Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.18 - MEDICAID COST-SHARING › Section 16.03.18.010 - DEFINITIONS

Current through August 31, 2023
01.
Copayment (Copay)
. The
			 amount a participant is required to pay to the provider for specified services.
			 (3-15-22)
02.
Cost-Sharing
. A payment the participant or the financially responsible
			 adult is required to make toward the cost of the participant's health care.
			 Cost-sharing includes both copays and premiums. (3-15-22)
03.
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. (3-15-22)
04.
Department
. The Idaho
			 Department of Health and Welfare, or a person authorized to act on behalf of
			 the Department. (3-15-22)
05.
Family Income
. The gross income of all financially responsible
			 adults who reside with the participant, as calculated under IDAPA 16.03.01,
			 "Eligibility for Health Care Assistance for Families and Children."
			 (3-15-22)
06.
Family
			 Size
. Family size is the number of people living in the same home as the
			 child. This includes relatives and other optional household members.
			 (3-15-22)
07.
Federal Poverty
			 Guidelines (FPG)
. The federal poverty guidelines issued annually by the
			 U. S. Department of Health and Human Services (HHS). The federal poverty
			 guidelines are available on the U.S. Health and Human Services website at
http://aspe.hhs.gov/poverty
.
			 (3-15-22)
08.
Financially
			 Responsible Adult
. An individual who is the biological or adoptive
			 parent of a child and is financially responsible for the participant.
			 (3-15-22)
09.
Medical
			 Assistance
. Payments for part or all of the cost of services funded by
			 Titles XIX or XXI of the federal Social Security Act, as amended.
			 (3-15-22)
10.
Participant
. A person eligible for and enrolled in the Idaho Medical
			 Assistance Program. (3-15-22)
11.
Physician Office Visit
. Services performed by a physician, nurse
			 practitioner or physician's assistant at the practitioner's place of business,
			 including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics
			 (RHCs). Indian Health Clinic/638 Clinics providing services to individuals
			 eligible for Indian Health Services are not included. (3-15-22)
12.
Premium
. A regular and
			 periodic charge or payment for health coverage. (3-15-22)
13.
Social Security Act
.
			 42 U.S.C.
			 101 et seq., authorizing, in part, federal
			 grants to the states for medical assistance to eligible low-income individuals.
			 (3-15-22)
14.
State
.
			 The state of Idaho. (3-15-22)
15.
Title XIX
. Title XIX of the Social Security Act, known as
			 Medicaid, is a medical benefits program jointly financed by the federal and
			 state governments and administered by the states. This program pays for medical
			 assistance for certain individuals and families with low income and limited
			 resources. (3-15-22)
16.
Title XXI
. Title XXI of the Social Security Act, known as the
			 State Children's Health Insurance Program (SCHIP). This is a program that
			 primarily pays for medical assistance for low-income children.
			 (3-15-22)