Ohio Administrative Code › Title 5160:1 - Eligibility › Chapter 5160:1-1 - General Medicaid Eligibility Policy › Section 5160:1-1-01 - Medicaid: definitions

Current through all regulations passed and filed through July 1, 2024
(A) This rule contains definitions generally
			 used in determining eligibility for medical assistance.
(B) Definitions.
(1) "Abuse" means any action by an individual
			 or entity that results in unnecessary costs to the medical assistance program
			 in accordance with 42 C.F.R
			 455.2 (as in effect October 1,
			 
									2022).
(2)
			 "Administrative agency" means the Ohio department of medicaid (ODM) and/or an
			 agent of ODM authorized to determine eligibility for a medical assistance
			 program.
(3) "Advance notice of
			 adverse action" means a written notice of the administrative agency's intent to
			 discontinue or suspend medical assistance, reduce the level of benefits or
			 covered services, or increase the amount of an individual's premium or patient
			 liability, sent no less than fifteen calendar days prior to the date of the
			 proposed action in accordance with rules
			 5101:6-2-04 and
			 5101:6-2-05 of the
			 Administrative Code.
(4)
			 "Applicant" means an individual who is seeking an eligibility determination for
			 himself or herself through an application submission or a transfer from another
			 agency or insurance affordability program in accordance with
			 42 C.F.R.
			 435.4 (as in effect October 1,
			 
									2022).
(5)
			 "Approve" or "approval" means a determination by the administrative agency that
			 an individual is eligible for one or more categories of medical assistance
			 applied for by the individual or on behalf of the individual by his or her
			 authorized representative.
(6)
			 "Assets" means all income and resources of the individual and of the
			 individual's spouse. This includes any income or resources the individual or
			 the individual's spouse is entitled to, but does not receive, because of an
			 action taken to avoid receipt of the asset by:
(a) The individual or the individual's
			 spouse; or
(b) A person, including
			 a court or administrative body, with legal authority to act in place of, or on
			 behalf of, the individual or the individual's spouse; or
(c) Any person, including any court or
			 administrative body, acting at the direction, or upon the request, of the
			 individual or the individual's spouse.
(7) "Assignment" means an individual eligible
			 for medical assistance has transferred his or her right, or the rights of any
			 other individual for whom he or she can legally make an assignment, to collect
			 and retain third-party and/or medical support payments to ODM up to the amount
			 of medical services paid under the medicaid program.
(8) "Authorized representative" means a
			 person, who is at least eighteen years of age, or a legal entity who stands in
			 place of the individual. Actions or failures of an authorized representative
			 will be accepted as the action or failure of the individual. When an individual
			 has designated an authorized representative, all references to the individual's
			 responsibilities include the authorized representative in accordance with rule
			 5160-1-33 of the Administrative
			 Code.
(9) "Base eligibility" means
			 the individual meets all of the eligibility requirements for at least one
			 category of medical assistance described in Chapter 5160:1-3, 5160:1-4, or
			 5160:1-5 of the Administrative Code.
(10) "Caretaker relative" means a relative of
			 a dependent child by blood, adoption, or marriage with whom the child is
			 living, who assumes primary responsibility for the child's care (as may, but is
			 not required to, be indicated by claiming the child as a tax dependent for
			 federal income tax purposes), and who is one of the following:
(a) The child's father, mother, brother,
			 sister, stepfather, stepmother, stepbrother, or stepsister; or
(b) The child's grandfather, grandmother,
			 uncle, aunt, nephew, or niece, including such relatives with the prefix great,
			 great-great, grand, or great-grand; or
(c) The child's first cousin or first cousin
			 once removed; or
(d) The spouse of
			 such parent or relative, even after the marriage is terminated by death or
			 divorce.
(11) "Case
			 record" means electronic or paper documents and information used to determine,
			 redetermine, or renew an individual's eligibility for medical
			 assistance.
(12) "Creditable
			 insurance" or "creditable coverage" means health insurance coverage as defined
			 in 42 U.S.C.
			 300gg-3(c) (as in
			 effect October 1, 
									2022).
(a) This
			 includes:
(i) A group health plan;
			 or
(ii) Health insurance coverage;
			 or
(iii) Medicare part A, as set
			 forth in 42 U.S.C.
			 1395c to
			 1395i-5 (as in effect October 1,
			 
