Revision 23-4; Effective Dec. 1, 2023
Account holder (owner) — Person who establishes an account for the purpose of paying for the beneficiary’s qualified higher education expenses at an eligible educational institution. Any person, including the designated beneficiary, can contribute to an educational savings account. Organizations, such as corporations and trusts, also can contribute to a tuition savings account.
Account transfer — The way in which an applicant’s information moves between the Marketplace and the Texas Health and Human Services Commission (HHSC) when applying for medical assistance. The account transfer from the Marketplace to HHSC and from HHSC to the Marketplace will include most of the information the applicant submitted through the Marketplace application and HHSC applications, along with information on any verifications performed by either the Marketplace or HHSC.
Admission Stamp — The U.S. Department of Homeland Security (DHS) places the admission stamp on the alien’s passport, on the alien’s machine-readable immigrant visa (MRIV) or on an I-94. The stamp shows:
- “Department of Homeland Security U.S. Customs and Border Protection”;
- information about the DHS Customs and Border Protection (CBP) field office with jurisdiction over the port of entry;
- information about the alien's port of entry and date of admission; and
- a four-digit stamp identification number.
The alien's class of admission and the validity date (that is, the date admitted until) are endorsed in ink by the admitting inspector.
Advanced authentication — Personal security questions generated by third-party software to perform authentication of an applicant's identity before granting the person an account through the Self-Service Portal with Case Visibility.
Adverse action — A termination, suspension or reduction of Medicaid eligibility or covered services.
Alien — A person who is not a citizen or national of the U.S.
Alien Category — A category based on the date of the alien status (date of entry) and the alien’s classification.
Alien Classification — A classification code on the I-94 or I-551 that identifies the terms and conditions of the person’s admission to the U.S.
Alien Sponsor — A person who signed an affidavit of support (USCIS Form I-864 or Form I-864-A) on or after Dec. 19, 1997, agreeing to support an alien as a condition of the alien's entry into the U.S.
- Note: Not all aliens must obtain a sponsor before being admitted into the U.S.
Annual review — The process of redetermining a person's continued eligibility for Medicaid.
Appeal — A request for a review of an action or failure to act by HHSC that may result in a fair hearing.
Applicant — A person seeking benefits under MEPD who is not currently receiving MEPD services.
Application for assistance — A form prescribed by HHSC that a person uses to apply for MEPD or to have MEPD eligibility redetermined.
Application Visibility — Type of Self-Service Portal account given to an applicant who has selected not to go through advanced authentication. Those with Application Visibility accounts may only apply for benefits and view and modify applications created under their user name.
Assets — All items a person owns that have monetary value. Assets include both income and resources.
Asylee — An alien already in the U.S. or at a port of entry who is granted asylum in the U.S. Asylum may be granted to non-citizens who are unable or unwilling to return to their countries of nationality, or to seek the protection of those countries, because of persecution or a well-founded fear of persecution.
Authorized representative — For medical programs, a person who is familiar with the applicant and knowledgeable of the applicant’s financial affairs and designated by the applicant or recipient to:
- sign an application on the applicant’s behalf;
- complete and submit a renewal form;
- receive copies of the applicant’s or recipient’s notices and other communications from the agency; and
- act on behalf of the applicant or recipient in all other matters with the agency.
Automobile — Includes, passenger cars and other vehicles used to provide necessary transportation.
BCIS — Bureau of Citizenship and Immigration Services
BENDEX — Beneficiary Data Exchange. Computer tape from the Social Security Administration giving Retirement, Survivors, and Disability Insurance (RSDI) and Medicare information about HHSC's applicants and recipients.
Beneficiary — A designated individual (student or future student) whose qualified higher education expenses are expected to be paid for from a tuition savings program. The designated beneficiary can be changed to another member of the account.
Benefits office — A local HHSC office.
Blind — A person who meets SSI program requirements for blindness, as defined in 42 U.S.C. §1382c(a)(2).
Bona Fide Agent — A person acting responsibly on behalf of a deceased applicant, who is familiar with the applicant, has knowledge of the applicant's financial affairs, and who can, under penalty of perjury, provide information required for an eligibility determination.
Brother — See definition of sibling.
Budget group — A group consisting of members of the family unit whose income is countable in the eligibility determination.
Budgeting — The process of determining a person's financial eligibility for MEPD or for calculating a co-payment.
Burial space — A burial plot, grave site, crypt, mausoleum, urn, casket, niche or other repository customarily and traditionally used for a deceased person's bodily remains. The term also includes necessary and reasonable improvements or additions to these spaces, including vaults, headstones, markers or plaques; burial containers; arrangements for opening and closing the grave site; and contracts for care and maintenance of the grave site. Contracts for care and maintenance are sometimes referred to as endowments or perpetual care.
