Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults › Subchapter 00 - Affordable Coverage Groups › Part 5 - Medicaid MAGI Financial Eligibility Determinations and Verification › Section 210-RICR-30-00-5.2 - Definitions

Current through June 14, 2024
A. As used herein, the following terms shall
				  be defined as follows:
1. "Affordable Care
				  Act" or "ACA" means the federal Patient Protection and Affordable Care Act of
				  2010.
2. "Attestation" means the
				  act of a person affirming through an electronic or written signature that the
				  statements the person made when applying for Medicaid eligibility are truthful
				  and correct.
3. "Caretaker" or
				  "Caretaker relative" means any adult living with a Medicaid-eligible dependent
				  child that has assumed primary responsibility for that child as defined in Part
				  1 of this Subchapter.
4. "Custodial
				  parent" means a relationship that is defined by a court order or binding
				  separation, divorce or custody agreement establishing physical custody of a
				  minor child. If no order or agreement exists, or in the event of a shared
				  custody agreement, the custodial parent is the parent with whom the child
				  spends most nights.
5. "Federal
				  poverty level" or "FPL", as used herein, means the most recently published
				  federal poverty level by the U.S. Department of Health and Human
				  Services.
6. "Federal data hub" or
				  "Data hub" means the database of the United States population built by the U.S.
				  Internal Revenue Service (IRS) and Health and Human Services (HHS) used to
				  facilitate determinations for coverage, including Medicaid, under the
				  ACA.
7. "Health Source RI" means
				  the entity that allows persons, families, and small businesses to access
				  insurance, as well as federal subsidies to assist in the payment of that
				  coverage.
8. "Household
				  composition" means, for the purposes of determining MAGI eligibility, the
				  person(s) filing taxes, whether jointly or separately, and anyone included as a
				  tax dependent of the person(s) filing taxes. Special relationship rules for
				  household composition may apply when the person filing taxes is not the
				  custodial parent of the tax dependent.
9. "MAGI" means modified adjusted gross
				  income, adjusted by any amount excluded from gross income under
				   26 U.S.C. §
												36B  of the IRS Code, and any
				  interest accrued.
10. "Medicaid
				  Affordable Care Coverage Group" or "MACC" means a classification of persons
				  eligible to receive Medicaid based on similar characteristics who are subject
				  to the MAGI standard for determining income eligibility.
11. "Non-MAGI coverage group" means a
				  Medicaid coverage group that is not subject to the modified adjusted gross
				  income standard for eligibility determination.
12. "Reasonable compatibility" means an
				  allowable difference or discrepancy between the information provided in the
				  application and the information reported by an electronic data
				  source.
13. "Reconciliation" means
				  the point in the verification process when discrepancies between an applicant's
				  attestation and information from data sources are resolved.