TERM | DEFINITION |
ABD DEFINITION | “ABD” is the short name used to refer to aged, blind or disabled individuals. |
AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC) | AFDC is the short name of the former Aid to Families with Dependent Children cash assistance program. It was a federally funded assistance program under Title IV-A of the Social Security Act. In Virginia, AFDC was replaced by TANF (Temporary Assistance to Needy Families) on February 1, 1997. |
AUXILIARY GRANTS (AG) | “AG” is the short name for the Auxiliary Grants Program. AG is Virginia’s assistance program that supplements the federal Supplemental Security Income (SSI) assistance program. AG is Virginia’s “State Supplementation of SSI.” AG is available only to ABD financially eligible individuals who reside in licensed Adult Care Residences (ACRs). |
BLIND | Blindness is defined by using one of two criteria. The first criteria indicates that blindness is defined as having best corrected central visual acuity of 20/200 or less in the better eye. The second criteria indicates that blindness is defined as the contraction of the visual field in the better eye with the widest diameter subtending an angle around the point of fixation no greater than 20 degrees. |
CARETAKER-RELATIVE | A “caretaker-relative” is an individual who is not a parent, but who • is a relative, of a specified degree, of a dependent child (as defined in M0310.111) and • is living with and assuming continuous responsibility for day-to-day care of the dependent child (as defined in M0310.111) in a place of residence maintained as his or their own home. |
CATEGORICALLY NEEDY (CN) | “CN” is the short name for “categorically needy.” The CN covered groups include both the mandatory categorically needy groups listed in the federal Medicaid regulations as well as the optional groups Virginia has chosen to cover in the Medicaid State Plan. |
CHILD (when modified adjusted gross income (MAGI) applies) | a. Tax-filer Household A child is an individual of any age who is claimed as a tax dependent by a biological or adopted parent or stepparent. b. Non-filer Household A child is an individual under 19. |
CHILD (when does not-MAGI apply), | A child is · an individual under age 21 who has not been legally emancipated from his/her parent(s). · A married individual under age 21 is a child unless he/she has been legally emancipated from his/her parents by a court. · Marriage of a child does not emancipate a child from his/her parents and does not relieve the parents of their legal responsibility to support the child. |
DEPENDENT CHILD | A child who is: · under the age of 18, OR • under the age of 19 and is a full-time student in a secondary school or in the equivalent level of vocational or technical training, or in a General Educational Development (GED) program IF he may be reasonably expected to complete the secondary school, training or program before or in the month he attains age 19; AND • living in the home of a parent or a caretaker-relative of the first, second, third, fourth or fifth degree of relationship in a place of residence maintained by one or more of such relatives as his or their own home. |
DISABLED 18 AND OLDER | For an individual 18 or older, the Social Security Adm. (SSA) defines “being disabled” as an individual’s inability to do any substantial gainful activity (SGA) or work because of a severe, medically determinable physical or mental impairment or combination of impairments. This impairment(s) has lasted or is expected to last for a continuous period of not less than 12 months, or the impairment is expected to result in death. |
DISABLED UNDER 18 | For a child under 18, the SSA defines “being disabled” as having a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations. These limitations must have lasted or be expected to last for a period of not less than 12 continuous months, or the impairment is expected to result in death. However, a child cannot be found disabled if, at application, the child is performing Substantial Gainful Activity (SGA) and is not currently entitled to Supplemental Security Income (SSI) benefits. |
FAMILIES & CHILDREN (F&C) | “Families & Children (F&C)” is the group of individuals that consists of • children under 19, • pregnant women, • specified subgroups of children under age 21, • Former Foster Care Children under age 26 and • parent/caretakers of dependent children under age 18. Also included in the F&C groups are individuals eligible only for family planning services (Plan First) and participants in BCCPTA. |
FOSTER CARE | 24-hour substitute care for children placed away from their parents or guardians and for whom the State agency has placement and care responsibility” (45 C.F.R. §1355.20). |
HOSPICE | Hospice” is a covered group of terminally ill individuals whose life expectancy is 6 months or less and who have voluntarily elected to receive hospice care. The term “hospice” is also used to refer to the covered service for a terminally ill Medicaid recipient, regardless of his covered group. Hospice services can be provided in the individual’s home or in a medical facility, including a nursing facility. |
INSTITUTION | An institution is an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more people unrelated to the proprietor. |
LOW INCOME FAMILIES WITH CHILDREN (LIFC)
| Low Income Families with Children (LIFC) is a covered group of individuals in families who have a dependent child(ren) living in the home, and whose income is within the Medicaid F&C income limits. |
MEDICALLY NEEDY (MN) | An MN is one who has enough income and resources to meet his maintenance needs, but not enough to meet his medical needs. MN individuals whose income exceeds the MN income limit may be placed on a spenddown (SD) and establish eligibility when medical and/or remedial expenses equal or exceed the SD amount. |