											2022) or
			 part B, as set forth in 42
			 U.S.C. 1395j to
			 1395w-6 (as in effect October 1,
			 
											2022);
			 or
(iv) Coverage under medicaid, as
			 set forth in Title XIX of the Social Security Act, other than coverage
			 consisting solely of benefits under the pediatric vaccine program set forth in
			 42 U.S.C.
			 1396s (as in effect October 1,
			 
											2022);
			 or
(v) Armed forces health
			 insurance as set forth in 10
			 U.S.C. 1071 to
			 1110b (as in effect October 1,
			 
											2022);
			 or
(vi) A medical care program of
			 the Indian health service or of a tribal organization; or
(vii) A state health benefits risk pool;
			 or
(viii) A federal employee health
			 plan offered under 5 U.S.C.
			 8901 to
			 8992 (as in effect October 1,
			 
											2022);
			 or
(ix) A public health plan;
			 or
(x) A peace corps volunteer
			 health benefit plan under section
			 22 U.S.C.
			 2504 (as in effect October 1,
			 
											2022).
(b) Creditable insurance does not include:
(i) Coverage only for accident or disability
			 income insurance; or
(ii) Liability
			 insurance, including general liability insurance and automobile liability
			 insurance, or coverage issued as a supplement to liability insurance;
			 or
(iii) Workers' compensation or
			 similar insurance; or
(iv)
			 Automobile medical payment insurance; or
(v) Credit insurance which pays off existing
			 debts in the event of death, disability, or unemployment; or
(vi) Coverage for employment onsite medical
			 clinics; or
(vii) Other similar
			 insurance coverage under which benefits for medical care are secondary or
			 incidental to other insurance benefits; or
(viii) Limited-scope dental or vision
			 benefits; or
(ix) Benefits for
			 long-term care, nursing facility care, home health care, or community-based
			 care; or
(x) Coverage only for a
			 specified disease or illness; or
(xi) Hospital indemnity or other fixed
			 indemnity insurance, if purchased separately; or
(xii) Medicare supplemental health insurance
			 as defined under 42 U.S.C.
			 1395ss (as in effect October 1,
			 
											2022),
			 coverage supplemental to the coverage provided to military or former military
			 personnel under 10 U.S.C.
			 1071 to
			 1110b (as in effect October 1,
			 
											2022),
			 and similar supplemental coverage provided to coverage under a group health
			 plan; or
(xiii) Coverage through a
			 medical cost-sharing program, including a health care cost-sharing
			 ministry.
(13) "Deduction" means a verifiable amount
			 the individual pays for an expense. Garnishments or liens placed against earned
			 or unearned income of an individual are not considered a deduction, regardless
			 of the reason for the garnishment or lien.
(14) "Deny" or "denial" means a determination
			 by the administrative agency that an individual is not eligible for one or more
			 categories of medical assistance applied for by the individual or on behalf of
			 the individual by his or her authorized representative.
(15) "Dependent child" means a person younger
			 than age eighteen living with a parent or caretaker relative.
(16) "Discontinue" or "discontinuance" means
			 a determination by the administrative agency that an individual is no longer
			 eligible, or has failed to cooperate with verification of eligibility, for one
			 or more categories of medical assistance currently being received by that
			 individual, resulting in a written notice of the administrative agency's
			 intention to end coverage under that category and providing notice of hearing
			 rights in accordance with 42
			 C.F.R. 435.917 (as in effect October 1,
			 
									2022).
(17) "Disregard" means the amount subtracted
			 from gross, non-excluded income in the medical assistance budget
			 calculation.
(18) "Early and
			 periodic screening, diagnostic and treatment" (EPSDT) means screening, vision,
			 dental, and hearing services, and such other necessary health care, diagnostic
			 services, treatment, and other measures described in
			 42 U.S.C.
			 1396d (as in effect October 1,
			 