Business day — Monday through Friday from 8 a.m. to 5 p.m. local time. Business day excludes Saturday, Sunday, and federal, state, or agency-designated holidays.
CAS — Community Attendant Services.
Case Visibility — Type of YourTexasBenefits.com account access given to an applicant who has been through advanced authentication and therefore granted a Case Visibility level account. With this type of access, people can view and modify an application created under their username and any case data for cases where they are the head of household, an adult member within the household or an authorized representative.
Certification — HHSC's official authorization of approved eligibility.
Child — An unmarried person under 19.
CFR — Code of Federal Regulations.
COLA — Cost of living adjustment.
Common Law Marriage — Relationship where the parties 18 or older:
- are free to marry;
- live together; and
- hold out to the public that they are married.
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.
Note: Same-sex common law marriages are considered valid effective June 26, 2015.
Community Spouse — The spouse of an institutionalized recipient or applicant who is not living in a setting that provides medical care and services.
Compacts of Free Association (COFA) — Agreements or treaties between the United States and the Republic of the Marshall Islands (RMI), the Federated States of Micronesia (FSM) and the Republic of Palau (PAL) which allow citizens of those nations to live and legally work in the U.S. without a visa.
Compact of Free Association Citizen — A permanent nonimmigrant who is living in the U.S. under the provisions of the Compact of Free Association Act of 1985. Under this act, citizens of the Republic of the Marshall Islands (RMI), the Federated States of Micronesia (FSM) and the Republic of Palau (PAL) may enter, live and work in the U.S. without restriction.
Conditional Resident Alien — An alien granted a two-year period of permanent resident status based on a “qualifying” marriage to a U.S. citizen or national, or to a permanent resident alien. A conditional resident alien has the same immigration documents as a lawful permanent resident (LPR), except the I-551 expires after two years instead of 10 years.
Co-payment — The amount of personal income a person must pay toward the cost of their care. Co-payment was formerly known as applied income.
Cost-share — The amount a person pays out of their own pocket for health care.
Cost-share Limit Amount — The total amount a family must pay out of its own pocket for the applicant's or recipient's medical care. This amount can change if there is an income change.
Cost-share Period — A time for tracking the cost-share limit. It begins the first day of the disposition month. This period is 12 months and reset every 12 months.
Countable Income — The amount of a person's income that is not exempt or excluded.
Countable Resource — A resource owned by and accessible to a person that is not exempt or excluded.
Coverage Group — A set of people who are eligible for MEPD under the Texas State Plan for Medical Assistance because they meet the federal definition of categorically needy.
Current Market Value — The amount of money an item would bring if sold in the current local market.
Cutoff — The monthly system deadline for making changes in eligibility effective the next calendar month. Cutoff dates are different each month.
DAC — Disabled adult child.
Date of application — The date when HHSC receives an application for assistance or when an application for SSI is filed with the Social Security Administration. If an application for assistance is received after the close of business, the date of application is the next working day. See B-4000, Date of Application.
DDU — Disability Determination Unit.
Deeming — Counting all or part of the income or resources of another person (for example, a parent or spouse) as income or resources available to an applicant or recipient.
DHS — U.S. Department of Homeland Security. Effective March 1, 2003, DHS absorbed the Immigration and Naturalization Service (INS).
DIC — Dependency and Indemnity Compensation.
Disabled — A person who meets SSI program requirements as defined in 42 U.S.C. §1382c(a)(3).
DRA — Deficit Reduction Act of 2005.
Earned income — Income a person receives for services performed as an employee or from self-employment.
Earned income tax credit (EITC) — A special tax credit that reduces the federal tax liability of certain low-income working taxpayers.
Eligible sibling — A sibling who is eligible for regular Medicaid. See definition of sibling.
Eligibility determination — A decision made by HHSC concerning a person's initial eligibility for MEPD. This term does not include any functional or other assessment required for some MEPD services, unless the context clearly indicates otherwise.
Eligible educational institution — Generally any college, university, vocational school or other postsecondary educational institution eligible to participate in a student aid program administered by the Department of Education.
Eligibility redetermination — A decision made by HHSC concerning a person's continued eligibility for MEPD. This term does not include any functional or other assessment required for some MEPD services, unless the context clearly indicates otherwise.
Enhanced Life Estate Deeds — A legal document (sometimes known as a Lady Bird Deed) in which one transfers property to their heirs while at the same time retaining a life estate with powers including the right to sell the property in their lifetime.
