U.S. Social Security Act, 42 U.S.C. §§ 1396 - 1396w - 7, that established the Medicaid program and provides the legal basis for providing services and benefits to certain populations in each MACC group.22. "Title XXI" means Title XXI of the U.S. Social Security Act, 42 U.S.C. §§ 1397aa - 1397mm, that established the Children's Health Insurance Program (CHIP) and provides the legal basis for providing services and benefits to certain targeted low-income children and pregnant women through Medicaid.210 R.I. Code R. 210-RICR-30-00-1.4
Amended effective 12/29/2022
Amended effective 12/11/2023