MEDICARE BENEFICIARY | A Medicare beneficiary is an individual who is entitled to Medicare (Title XVIII of the Social Security Act). Medicare is a federally funded and administered health insurance program and consists of hospital insurance (Part A), medical insurance (Part B) and prescription drug coverage (Part D). |
PARENT | Either the mother or the father, married or unmarried, natural or adoptive following entry of the interlocutory or final adoption order, whichever comes first. |
PREGNANT WOMAN | A woman of any age who attests that she is pregnant meets the definition of a pregnant woman. |
QUALIFIED DISABLED & WORKING INDIVIDUALS (QDWI)
| QDWI is the short name for Medicare beneficiaries who are “Qualified Disabled and Working Individuals • who is entitled to enroll for Medicare Part A, • whose resources do not exceed twice the maximum number of resources that an individual or couple may have and be eligible for SSI, • whose income does not exceed 200% of the federal poverty limit, • who is NOT otherwise eligible for Medicaid. |
QUALIFIED INDIVIDUALS (QI)
| QI is the short name used to designate A qualified individual • who is entitled to Medicare Part A, • who has resources that are within the resource limits for the Medicare Savings Programs (MSPs). • whose income is equal to or more than 120% of the federal poverty level (FPL) · and is less than 135% FPL. |
QUALIFIED MEDICARE BENEFICIARY (QMB) | QMB is the short name used to designate a qualified Medicare beneficiary and means an individual • who is entitled to enroll for Medicare Part A, • who has resources that are within the resource limits for the Medicare Savings Programs (MSPs). • whose income does not exceed 100% of the FPL. |
RETIREMENT, SURVIVORS & DISABILITY INSURANCE (RSDI) | Retirement, Survivors & Disability Insurance (RSDI) is another name for Old Age, Survivors & Disability Insurance (OASDI) – the federal insurance benefit program under Title II of the Social Security Act that provides cash benefits to workers and their families when the workers retire, become disabled or die. |
SPECIAL LOW-INCOME MEDICARE BENEFICIARY (SLMB) | SLMB is the short name used to designate a special low-income Medicare beneficiary and is an individual • who is entitled to enroll for Medicare Part A, • who has resources that are within the resource limits for the Medicare Savings Programs (MSPs). and • whose income exceeds the QMB income limit (100% of the FPL) but does NOT exceed the higher SLMB income limit, which is 120% of the FPL. |
SUPPLEMENTAL SECURITY INCOME (SSI) | Supplemental Security Income (SSI) is the federal cash assistance benefit program under Title XVI of the Social Security Act that provides cash assistance to eligible aged, blind or disabled individuals to meet their shelter, food and clothing needs. |
STATE PLAN | The State Plan for Medical Assistance is a comprehensive written statement submitted by the Department of Medical Assistance Services (DMAS) describing the nature and scope of Virginia’s Medicaid program. It contains all the information necessary for the federal Centers for Medicare and Medicaid Services (CMS) to determine whether the state plan can be approved for federal financial participation (FFP) in the state’s Medicaid program expenses. |
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) | TANF is the federally-funded (with matching funds from the states) block grant program in Title IV Part A of the Social Security Act that provides temporary cash assistance to needy families. In Virginia, TANF replaced the previous Title IV-A program called Aid to Families With Dependent Children (AFDC). |
BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT (BCCPTA) | The BCCPTA created a Medicaid covered group for women and men age 18 through 64 who have been identified by the Centers for Disease Control and Prevention’s (CDC) Breast and Cervical Cancer Early Detection Program (BCCEDP) as being in need of treatment for breast or cervical cancer. |
VIRGINIA INITIATIVE FOR EMPLOYMENT NOT WELFARE (VIEW) PARTICIPANTS | A VIEW participant is an individual who has signed the TANF Agreement of Personal Responsibility. For renewals completed and changes reported prior to April 1, 2014, VIEW participants have a higher earned income limit than non-VIEW participants. An individual under a TANF VIEW sanction is a VIEW participant for Medicaid purposes. An individual only receiving TANF transitional support services is not a VIEW participant for Medicaid purposes. |
HEALTH INSURANCE PREMIUM PAYMENT (HIPP) PROGRAM | HIPP is a cost savings program administered by the DMAS for Medicaid enrollees which reimburses some or all of the employee portion of group health insurance premiums. HIPP is available to Medicaid enrollees when a family member is employed at least 30 hours per week and is enrolled in an employer’s group health plan. Eligibility for HIPP is determined by the HIPP Unit at DMAS. Participation in HIPP is voluntary. |
MAGI ADULT | A MAGI Adult is a person who is not defined as a “child” and covers individuals ages 19-64 who are not eligible for or enrolled in Medicare and who have income at or below 138% of FPL. Several new aid categories have been added for the MAGI Adults covered group. · Childless adults, income less than 100% FPL; • Childless adults, income less than 138% FPL (133% + 5% income disregard); • Parent/Caretaker adult relatives, above current LIFC income limit and at or below 100% FPL; • Parent/Caretaker adult relatives, above 100% FPL and at or below 138% FPL (133% + 5% income disregard); • Presumptive eligible adult, income at or below 138% FPL (133% + 5% income disregard); • Incarcerated adult who otherwise meet a Medicaid MAGI Adult aid category but not enrolled due to incarceration. |