Since the life estate holder retains the power to sell the property, its value as a resource is its full equity value. If you see a document that appears to transfer property to heirs while retaining a life estate with powers, contact the regional attorney to determine the value of any transfer. The full value of the asset is treated as a countable resource to the individual, unless it is a resource that is otherwise excluded, such as a home to which the individual intends to return.
All Enhanced Life Estate Deeds must be reviewed by the regional attorney.
Equity value — The value of a resource based on its fair market value or current market value minus all money owed on the resources and, if sold, any costs usually associated with the sale.
ESI — Employer-sponsored health insurance. This is health insurance someone gets through their job.
Excluded — Income or resources not counted for the purpose of determining eligibility only.
Exempt — Income or resources not counted for the purpose of determining eligibility or calculating a co-payment.
Fair hearing — An informal proceeding held before an impartial hearings officer where a person or the person's representative appeals an action taken on the person's case.
Fair market value (FMV) — The current market value of a resource at the time of its sale or transfer.
Family member — An applicant's or recipient's spouse, minor child, adult child, stepchild, adopted child, brother, sister, parent or adoptive parent. A spouse of the applicant's or recipient's minor child, adult child, stepchild, adopted child, brother, sister, parent or adoptive parent.
Family unit — A unit consisting of an applicant or recipient and the applicant's or recipient's parents and siblings who live in the same household as the applicant or recipient.
FBR — Federal benefit rate.
Federal poverty level (FPL) — A guideline for a household’s yearly income used to determine eligibility for certain benefit programs. It is published each year by the U.S. Department of Health and Human Services.
FFP — Federal financial participation.
Fiduciary agent — A person or organization acting on behalf of or with the authorization of another person under circumstances that involve a high degree of confidence, good faith and honesty. The term applies to anyone who acts in a financial capacity, whether formal or informal, regardless of title, such as representative payee, guardian or conservator.
Financial Duress — Not having enough funds to meet living expenses because of debts incurred for medical expenses for the institutionalized spouse, community-based spouse or dependent, or because of replacement of a resource lost through theft or acts of God.
Foreign-born Alien — A person born outside the 50 states, District of Columbia, American Samoa, Swains Island, Guam, Northern Mariana Islands, Puerto Rico or the U.S. Virgin Islands.
Fraud — Deliberate misrepresentation or willful withholding of information for the purpose of obtaining public assistance, either for self or another person.
Good Cause — A term used to indicate that a person has an acceptable reason for not complying with a program requirement.
Green Card — A vernacular term for the Alien Registration Receipt Card (I-551, I-151, AR-3 or AR-3a). The current version of the card is not green.
Health Insurance Premium Payment Program (HIPP) — A Medicaid program that pays for the cost of medical premiums. The program reimburses recipients or employers for private health insurance payments for Medicaid-eligible persons when it is cost-effective to do so.
HHSC — The Texas Health and Human Services Commission.
HIPAA — Health Insurance Portability and Accountability Act.
Home — A structure in which a person lives (including a mobile home, a houseboat and a motor home), other buildings on the home property and all adjacent land (including land separated by a road, river or stream) in which the person has an ownership interest and that serves as his or her principal place of residence.
Home and Community-Based Services waiver program — A home or community-based service authorized for use in Texas by the Centers for Medicare and Medicaid Services in accordance with Sections §1115 and §1915 of the Social Security Act.
Illegal Alien (undocumented alien) — A foreign national who entered the U.S. without inspection or with fraudulent documentation or who, after entering legally as a nonimmigrant, violated status and remained in the U.S. without authorization.
Immigrant — A person who abandons residence in a foreign country to live in the U.S as a permanent resident. A lawful permanent resident (LPR) is an example.
Immigrant Visa — A document on security paper, issued by a U.S. consul abroad, that permits a foreign national to apply to DHS for admission into the U.S. as a permanent resident.
Immigration and Naturalization Service (INS) — On March 1, 2003, the former Immigration and Naturalization Service officially became the Bureau of Citizenship and Immigration Services (BCIS), operating under the Department of Homeland Security.
Immigration Reform and Control Act (IRCA) — IRCA of 1986. This is public law (P.L. 99-603) that amended and repealed certain sections of the INA. The IRCA provides for the legalization of certain illegal aliens and updates the registry date that allows DHS to process certain illegal aliens differently.
Immigration Status — The legal status conferred on an alien by immigration laws.
INA — Immigration and Nationality Act.