									2022) to
			 correct or ameliorate defects and physical and mental illnesses and conditions
			 discovered by the screening services, whether or not such services are covered
			 under the medicaid state plan. Healthchek is Ohio's EPSDT program.
(19) "Earned income" means income in cash or
			 in-kind received as payment for services performed as an employee or as a
			 self-employed individual. Earned income includes but is not limited to wages,
			 salary, or commissions from which state or federal income taxes are paid or
			 withheld.
(20) "Electronic
			 equivalent" means an electronic version of an Ohio department of job family
			 services (ODJFS) or ODM form or application which has not been modified in any
			 way, other than format, prior to completion and submission of that form to the
			 administrative agency. The administrative agency is not required to accept
			 forms that are altered.
(21)
			 "Electronic protected health information" (ePHI) means any protected health
			 information (PHI) that is maintained or transmitted in electronic form,
			 regardless of the format.
(22)
			 "Electronic signature" means an electronic sound, symbol, or process attached
			 to, or logically associated with, a record and executed or adopted by a person
			 with the intent to sign the record as defined in section
			 1306.01 of the Revised
			 Code.
(23) "Encumbrance" means a
			 claim, lien, charge, or liability attached to and binding on an identified
			 piece of real or personal property.
(24) "Equity value" means the fair market
			 value of a resource minus any encumbrance.
(25) "Erroneous payment" means a medicaid
			 reimbursement made for an individual who was ineligible at the time services
			 were received, regardless of the presence of fraud or abuse.
(26) "Excluded income" means income that
			 state or federal law prohibits from consideration in determining eligibility
			 for medical assistance.
(27) "Fair
			 market value" means, unless otherwise stated, the going price, at the time of
			 the transfer or contract of sale, for which real or personal property can
			 reasonably be expected to sell on the open market in the relevant geographic
			 area. The appraised value of real property is determined by the county auditor
			 and may be used to establish fair market value.
(28) "Family size" means the number of
			 persons counted as members of an individual's medicaid household.
(29) "Federal adoption assistance" (AA) means
			 the Title IV-E subsidy program as defined by the Adoption Assistance and Child
			 Welfare Act of 1980 (Pub.
			 L. No. 96-272).
(30) "Federal benefit rate" (FBR) means the
			 supplemental security income (SSI) current payment standard published annually
			 by the social security administration (SSA).
(31) "Federal foster care maintenance" (FCM)
			 means the Title IV-E program, as described in rule
			 5101:2-47-01 of the
			 Administrative Code.
(32)
									"Federal kinship guardianship assistance program"
			 (KGAP) means the Title IVE program to provide payments to relatives, as defined
			 in section 5101.141 of the Revised Code,
			 who have assumed legal custody or guardianship of eligible children whom they
			 have cared for as foster parents for a minimum of six consecutive months and
			 for whom there is a valid KGAP or KGAP C21 agreement.
(33)
			 "Federal means-tested public benefit" means a benefit in which eligibility for
			 the benefit or the amount of the benefit, or both, is determined on the basis
			 of income or resources of the individual seeking the benefit. Medicaid, cash
			 assistance, and food assistance are federal means-tested public benefits, but
			 certain other benefits listed in
			 8 U.S.C.
			 1613(c) (as in effect
			 October 1, 
									2022) are not considered means-tested.
(34)
			 "Federal poverty level" (FPL) means a measure of income determined annually by
			 the department of health and human services (HHS). The FPL is designed to
			 provide a baseline for determining financial eligibility for federal programs
			 and benefits.
(35) "Good cause"
			 means circumstances that reasonably prevent an individual from cooperating with
			 the administrative agency in the eligibility determination process. Factors
			 relevant to good cause include, but are not limited to, natural disasters,
			 riots or civil unrest, death or serious illness of the individual or a member
			 of his/her immediate family, or the physical, mental, educational, or
			 linguistic limitations of the individual.
(36) "Gross income"
			 means income prior to any deductions or disregards, with the exception of
			 self-employment gross countable income.
(37) "Health Insurance
			 Portability and Accountability Act of 1996" (HIPAA) means a federal law to
			 protect patient privacy, to protect security of electronic medical records, to
			 prescribe methods and formats for exchange of electronic medical information,
			 and to uniformly identify providers.
(38) "Immigrant" means
			 a person who comes to the United States (U.S.) with plans to live in the
			 country permanently. This term includes, but is not limited to, an individual
			 who is a refugee, asylee, parolee, or other entrant regardless of whether he or
			 she is residing in the U.S. legally.
(39) "Income" means
			 cash, in-kind income as defined in paragraph(B)(43) of this rule, or something of value which is
			 received, available, and attributable to an individual. Income includes the
			 receipt of any item which can be applied, either directly or by sale or
			 conversion, to meet the needs of an individual.
(40) "Income and
			 eligibility verification system" (IEVS) means the electronic system that shares
			 income and asset information among the social security administration (SSA),
			 internal revenue service (IRS), state wage information collection agency
			 (SWICA), agencies administering unemployment compensation (UC) benefits, and
			 the administrative agency.
(41) "Individual"
			 means a person applying for or receiving medical assistance.
(42)
			 "Individually identifiable health information" means information that is a
			 subset of health information that includes demographic information collected
			 from an individual and:
(a) Is created or
			 received by a health care provider, health plan, employer, or health care
			 clearinghouse; and
(b) Relates to
			 the past, present, or future physical condition or mental health condition of
			 an individual, the provision of health care to an individual, or the past,
			 present, or future payment for the provision of health care to an individual
			 and either:
(i) Identifies the individual;
			 or
(ii) There is a reasonable basis
			 to believe the information can be used to identify the individual.
(43) "In-kind income"
			 means any benefit received other than cash such as food, shelter, or something
			 that can be used to get food or shelter.
(44)
			 "Institution for mental diseases" (IMD) means a hospital, nursing facility, or
			 other institution of more than sixteen beds which primarily provides diagnosis,
			 treatment, or care of persons with mental diseases, including medical
			 attention, nursing care, and related services.
(a) A facility is an IMD, whether or not it
			 is licensed as such, if it is operated primarily for the care and treatment of
			 individuals with mental diseases.
(b) An institution for persons with cognitive
			 impairments or other developmental disabilities is not an IMD.
(45) "Lawfully
			 residing" means a qualified non-citizen immigration status granted to an
			 individual allowing him or her to live and/or work in the United
			 States.
(46) "Legal custodian"
			 means a person who has legal rights to have physical care and control of a
			 child, as defined in section
			 2151.011 of the Revised
			 Code.
(47) "Legal guardian"
			 means any person, association, or corporation appointed by a probate court to
			 exercise care and management of an individual, his or her estate, or both, as
			 defined in section 2111.01 of the Revised
			 Code.
(48) "Limited English
			 proficiency" (LEP) means the inability of any person or group of persons to
			 speak, read, write, or understand the English language at a level that allows
			 them to meaningfully communicate with the administrative agency.
(49)
			 "Liquid resource" means cash or property immediately convertible to
			 cash.
(50) "Lump-sum" means
			 a non-recurring payment received in a single amount, as opposed to smaller
			 payments over time.
(51) "Managed care
			 organization" (MCO) has the same meaning as in rule
			 5160-26-01 of the Administrative
			 Code.
(52) "Medicaid buy-in
			 for workers with disabilities" (MBIWD) as set forth in rule
			 5160:1-5-03 of the
			 Administrative Code, is a category of medical assistance that enables workers
			 with disabilities to earn income and have resources, not to exceed the limits
			 established by the state, without the risk of losing health care
			 coverage.
(53) "Medicaid
			 eligibility fraud" means an intentional deception or misrepresentation made by
			 a person with the knowledge that the deception could result in an unauthorized
			 benefit to himself, herself, or some other person in accordance with
			 42 C.F.R.
			 455.2 (as in effect October 1,
			 
