Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.62 - Separate Children's Health Insurance Program (CHIP) and CHIP Health Services Initiative Eligibility › Section 10.09.62.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this
				  chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Affordable Care Act" means 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),
				  as amended by the Three Percent Withholding Repeal and Job Creation Act
				  (Pub.L.
				  112-56).
(2) Applicant.
(a) "Applicant" means an individual whose
				  written application for the separate CHIP Program has been submitted to the
				  local health department or the local department of social services but has not
				  received final action.
(b)
				  "Applicant" includes an individual whose application is submitted through a
				  representative.
(3)
				  "Application" means the filing of a written, telephonic, or electronic signed
				  application for health coverage in an insurance affordability program to the
				  Department or its designee.
(4)
				  "Application date" means the date on which a written, telephonic, or electronic
				  signed application is received by the Department or its designee.
(5) "Authorized representative" has the
				  meaning stated in COMAR 10.01.04.12.
(6) "Birthing parent" means the individual
				  who gives birth to the targeted low-income child who is enrolled in the
				  separate CHIP Program on the day prior to their birth.
(7) "CHIP Health Services Initiative" means
				  services offered to improve the health of low-income children pursuant to
				  §2105(a)(1)(D)(ii) of the Social Security Act.
(8) "Department" means the Maryland
				  Department of Health.
(9)
				  "Determination" means a decision regarding an applicant's eligibility for the
				  separate CHIP Program.
(10)
				  "Eligibility worker" means an employee of the local health department, or the
				  local department of social services, responsible for determining the
				  eligibility of applicants and participants.
(11) "Family members" means those individuals
				  living with the applicant whose income is counted as household income under
				  Regulation .07B of this chapter.
(12) "Federal poverty level" means the
				  nonfarm 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.
(13) "Inpatient services" means services
				  received by a participant while in a medical institution, birthing center, or
				  clinic for which Medical Assistance is provided.
(14) "Institution for mental diseases" means
				  an institution which falls within the jurisdiction of Health-General Article,
				  §19-307(a)(1), Annotated Code of Maryland, and is licensed under COMAR
				  10.07.04.
(15) "Insurance
				  affordability program" means a program that is one of the following:
(a) Maryland Medicaid;
(b) The Maryland Children's Health Insurance
				  Program (CHIP), including the program known as Maryland Children's Health
				  Program (MCHP) Premium;
(c) The
				  separate CHIP Program;
(d) An
				  optional state basic health program established under §1331 of the
				  Affordable Care Act;
(e) A program
				  that makes available to qualified individuals coverage in a qualified health
				  plan through the Maryland Health Benefit Exchange with advance payments of the
				  premium tax credit established under
				  26 U.S.C. §
													36B of the Internal Revenue Code;
				  or
(f) A program that makes
				  available coverage in a qualified health plan through the Maryland Health
				  Benefit Exchange with cost-sharing reductions established under 42 U.S.C.
				  § 1402 of the Affordable Care Act.
(16) "Living together" means sharing a common
				  household.
(17) "MAGI" means
				  modified adjusted gross income, as calculated for purposes of determining
				  eligibility for insurance affordability programs under the Affordable Care
				  Act.
(18) "Maryland Health Benefit
				  Exchange" means the unit of State government that determines initial and
				  continuing eligibility for the MAGIbased insurance affordability programs,
				  including, by delegation, certain eligibility in the program.
(19) "Maryland Medicaid Managed Care Program"
				  has the meaning stated in COMAR 10.09.24.02.
(20) "Period under consideration" has the
				  meaning stated in COMAR 10.09.24.02.
(21) "Postpartum period" means the period of
				  time beginning on the first day of the month following the end of the pregnancy
				  and ending on the last day of the fourth month after the pregnancy
				  ends.
(22) "Public institution" has
				  the meaning stated in COMAR 10.09.24.02.
(23) "Qualified alien" has the meaning
				  defined in 8 U.S.C. §
												1641.
(24) "Participant" means an individual who is
				  certified as eligible for the Maryland Children's Health Program.
(25) "Redetermination" has the meaning stated
				  in COMAR 10.09.24.02.
(26)
				  "Separate CHIP Program" means the program for targeted low-income children
				  established under Title XXI of the Social Security Act.
(27) "Spouse" has the meaning stated in COMAR
				  10.09.24.02.
(28) "Targeted
				  low-income child" means an individual who qualifies for the Maryland Children's
				  Health Program from conception to birth when the birthing parent is not
				  eligible for Medicaid as a citizen or qualified alien, when the family income
				  is equal to or less than 250 percent of the federal poverty level.
(29) "Title XIX" means the title of the
				  Social Security Act, 42
				  U.S.C. §
												1396 et seq., which governs
				  establishment of a medical assistance program for low-income
				  individuals.
(30) "Title XXI" means
				  the title of the Social Security Act through which funding is provided, in
				  part, for the separate CHIP Program.