Revision 23-4; Effective Sept. 22, 2023
The following words and terms, when used in this manual, have the following meanings:
Accessible Resources – Resources legally available to the household.
Adult – A person at least age 18 or a younger person who is or has been married or had the disabilities of minority removed for general purposes.
Aged Person – Someone age 60 or older as of the last day of the month for which benefits are being requested.
Alien Sponsor – A person who signed an affidavit of support (namely, INS Form I-864 or I-864-A) on or after Dec. 19, 1997, agreeing to support an alien as a condition of the alien’s entry into the United States.
Approval Date – The date Form 3077, Notice of Eligibility, is issued to the household.
Assets – All items of monetary value owned by an individual.
Budgeting – The method used to determine eligibility by calculating income and deductions using the best estimate of the household’s current and future circumstances and income.
Claim – CMS-1500, UB-04 or pharmacy statement.
Claim Pay Date – The date the county writes a check to pay a claim.
Client—A person who has been screened and determined to be eligible for the program. The term client and patient may be used interchangeably in other sources.
Common Law Marriage – A relationship in which the parties age 18 or older are free to marry, live together and hold out to the public that they are spouses. A minor child in Texas is not legally allowed to enter a common law marriage unless the claim of common law marriage began before Sept. 1, 1997.
Complete Application – Includes Form 3064, Application for Health Care Assistance, and:
- applicant’s full name and address;
- applicant’s county of residence;
- names of everyone who lives in the house with the applicant and their relationship to the applicant;
- type and value of the CIHCP household’s resources;
- CIHCP household’s monthly gross income;
- information about any health care assistance that household members may receive;
- applicant’s Social Security number, if available;
- applicant’s and spouse’s signatures with the date Form 3064 is signed; and
- all needed information, such as verifications.
The date that Form 3064 and all information necessary to make an eligibility determination is received is the application completion date.
Confidentiality—The state of keeping information private and not sharing it without permission.
County – A county not fully served by a public facility, namely a public hospital or hospital district; or a county that provides indigent health care services to its eligible residents through a hospital established by a board of managers jointly approved by a county and a municipality.
Days – All calendar days, except as specifically identified as workdays.
Denial Date – The date Form 3082, Notice of Ineligibility, is issued to the household.
Disqualified Member – A person receiving, or categorically eligible to receive, Medicaid.
Earned Income – Income a person receives for a certain degree of activity or work. Earned income is related to employment and, therefore, entitles the person to work-related deductions not allowed for unearned income.
Eligibility Date—Date the program administrator determines a person becomes eligible for the program.
Emancipated Minor – A person under age 18 who has been married. The marriage must not have been annulled.
Equity – The amount of money that would be available to the owner after the sale of a resource. Determine this amount by subtracting from the fair market value any money owed on the item and the costs normally associated with the sale and transfer of the item.
Family Planning Services—Educational or comprehensive medical activities that enable clients to freely determine the number and spacing of their children and select how this may be achieved.
Federal Poverty Level (FPL)— The set minimum amount of income that a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies according to family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.
Fiscal Year— The state fiscal year is from Sept. 1 through Aug. 31.
Expenditure – Funds spent on basic or department-established optional health care services.
Expenditure Tracking – A county should track monthly basic and department-established optional health care expenditures.
Fair Market Value – The amount a resource would bring if sold on the current local market.
General Revenue Tax Levy (GRTL) – Used by the county to determine eligibility for state assistance funds. For information on determining and reporting the GRTL, contact the Property Tax Division of the Texas State Comptroller of Public Accounts at 512-475-1826.
Governmental Entity – A county, municipality or other political subdivision of the state, excluding a hospital authority.
Gross Income – Income before deductions.
Health and Human Services Commission – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.
Hospital Authority – Created under Article 4437E, Section 3, City Created Hospital Authorities or Article 4494R, Section 3, County Created Hospital Authorities, a hospital authority has no obligation under Chapter 61, Health and Safety Code, to provide indigent health care assistance.