									2022).
			 It includes any act that constitutes fraud under applicable federal or state
			 law.
(54) "Medicaid
			 household" means a group of individuals, defined in relationship to one
			 specific medical assistance applicant or recipient, who impact the applicant's
			 or recipient's family size, household income, or both.
(55)
			 "Medical assistance" includes all programs administered by the state medicaid
			 administrative agency.
(56) "Medical support"
			 means an order by a court to provide medical coverage.
(57)
			 "Medical verification of pregnancy" means a written statement signed by a
			 licensed medical professional verifying pregnancy and includes the expected
			 date of delivery and, if more than one, the expected number of
			 fetuses.
(58) "Minor child"
			 means a person younger than age eighteen.
(59) "Modified
			 adjusted gross income" (MAGI or MAGI-based income) means the income methodology
			 used for determining medical assistance eligibility for children through age
			 eighteen, parents, caretaker relatives, pregnant women, and adults age nineteen
			 through sixty-four.
(60) "Non-applicant"
			 means a person who is not seeking an eligibility determination for himself or
			 herself but is included in an applicant's or recipient's medicaid household to
			 determine eligibility for such applicant or recipient.
(61)
			 "Non-citizen emergency medical assistance" (NCEMA) as established in rule
			 5160:1-5-06 of the
			 Administrative Code, means time-limited coverage of an emergency medical
			 condition for certain individuals who do not meet the citizenship or
			 satisfactory immigration status requirements.
(62) "Non-cooperation"
			 or "failure to cooperate" means failure by an individual to present required
			 verification, or to explain why it is not possible to present the verification,
			 after being notified the verification was required for eligibility
			 determination.
(63) "Non-excluded
			 income" means income (earned or unearned) that is used in the eligibility
			 determination for medical assistance.
(64) "Outstationing"
			 means the federal requirement as described in
			 42 C.F.R.
			 435.904 (as in effect October 1,
			 