Income Eligibility Verification System (IEVS) — Computer tape matches required by federal law.
Income — Any item a person receives in cash or in-kind that can be used to meet their need for food or shelter. For purposes of determining MEPD financial eligibility, income includes the receipt of any item that can be applied, either directly or by sale or conversion, to meet the basic needs of food or shelter.
Ineligible sibling — A sibling who is not eligible for regular Medicaid. See definition of sibling.
Inheritance — Cash, other liquid resources, noncash items, or any right in real or personal property received as the result of someone's death. A person may not have access to their inheritance pending legal action or the discovery of the inheritance.
Initial eligibility period — The time from a person's certification date to the person's first annual review.
In-kind — Consisting of something such as food, shelter or replacement of a resource that is not cash.
Institution for mental diseases (IMD) — A hospital, nursing facility or other institutional setting of more than 16 beds. It is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. An IMD includes a state mental health facility operated by the Texas Department of State Health Services.
Institutional care — Long-term nursing care, treatment or services received in a Medicaid-certified long-term care facility.
Institutional setting — A living arrangement in which a person applying for or receiving Medicaid lives in a Medicaid-certified long-term care facility or receives services under a Home and Community-Based Services waiver program. Formerly known as a vendor living arrangement.
Insurance — The following terms apply to the definition of insurance:
- "The insured" means the person named in a life insurance policy whose death affects the proceeds and distribution of the policy.
- "The beneficiary" means the person or entity named in a contract to receive the proceeds of the policy upon the death of the insured.
- "The owner" means the person with the right to change the policy as the person sees fit. The owner is the only person who can receive the cash surrender value of the policy.
- "The insurer" is the company that contracts with the owner.
- "Cash surrender value" means the amount that the insurer pays the owner if the policy is cancelled before death or before it has matured. The cash surrender value usually increases with the age of the policy.
- A "participating life insurance policy" is one in which dividends are distributed to the policyholder.
- "Term life insurance" means life insurance that has no cash, loan or dividend value, nor the potential for cash, loan or dividend value.
- "Dividend" means a share of surplus funds allocated to the policyholders of a participating insurance policy. A dividend generally represents a previous overpayment of premiums.
Intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) — A Medicaid-certified facility that provides care in a 24-hour specialized residential setting for people with an intellectual disability or related condition. An ICF/IID includes a state supported living center and a state center.
Inter vivos trust — A trust established while the person creating the trust is still living.
LAPR — Lawfully admitted for permanent residence.
Lawfully Admitted but Not for Permanent Residence — An alien (non-citizen) who is lawfully admitted to the U.S. but not a permanent resident.
Lawful Permanent Resident (LPR) — An alien (non-citizen) who is lawfully authorized to live permanently within the United States.
Note: The Immigration Act of 1990 also grants permanent resident status to alien entrepreneurs who enter the U.S. to engage in a new commercial enterprise and meet certain criteria for investment. These persons must apply for termination of conditional status or the LPR status terminates.
Level of care (LOC) — The type of care required by a Medicaid applicant or recipient based on an assessment of the person's need for care.
Level of care determination — An assessment to determine the appropriate level of care required based on a person’s medical or related needs.
Life estate — A right to real property conferred in a legal instrument on a person who is a beneficiary. The right is conferred for the duration of the beneficiary's lifetime or the lifetime of another person. The beneficiary usually has the right to possess, use, and receive profits from the real property during his or her possession.
Liquid resource — Cash or other property that can be converted to cash within 20 working days.
Long-term care facility — A nursing facility, ICF/IID or IMD where medical services are provided.
Look-back period — The time-period HHSC uses to determine if a person transferred, gave away, disposed of or otherwise reduced their countable resources and income without receiving equal value in return and with the intent to qualify for MEPD.
MAGI — Modified Adjusted Gross Income. The rules used to determine financial eligibility for certain medical programs. These rules are based on Internal Revenue Service tax rules.
Marketplace — The governmental entity that makes qualified health plans available to qualified individuals and/or qualified employers. The Marketplace in Texas is operated by the United States Department of Health and Human Services. Also known as the Exchange, Health Insurance Marketplace, and Federally Facilitated Marketplace (FFM).
Marriage — A legal union between two people recognized under federal law.
Note: Same-sex marriages that occurred before June 26, 2015, are considered valid effective June 26, 2015, and same-sex marriages that occurred on or after June 26, 2015, are considered valid on the date they occurred.
MAO — Medical assistance only.
Medicaid — A state and federal cooperative program, authorized under Title XIX of the Social Security Act (42 U.S.C. §1396 et seq.) and Chapter 32 of the Texas Human Resources Code, that pays for certain medical and health care costs for people who qualify. Also known as the medical assistance program.
