Md. Code Regs. 10.09.43.02

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.43.02 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Applicant" means a child:

(a) Whose representative has submitted a written application for the Maryland Children's Health Program to the local health department or the local department of social services;

(b) Who has been determined ineligible for MCHP;

(c) Whose representative indicated on the application form an interest in participating in MCHP Premium; and

(d) Whose family income is more than 200 percent but not more than 300 percent of the federal poverty level.

(2) "Application" means submitting a written and signed application form for the Maryland Children's Health Program to the local health department or the local department of social services.

(3) "Application date" means the date the MCHP application form is received by the Department to be considered for eligibility for MCHP Premium.

(4) "Application form" means the form designated by the Department to be completed, signed, and submitted to the local health department or the local department of social services as an official application for MCHP and MCHP Premium.

(5) "Authorized representative" means an individual 21 years old or older who acts on behalf of the applicant.

(6) "Case manager" means an employee of the:

(a) Local health department, or the local department of social services, responsible for determining the eligibility of applicants and recipients for MCHP; or

(b) Department responsible for determining eligibility of applicants for MCHP Premium.

(7) "Department" means the Department of Health and Mental Hygiene.

(8) "Determination" means a decision regarding an applicant's eligibility for MCHP Premium.

(9) "Disregard" means the amount of money specified by regulation that can be subtracted from countable income.

(10) Earned Income.

(a) "Earned income" means payment received by an individual in cash as a result of employment, including self-employment.

(b) "Earned income" includes, but is not limited to:

(i) Wages;

(ii) Salaries;

(iii) Commissions;

(iv) Tips; and

(v) Profit from self-employment.

(11) "Eligible individual" means a child who meets all nonfinancial eligibility requirements to participate in MCHP under COMAR 10.09.11 and whose family income is above 200 percent but at or below 300 percent of the federal poverty level.

(12) "Family contribution" means the portion of the premium cost paid for an eligible individual to enroll and participate in MCHP Premium.

(13) "Family member" means an individual living with the applicant whose income is counted, or would be counted as family income under Regulation .07 of this chapter.

(14) "Federal poverty level (FPL)" means the non-farm income official poverty level as defined by the Office of Management and Budget and revised annually in accordance with § 673(2) of the Omnibus Budget Reconciliation Act of 1981.

(15) "Group health plan" has the meaning stated in 42 U.S.C. § 300g g-91.

(16) "Hardship" means unreasonable financial adversity or misfortune.

(17) "Health insurance coverage" has the meaning stated in 42 U.S.C. § 300g g-91.

(18) "Inpatient services" means services received by a recipient while in a medical institution, birthing center, or clinic for which Medical Assistance is provided.

(19) "Institution for mental disease (IMD)" has the meaning stated in COMAR 10.09.62.01B(78)(a).

(20) "Local department of social services (LDSS)" means the Baltimore City or a county social services department under the supervision of the Department of Human Resources.

(21) "Local health department (LHD)" means the Baltimore City Health Department and its subgrantees, or a county health department.

(22) "Managed care organization (MCO)" means:

(a) A certified health maintenance organization that is authorized to receive Medical Assistance prepaid capitation payments; or

(b) A corporation that:

(i) Is a managed care system that is authorized to receive Medical Assistance prepaid capitation payments;

(ii) Enrolls only program recipients, individuals, or families served under the Maryland Medicaid Managed Care Program; and

(iii) Is subject to the requirements of Health-General Article, §15-102.4, Annotated Code of Maryland.

(23) "Maryland Children's Health Program (MCHP)" means the program established in Health-General Article, §15-301(b)(1), Annotated Code of Maryland, to provide comprehensive medical care and other health care services to certain children and pregnant women.

(24) "Maryland Medicaid Managed Care Program" has the meaning stated in COMAR 10.09.62.01B(88).

(25) "MCHP Premium" means the program established in Health-General Article, §15-301.1 et seq., Annotated Code of Maryland, to provide access to health coverage to eligible individuals through managed care organizations (MCOs) under MCHP.

(26) "Medical institution" means an institution that:

(a) Is organized to provide medical care, including nursing and convalescent care;

(b) Has the necessary professional equipment and facilities to manage the medical, nursing, and other health needs of a patient on a continuing basis in accordance with accepted standards;

(c) Is authorized under State law to provide medical care; and

(d) Is staffed by medical and nursing professionals.

(27) "Period under consideration" means the specific months that are assessed in order to determine eligibility for MCHP Premium.

(28) Public Institution.

(a) "Public institution" means an:

(i) Institution that is the responsibility of a government unit or over which a government unit exercises administrative control; or

(ii) Establishment that furnishes, in single or multiple facilities, food, shelter, and some treatment or services to four or more individuals unrelated to the proprietor.

(b) "Public institution" does not include a medical institution, a skilled nursing facility, or a publicly operated community residence that serves fewer than 17 residents.

(29) "Qualified alien" means an individual who:

(a) Has been fully admitted for permanent residence in the United States under the Immigration and Nationality Act (INA);

(b) Has been granted asylum in the United States as a refugee under § 208 of the INA;

(c) Has been admitted into the United States as a refugee under § 207 of the INA;

(d) Has been paroled into the United States under § 212(d)(5) of the INA for a period of at least 1 year;

(e) Has had deportation withheld under § 243(h) of the INA;

(f) Has been granted conditional entry into the United States under § 203(a)(7) of the INA which was in effect before April 1, 1980;

(g) Is a documented or undocumented immigrant who has been battered or subjected to extreme cruelty by the individual's U.S. citizen or lawful permanent resident spouse or parent, or by a member of the spouse's or parent's family residing in the same household as the alien, if:

(i) The spouse or parent consented to, or acquiesced in, the battery or cruelty;

(ii) The immigrant has filed a Violence Against Women Act (VAWA) immigration case or a family-based visa petition with INS; and

(iii) In the opinion of the agency providing benefits, there is a substantial connection between the battery or cruelty and the need for the benefits to be provided;

(h) Is a victim of a severe form of trafficking who has been subjected to:

(i) Sex trafficking, if the act is induced by force, fraud, or coercion, or if the individual induced to perform the act is younger than 18 years old; or

(ii) Involuntary servitude;

(i) Is a member of a federally recognized Indian tribe, as defined in 25 U.S.C. § 450b(e); or

(j) Is an American Indian born in Canada to whom § 289 of the Immigration and Nationality Act applies.

(30) "Recipient" means a child younger than 19 years old who is certified as eligible for MCHP Premium.

(31) "Redetermination" means a determination regarding the continuing eligibility of a recipient.

(32) "Representative" means:

(a) A parent or parents living with the applicant;

(b) The applicant's guardian; or

(c) The applicant's authorized representative.

(33) "Title XXI" means the title of the Social Security Act through which funding is provided, in part, for MCHP Premium.

(34) "Unearned income" means all income that does not meet the definition of earned income.

Md. Code Regs. 10.09.43.02

Regulations .02 adopted as an emergency provision effective July 1, 2001 (28:12 Md. R. 1102); adopted permanently effective September 3, 2001 (28:17 Md. R. 1556)
Regulation .02B amended effective November 10, 2003 (30:22 Md. R. 1580)
Regulation .02B amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251); amended permanently effective September 27, 2004 (31:19 Md. R. 1432)