									2022)
			 that administrative agencies provide opportunities for low-income pregnant
			 women and children to apply for medical assistance at locations other than the
			 local county department of job and family services.
(65) "Parent" means a
			 natural, adoptive, or step-parent.
(66) "Personal
			 property" means any property that is not real property, as defined in paragraph
			 (B)(75)) of this rule. Personal property
			 includes, but is not limited to, such things as cash, jewelry, household goods,
			 tools, life insurance policies, automobiles, and promissory notes.
(67)
			 "Postpartum period" means the maximum permitted period of coverage as described
			 in 42 U.S.C.
			 1396a(e) (as in effect
			 October 1, 
									2022).
(68) "Pre-termination
			 review" (PTR) means a review of eligibility criteria completed prior to each
			 discontinuance of medical assistance, to determine whether an individual is
			 eligible for any other category of medical assistance in accordance with
			 42 C.F.R.
			 435.916(f)(1) (as in effect
			 October 1, 
									2022). Home and community-based services (HCBS), as
			 defined in rule
			 5160:1-6-01.1 of the Administrative Code,
			 the specialized recovery services (SRS) program described in rule
			 5160:1-5-07 of the
			 Administrative Code, or both will be explored as part of the PTR process when:
(a) The individual or his or her authorized
			 representative has requested HCBS or SRS; or
(b) The individual's case record contains
			 information indicating that he or she may be eligible for or in need of HCBS or
			 SRS. Receipt of SSI, social security disability insurance (SSDI), or any other
			 income type resulting from an individual's disability is not sufficient, by
			 itself, to demonstrate potential eligibility for or need of HCBS or SRS. There
			 must be additional factors in the case record that indicate the individual's
			 potential eligibility for or need of HCBS or SRS.
(69)
			 "Private child placing agency" (PCPA) means any association that is certified
			 to accept temporary, permanent, or legal custody of children and place the
			 children for foster care or adoption, as defined in rule
			 5101:2-1-01 of the
			 Administrative Code.
(70) "Protected health
			 information" (PHI) means individually identifiable health information that is
			 transmitted by electronic media, maintained in electronic media, or transmitted
			 or maintained in any other form or medium.
(71) "Public children
			 services agency" (PCSA) means an entity that has assumed the powers and duties
			 of the children services function for a county, as defined in rule
			 5101:2-1-01 of the
			 Administrative Code.
(72) "Public
			 institution" means an institution, as defined in
			 42 C.F.R.
			 435.1010 (as in effect October 1,
			 
