Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.01 - ELIGIBILITY FOR HEALTH CARE ASSISTANCE FOR FAMILIES AND CHILDREN › Section 16.03.01.010 - DEFINITIONS (A THROUGH L)

Current through August 31, 2023
For the purposes of this chapter, the following terms apply.
				(3-17-22)
01.
Advanced Payment
			 of Premium Tax Credit
. Payment of federal tax credits specified in 26
			 U.S.C. Part 36B (as added by section
			 1401 of the Affordable Care Act)
			 which are provided on an advance basis to an eligible individual enrolled in a
			 Qualified Health Plan (QHP) through an exchange in accordance with sections
			 1402 and
			 1412 of the Affordable Care Act.
			 (3-17-22)
02.
Adult
.
			 Any individual who has passed the month of his nineteenth birthday.
			 (3-17-22)
03.
Affordable Care
			 Act
. The Patient Protection and Affordable Care Act of 2010
			 (Pub. L.
			 111-148), as amended by the Health Care and
			 Education Reconciliation Act of 2010 (Pub. L. 111-152).
			 (3-17-22)
04.
Applicant
. A person applying for public assistance from the
			 Department, including individuals referred to the Department from a Health
			 Insurance Exchange or Marketplace. (3-17-22)
05.
Application
. An application
			 for benefits including an Application for Assistance (AFA) or other application
			 recognized by the Department, including referrals from a Health Insurance
			 Exchange or Marketplace. (3-17-22)
06.
Application Date
. The date
			 the Application for Assistance (AFA) is received by the Department or by the
			 Health Insurance Exchange or Marketplace electronically, telephonically, in
			 person, or the date the application is postmarked, if mailed.
			 (3-17-22)
07.
Caretaker
			 Relative
. A caretaker relative is a relative of a child by full- or
			 half-blood, adoption, or marriage with whom the child is living and who assumes
			 primary responsibility for the child's care. A caretaker relative includes a
			 child's natural, adoptive, or step parents, grandparents, siblings, aunt,
			 uncle, niece, nephew, or cousin. (3-17-22)
08.
Child
. Any individual from
			 birth through the end of the month of his nineteenth birthday.
			 (3-17-22)
09.
Citizen
.
			 A person having status as a "national of the United States" defined in
			 8 U.S.C.
			 1101(a)(22) that includes
			 both citizens of the United States and non-citizen nationals of the United
			 States. (3-17-22)
10.
Cost-Sharing
. A participant payment for a portion of Medicaid
			 service costs such as deductibles, co-insurance, or co-payment amounts.
			 (3-17-22)
11.
Creditable
			 Health Insurance
. Creditable health insurance is coverage that provides
			 benefits for inpatient and outpatient hospital services and physicians' medical
			 and surgical services. Creditable coverage excludes liability, limited scope
			 dental, vision, specified disease, or other supplemental-type benefits.
			 (3-17-22)
12.
Department
. The Idaho Department of Health and Welfare.
			 (3-17-22)
13.
Federal Poverty
			 Guidelines (FPG)
. The federal poverty guidelines issued annually by the
			 Department of Health and Human Services (HHS).The Federal Poverty Guidelines
			 (FPG) are available on the U.S. Health and Human Services website at
http://aspe.hhs.gov/poverty
.
			 (3-17-22)
14.
Health
			 Assessment
. Health Assessment is an examination performed by a primary
			 care provider in order to determine the appropriate health plan for a
			 Medicaid-eligible individual. (3-17-22)
15.
Health Care Assistance
			 (HCA)
. Health coverage includes Medicaid coverage under Title XIX or
			 Title XXI as well as private health insurance plans purchased with a Premium
			 Tax Credit described in Subsection
			 010.01 of this rule granted by
			 the Department for persons or families within the State of Idaho.
			 (3-17-22)
16.
Health
			 Insurance Premium Program (HIPP)
. The Premium Assistance program in
			 which Title XIX and Title XXI participants may participate. (3-17-22)
17.
Health Plan
. A set of health
			 services paid for by Idaho Medicaid, or health insurance coverage obtained
			 through the Health Insurance Exchange or Marketplace. (3-17-22)
18.
Health Questionnaire
. A tool
			 used to assist Health and Welfare staff in determining the correct Health Plan
			 for the Medicaid applicant. (3-17-22)
19.
Internal Revenue Code
. The
			 federal tax law used to determine eligibility under Title 26 U.S.C. for
			 individual income and self-employment income. (3-17-22)
20.
Internal Revenue Service
			 (IRS)
. The U.S. government agency in charge of tax laws. These laws are
			 used to determine income eligibility. The IRS website is at
http://www.irs.gov
. (3-17-22)
21.
Insurance Affordability
			 Programs
. Insurance affordability programs include Title XIX title XXI
			 and all insurance programs available in the Health Insurance Exchange or
			 Marketplace. (3-17-22)
22.
Lawfully Present
. An individual who is a qualified non-citizen as
			 described in Section 221 of these
			 rules. (3-17-22)