Hospital District – Created under the authority of the Texas Constitution, Article IX, Sections 4 – 11.
Identifiable Application – An application is identifiable if it includes the applicant’s name, applicant’s address, applicant’s signature and the date the applicant signed the application.
Inaccessible Resources – Resources not legally available to the household. Examples include, but are not limited to irrevocable trust funds, property in probate, security deposits on rental property and utilities.
Managing Conservator – A person designated by a court to have daily responsibility for a child.
Mandated Provider – A health care provider, selected by the county, who agrees to provide health care services to eligible residents.
Married Minor – An individual, age 14-17, who is married. These individuals must have parental consent or court permission. An individual under age 18 may not be a party to an informal (common law) marriage.
Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section 1396, et seq. Reimburses for health care services delivered to low-income clients who meet eligibility guidelines.
Minor— In accordance with the Texas Family Code, a person under 18 years old who is not and has not been married or who has not had the disabilities of minority removed for general purposes (i.e., emancipated). In this policy manual, “minor” and “child” may be used interchangeably.
Minor Child – A person under age 18 who is not, or has not been, married and has not had the disabilities of minority removed for general purposes.
Net Income – Gross income minus allowable deductions.
Optional Services – Department-established optional health care services that a county may choose to provide.
Person with Disabilities – Someone who is physically or mentally unfit for employment.
Personal Possessions – Appliances, clothing, farm equipment, furniture, jewelry, livestock and other items if the household uses them to meet personal needs essential for daily living.
Public Facility – A public hospital or a hospital owned, operated or leased by a hospital district.
Public Hospital – A hospital owned, operated or leased by a county, city, town or other political subdivision of the state, excluding a hospital district and a hospital authority. For additional information, refer to Chapter 61, Health and Safety Code, Subchapter C.
Real Property – Land and any improvements on it.
Reimbursement – Repayment for a specific item or service.
Referral – The process of directing or redirecting (as a medical case or a person) to an appropriate specialist or agency for information, help or treatment.
Reimbursement Expenditure – A health care expenditure that may be applied to state assistance funds eligibility/reimbursement and that is for a service provided to a person who is eligible under a monthly net income standard that is at least 21% of the Federal Poverty Level (FPL) or up to 50% of the FPL. For additional information, refer to Section 5, State Assistance Funds.
Relative – A person who has one of the following relationships biologically or by adoption:
- mother or father;
- child, grandchild or stepchild;
- grandmother or grandfather;
- sister or brother;
- aunt or uncle;
- niece or nephew;
- first cousin;
- first cousin once removed; and
- stepmother or stepfather.
Relationship also extends to:
- the spouse of the relatives listed above, even after the marriage is terminated by death or divorce;
- the degree of great-great aunt or uncle, and niece or nephew; and
- the degree of great-great-great grandmother or grandfather.
Resident – An individual who resides within the geographic boundaries of the state of Texas.
Resources – Both liquid and non-liquid assets a person can convert to meet their needs. Examples include, but are not limited to bank accounts, boats, bonds, campers, cash, certificates of deposit, gas rights, livestock (unless the livestock is used to meet personal needs essential for daily living), mineral rights, notes, oil rights, real estate (including buildings and land, other than a homestead), stocks and vehicles.
Service Area – The geographic region in which a governmental entity, public hospital or hospital district has a legal obligation to provide health care services.
Sponsored Alien – A person who has been lawfully admitted to the United States for permanent residence under the Immigration and Nationality Act (8 U.S.C. Section 1101 et seq.) and who, as a condition of admission, was sponsored by a person who executed an affidavit of support on behalf of the person.
Tip Income – Income earned in addition to wages that is paid by patrons to people employed in service-related occupations, such as beauticians, waiters, valets, pizza delivery staff, etc.
Unearned Income – Payments received without performing work-related activities.