									2022),
			 that is the responsibility of a governmental unit or over which a governmental
			 unit exercises administrative control, such as a state or federal prison, local
			 jail, detention facility, or other penal setting. Public institution does not
			 include a medical institution, an intermediate care facility, a publicly
			 operated community residence that serves no more than sixteen residents, or a
			 child care institution.
(73) "Qualified
			 entity" means the source of eligibility determinations for the presumptive
			 eligibility program and is limited to the following:
(a) A county department of job and family
			 services (CDJFS); or
(b) A
			 hospital, the Ohio department of rehabilitation and correction (DRC), or the
			 Ohio department of youth services (DYS); or
(c) A federally qualified health center
			 (FQHC) or an FQHC look-alike that meets the requirements described in Chapter
			 5160-28 of the Administrative Code; or
(d) A local health department, a special
			 supplemental nutrition program for women, infants, and children (WIC) clinic,
			 or other entity as designated by the director.
(74)
			 "Recipient" means an individual who has been determined eligible and is
			 currently receiving medical assistance in accordance with
			 42 C.F.R.
			 435 (as in effect October 1,
			 
									2022).
(75) "Real property"
			 means land, including buildings or immovable objects attached permanently to
			 the land.
(76) "Refugee" means a
			 person who flees his or her country due to persecution or a well-founded fear
			 of persecution because of race, religion, nationality, political opinion, or
			 membership in a social group and is admitted to the United States under Section
			 207 of the Immigration and Nationality Act (INA),
			 8 U.S.C.
			 1157 (as in effect October 1,
			 
