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 1 - Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways › Section 210-RICR-30-00-1.4 - Definitions

Current through June 14, 2024
A. For the purposes of Medicaid MACC and
				  non-MAGI eligibility groups covered under this Part, the following definitions
				  apply:
1. "ACA expansion adults" means the
				  eligibility pathway established by the Federal Patient Protection and
				  Affordable Care Act (ACA), Pub. Law No. 111-148, and by
				  R.I. Gen. Laws Chapter
				  40-8.12, for persons between the
				  ages of nineteen (19) and sixty-four (64) who are not eligible for or enrolled
				  in Medicare and do not qualify for Medicaid in any other eligibility
				  group.
2. "Dependent child" means a
				  child under the age of eighteen (18) or under the age of nineteen (19), if
				  enrolled full-time in school.
3.
				  "Extended Medicaid" means Medicaid eligibility granted to certain individuals
				  who previously qualified for benefits pursuant to §1931 of the Social
				  Security Act,  42 U.S.C. §
												1396u-1, but no longer qualify due to
				  excess income.
4. "Hospital
				  presumptive eligibility" means the temporary and time-limited Medicaid
				  eligibility pathway for persons who meet certain requirements and are receiving
				  care in a hospital pending submission of a complete application.
5. "Managed care organization" or "MCO" means
				  a health plan system that integrates an efficient financing mechanism with
				  quality service delivery and a "medical home" to assure appropriate preventive
				  care and deter unnecessary services.
6. "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.
7. "Rhode
				  Island Code of Regulations" or "RICR" means the compilation of Rules governing
				  the Rhode Island Medicaid program promulgated in accordance with the State's
				  Administrative Procedures Act (R.I. Gen. Laws Chapter
				  42-35).
8. "Medicaid member" means a Medicaid
				  beneficiary enrolled in a managed care plan.
9. "Modified adjusted gross income" or "MAGI"
				  means income, adjusted by any amount excluded from gross income under
				   26 U.S.C. §
												911, and any interest accrued.
10. "Navigator" means a person working for a
				  State-contracted organization that provides certified assisters who have
				  expertise in Medicaid eligibility and enrollment.
11. "Non-citizen" means anyone who is not a
				  U.S. citizen at the time of application including lawfully present immigrants
				  and persons born in other countries who are present in the U.S. without
				  documentation.
12. "Non-MAGI
				  coverage group" means a Medicaid coverage group that is not subject to the
				  modified adjusted gross income eligibility determination. For the purposes of
				  this Part, it includes Medicaid for persons who qualify for Medicaid based on
				  their eligibility for another publicly funded program, including children in
				  the substitute care under the auspices of the DCYF such as current, and some
				  instances, former foster care recipients and anyone receiving Supplemental
				  Security Income (SSI).
13.
				  "Qualified non-citizen" means a person legally present in the United States
				  based on immigration status who, if otherwise eligible for Medicaid, is
				  prohibited or "barred" under Federal law from receiving Medicaid coverage for a
				  period of five (5) years from the date the immigration status was secured from
				  the United States Citizenship and Immigration services (USCIS). Certain
				  qualified non-citizens are exempt from the five (5) year Medicaid
				  ban.
14. "Rhody Health Partners"
				  means the Medicaid managed care delivery system for ACA expansion adults (see
				  Subchapter 05 Part 2 of this Chapter) and adults with disabilities (See Chapter
				  40 of this Title).
15. "RIte Care"
				  means the Medicaid managed care delivery system for eligible families, pregnant
				  people, children up to age nineteen (19), and young adults older than age
				  nineteen (19) (see Subchapter 05 Part 2 of this Chapter).
16. "RIte Share" means the Medicaid premium
				  assistance program for eligible individuals and families who have access to
				  cost-effective commercial health insurance plans coverage.
17. "Section
				  1115 W aiver" means the
				  waiver authorized pursuant to §1115 of the Social
				  Security Act,  42 U.S.C. §
												1315.
18. "Section
				  1931" or "§1931" means §1931 of Title XIX of the
				  Social Security Act,  42 U.S.C. §
												1396u-1.
19. "Self-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.
20. "Title IV-E" means
				  Title IV-E of the Social Security Act,
				   42 U.S.C. §§
												670- 679c.
21. "Title XIX" means Title XIX of the U.S.
				  Social Security Act,  42
				  U.S.C. §§
												1396 - 1396w - 7,
				  that established the Medicaid program and provides the legal basis for
				  providing services and benefits to certain populations in each MACC
				  group.
22. "Title XXI" means Title
				  XXI of the U.S. Social Security Act,
				   42 U.S.C. §§
												1397aa - 1397mm, that
				  established the Children's Health Insurance Program (CHIP) and provides the
				  legal basis for providing services and benefits to certain targeted low-income
				  children and pregnant women through Medicaid.