Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 7 - Family Healthcare › Section 13 CSR 40-7.010 - Scope and Definitions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This proposed amendment adds the Adult
				  Expansion Group to the list of populations that fall under Family MO HealthNet
				  programs, pursuant to Amendment 2, which was ratified on August 4, 2020, and
				  which created Article IV, Section 36(c) of the Missouri
				  Constitution.
(1) Definitions.
(A) "Applicant" is a participant as listed in
				13 CSR
				40-7.015 who completes and submits an application for
				a Family MO HealthNet Program or CHIP program, whether for themselves or on
				behalf of someone else.
(B)
				"Authorized Representative" means an individual as defined in
				13 CSR
				40-2.015(2)(B).
(C) "Child" or "Children" means a person or
				persons who are under nineteen (19) years of age.
(D) "Children's Health Insurance Program" or
				"CHIP" means the health assistance provided to uninsured, low income children
				under Title XXI of the Social Security Act and established in sections
				208.631
				through
				208.658,
				RSMo.
(E) "Deductions" means an
				allowable amount that is deducted from earned income and claimed on the
				participant's federal income taxes.
(F) "Division" means the Family Support
				Division, Department of Social Services.
(G) "Earned Income" means-
1. Wages, salaries, tips, commissions, and
				other taxable employee pay;
2.
				Union strike benefits;
3. Long-term
				disability benefits received prior to minimum retirement age;
4. Net earnings from self-employment if-
A. The participant or household member owns
				or operates a business or a farm;
B. The participant or household member is a
				minister or member of a religious order; or
C. The participant or household member meets
				the definition of a "statutory employee" under section 3121(d) of the Internal
				Revenue Code and has income;
5. Compensation in lieu of
				wages/bar-tering.
(H)
				"Electronic data hub" means any electronic service established by the Secretary
				of the United States Department of Health and Human Services, through which the
				division may verify certain information with, or obtain such information from,
				federal agencies and other data sources.
(I) "Emancipated minor" means a minor who-
1. Has been declared emancipated by a court
				of competent jurisdiction; or
2.
				Meets all of the following criteria:
A. The
				minor is sixteen (16) or seventeen (17) years of age; and
B. The minor is self-supporting, such that
				the minor is without the physical or financial support of a parent or legal
				guardian; and
C. The minor's parent
				or legal guardian has consented to the minor living independent of the parents'
				or guardians' control. Consent may be expressed or implied, such that-
(I) Expressed consent is any verbal or
				written statement made by the parent(s) or guardian(s) of the minor displaying
				approval or agreement that the minor may live independently of the parent's or
				guardian's control;
(II) Implied
				consent is any action made by the parent or guardian of the minor that
				indicates the parent or guardian is unwilling or unable to adequately care for
				the minor. Such actions may include, but are not limited to:
(a) Barring the minor from the home or
				otherwise indicating that the minor is not welcome to stay;
(b) Refusing to provide any or all financial
				support for the minor; or
(c)
				Abusing or neglecting the minor, as defined in section
				210.110, RSMo, or
				committing an act or acts of domestic violence against the minor, as defined in
				section
				455.010,
				RSMo.
(J) "Family member" means a person who meets
				the following relationship criteria: father, mother, grandfather, grandmother,
				brother, sister, stepfather or stepmother (but not step-grandparents),
				stepbrother, stepsister, uncle, aunt, first cousin, first cousin of a parent,
				nephew, niece, adoptive father or adoptive mother, grandfather-in-law or
				grandmother-in-law (meaning the spouse of a second marriage of one (1) of the
				child's biological grandparents), great-grandfather or great-grandmother
				(including great-great grandfather or great-great grandmother), brother or
				sister of half-blood, adoptive brother or adoptive sister, brother-in-law or
				sister-in-law, uncle or aunt of the half-blood, uncle-in-law or aunt-in-law,
				great-uncle or great-aunt (including great-great uncle or great-great aunt).
				Relatives by adoption not specifically mentioned in this subsection are treated
				in the same way as blood relatives.
(K) "Family Mo HealthNet programs" means MO
				HealthNet ben-efits provided to participants under the MO HealthNet for
				Families (MHF) program, the Adult Expansion Group (AEG) pursuant to Article IV,
				Section 36(c) of the Missouri Constitution, MO HealthNet for Kids (MHK)
				program, MO HealthNet for Pregnant Women (MPW) program, and Uninsured Women's
				Health Services (UWHS) program. Family MO HealthNet programs also include
				presumptive eligibility for any of the above programs.
(L) "Household" means individuals who make up
				an eligibility group under 42 CFR 45.603(f) and
				13 CSR
				40-7.020.
(M) "Non-custodial parent" means the parent
				who does not have physical custody of the child.
1. If physical custody is questioned, a court
				order, judgment, decree, or any legally enforceable separation, divorce, or
				custody agreement establishing which party has physical custody shall control
				who is the custodial parent.
2. If
				there is no such order or agreement, or the order or agreement is silent, or in
				the event of joint custody, the custodial parent is the parent with whom the
				child expects to spend more than fifty percent (50%) of his or her overnight
				visits in the year for which eligibility is being determined.
3. In the case of true joint physical custody
				where the child spends an equal amount of overnight visits with both parents,
				the noncustodial parent is the parent who does not claim the child as part of
				their tax household.
(N)
				"Non-Filer" means an individual who is not expected to file a tax return or be
				claimed as a tax-dependent.
(O)
				"Parent" means a natural or biological, adopted, or stepparent.
(P) "Participant" means any individual who
				has applied for, is receiving, or has been denied Family MO HealthNet benefits
				or CHIP benefits.
(Q) "Sibling"
				means a natural or biological, adopted, half, or step sibling.
(R) "Reasonable Compatibility" means the
				information received by the division, is not in conflict with other information
				known by the division. Income information is "reasonably compatible" if the
				sources of information are above or both are at or below the applicable income
				standard or other relevant income threshold limit, or the difference between
				the sources of the income information is ten percent (10%) or less and the
				sources of income are similar.
(S)
				"Tax Dependent" means an individual for whom another individual claims a
				deduction for a personal exemption under Internal Revenue Code, section 151 for
				a taxable year.
(T) "Taxpayer"
				means an individual who expects to file a tax return for the taxable year in
				which an initial determination or renewal of eligibility is being made and who
				does not expect to be claimed as a tax dependent by another
				individual.
(U) "Unearned Income"
				means-
1. Pay received for work while an
				inmate is in a penal institution;
2. Interest and dividends;
3. Retirement income;
4. Social Security;
5. Unemployment benefits;
6. Alimony; and
7. Child support.