									2022).
(77) "Redetermination"
			 means acting upon new or changed information received after an individual's
			 eligibility has been determined but prior to the regularly scheduled annual
			 renewal.
(a) The administrative agency shall
			 only redetermine eligibility using the new or changed information. All other
			 factors of eligibility not affected by the new or changed information are
			 presumed unchanged.
(b) The
			 original renewal date is not changed when eligibility has been redetermined,
			 unless the administrative agency has sufficient information regarding all
			 eligibility factors to renew eligibility without requesting additional
			 information from the individual.
(78) "Renew" or
			 "renewal" means a review of eligibility factors to determine whether the
			 individual continues to meet all of the criteria of a medical assistance
			 category. A renewal is performed annually.
(79) "Reporting" means
			 notifying the administrative agency of any changes that may affect an
			 individual's eligibility for medical assistance. Reporting changes and
			 providing verifications is the responsibility of any individual, person, or
			 entity who has a legal or financial responsibility for, or who stands in the
			 place of, an individual, including:
(a) The
			 individual; and
(b) The
			 individual's spouse, including a community spouse; and
(c) The individual's parent, legal custodian,
			 legal guardian, or caretaker relative; and
(d) The individual's authorized
			 representative.
(80) "Residence" means
			 the place the individual considers his or her established or principal home and
			 to which, if absent, he or she intends to return.
(81) "Residential care
			 facility" (RCF) means a home that provides either of the following as described
			 in section 3721.01 of the Revised Code:
(a) Accommodations for seventeen or more
			 unrelated individuals and supervision and personal care services for three or
			 more of those individuals who are dependent on the services of others by reason
			 of age or physical or mental impairment; or
(b) Accommodations for three or more
			 unrelated individuals, supervision and personal care services for at least
			 three of those individuals who are dependent on the services of others by
			 reason of age or physical or mental impairment, and, to at least one of those
			 individuals, any of the skilled nursing care authorized by section
			 3721.011 of the Revised
			 Code.
(82) "Resources" means
			 cash, funds held within a financial institution, investments, personal
			 property, and real property an individual and/or the individual's spouse has an
			 ownership interest in, has the legal ability to access in order to convert to
			 cash, and is not legally prohibited from using for support and
			 maintenance.
(83) "Safeguarding"
			 means security measures taken to ensure that the information of individuals
			 applying for or receiving medical assistance is protected against unauthorized
			 inspection, disclosure, or use. Safeguarding also refers to the restriction on
			 the use, or disclosure, of individual information including federal tax
			 information (FTI), any protected health information (PHI), or other
			 confidential information used in the administration of the medicaid program in
			 accordance with rule
			 5160-1-32 of the Administrative
			 Code.
(84)
			 "Self-attestation" or "self-declaration" means a statement of factual
			 information made by an individual.
(85) "Self-Employment
			 gross countable income" means the income from a business minus the expenses
			 directly related to producing the goods or services, and without which the
			 goods or services could not be produced.
(a)
			 When the individual has filed taxes for the previous year, use all tax forms
			 that were filed with the internal revenue service (IRS) to determine his or her
			 self-employment gross countable income.
(b) When the individual has not filed taxes
			 for the previous year, the following may be used to determine his or her
			 self-employment gross countable income:
(i)
			 Business records including receipts for the costs of doing business;
			 or
(ii) Estimate of anticipated
			 income and expenses.
(86) "Spouse" means a
			 person who is legally married to another under Ohio law.
(87)
			 "State adoption assistance" means the state-only adoption subsidy program as
			 described in rule
			 5101:2-44-03 of the
			 Administrative Code.
(88) "State foster
			 care maintenance" means an entitlement for financial assistance for state-only
			 foster care services as described in Chapter 5101:2-7 of the Administrative
			 Code.
(89) "Support
			 Services" means non-medical services offered or provided by the administrative
			 agency to assist the individual and may include arranging or providing
			 transportation, making medical appointments, accompanying the individual to
			 medical appointments, and making referrals to community and other social
			 services to be coordinated with the individual's medicaid-contracted managed
			 care organization (MCO), where applicable.
(90) "Suspend" or
			 "suspended" means the temporary discontinuance of eligibility.
(91)
			 "Temporary absence" means that an individual is considered not to have changed
			 residence and intends to return.
(a) An
			 individual is considered to be temporarily absent with no time limit when all
			 of the following conditions are met:
(i) The
			 location of the absent individual is known; and
(ii) There is a definite plan for the return
			 of the absent individual to the residence; and
(iii) The absent individual lived in the
			 residence immediately prior to the absence, except for individuals described in
			 paragraph (C)(1)(h) of rule
			 5160:1-4-02 of the
			 Administrative Code.
(b)
			 Child(ren) removed by the PCSA are considered temporarily absent as long as the
			 reunification requirements specified in the reunification plan are
			 met.
(92) "Terminate" or
			 "terminated" has the same meaning as "discontinue" or "discontinuance" as
			 defined in paragraph (B)(16) of this rule.
(93) "Unearned income"
			 means all income that is not earned income as defined in paragraph (B)(19) of
			 this rule.
(94) "United States
			 (U.S.)" and "state(s)" mean all fifty U.S. states, the District of Columbia,
			 and the U.S. territories of American Samoa, Guam, the Northern Mariana Islands,
			 Puerto Rico, Swain's Island, and the U.S. Virgin Islands.
(95)
			 "United States citizen or national" means any individual who is:
(a) A citizen or national through birth or
			 collective naturalization as set forth in 8 U.S.C. Chapter 12, Subchapter III,
			 Part I (as in effect October 1, 
										2022); or
(b) A naturalized citizen or national as set
			 forth in 8 U.S.C. Chapter 12, Subchapter III, Part II (as in effect October 1,
			 
										2022).
(96) "Verification"
			 means a document, statement, electronic validation, or other type of
			 information provided by an individual or by a third party to confirm statements
			 made by the individual regarding any requirement for eligibility for medical
			 assistance. A verification document or written statement may be an original,
			 photocopy, facsimile (fax), or electronic version of the original, unless
			 otherwise stated.