Medical care identification card — The Your Texas Benefits Medicaid card is a plastic card with a magnetic strip, like a credit card, that holds the individual's Medicaid ID number and verification of coverage. Also referred to as the Medicaid card.
Medical effective date (MED) — The date a person's Medicaid coverage begins.
Medical necessity (MN) — The determination that a person requires the services of a licensed nurse in an institutional setting to carry out a physician's planned regimen for total care.
Medical services — Services that are directed toward diagnostic, preventive, therapeutic or palliative treatment of a medical condition and that are performed, directed or supervised by a state-licensed health professional.
Medicare — Medical coverage available under Title XVIII of the Social Security Act to people age 65 or older and to certain people with disabilities under age 65.
MEPD — Medicaid for the Elderly and People with Disabilities. A public assistance program providing medical assistance, institutional and community-based health-related care, and Medicare cost-sharing assistance for the elderly and people with disabilities. MEPD does not provide cash assistance. Examples of MEPD services and programs are:
- primary home care services;
- Home and Community-Based Services waiver programs, which provide community-based care as an alternative to institutional care;
- care in a Medicaid-certified long-term care facility;
- the Program of All-Inclusive Care for the Elderly (PACE);
- Medicaid Buy-In programs; and
- Medicare Savings Programs.
MERP — Medicaid Estate Recovery Program.
Mineral rights — Ownership interest in the oil, gas or minerals beneath the surface of a piece of property.
MMMNA — Minimum monthly maintenance needs allowance.
Month of application — The month in which the date of application falls.
MQMB — Medicaid Qualified Medicare Beneficiary.
MSP — Medicare Savings Programs.
Non-immigrant — An alien temporarily in the U.S. for a specific purpose other than permanent residency. This includes foreign government officials, religious workers, visitors, students and temporary employees.
Non-immigrant Visa — A travel document issued to foreign nationals who wish to enter the U.S. on a temporary basis. Reasons for entry include tourism, business, medical treatment and certain types of temporary work or study.
Non-institutional setting — A living arrangement where a person applying for or receiving Medicaid does not live in a long-term care facility or receive services under a Home and Community-Based Services waiver program. Formerly known as a nonvendor living arrangement.
Nursing facility (NF) — An entity that provides organized and structured nursing care and services, and is subject to licensure under Texas Health and Safety Code, Chapter 242.
OBRA — Omnibus Budget Reconciliation Act (also COBRA, Consolidated Omnibus Budget Reconciliation Act, and SOBRA, Sixth Omnibus Budget Reconciliation Act).
OSS — Office of Social Services
Parent — A child's natural or adoptive parent or the spouse of the natural or adoptive parent.
Parolee — An alien who appears to be inadmissible to the inspecting DHS officer, but who is legally allowed to enter the U.S. under emergency conditions or when that alien's entry is in the public interest. Although parolees are required to leave when the conditions supporting their parole cease to exist, sometimes they adjust their immigration status to stay in the U.S.
PEI — Protected earned income.
Pension funds — Monies held in a retirement fund under a plan administered by an employer or union. An individual retirement account (IRA) or Keogh account as described in the Internal Revenue Code.
Permanent Release — Release from a correctional facility such as a jail, prison, reformatory or holding facility when a person is no longer considered under the control of that institution.
Personal needs allowance (PNA) — An amount of the recipient's income that a recipient in an institutional setting may retain for personal use.
Personal Representative — A person who can represent another person’s rights with respect to individually identifiable health information. Only a person’s personal representative may authorize the use or disclosure of individually identifiable health information or obtain individually identifiable health information on behalf of a person.
Preadmission screening and annual resident review (PASARR) — Federally mandated screening for mental illness, intellectual or developmental disabilities (IDD) and related conditions before admission to a nursing facility. Helps determine if placement is appropriate.
Premium — A monthly payment made by a family to HHSC or its designee to buy MBI or MBIC coverage.
Premium processing vendor (PPV) — HHSC's designee that handles premium processing for MBIC.
Primary home care services — Medicaid-funded, in-home attendant services provided to a person with a medical need for specific tasks to delay or prevent the person's need for institutional care.
Principal place of residence — The home where a person resides, occupies and lives.
Provider — A person, group or agency contracted to provide a Medicaid-funded service to a person for a fee.
Public institution — An institution that has 17 or more residents. It is operated or controlled by the federal or state government, or by a political subdivision of a state such as a city or county, including a jail, prison, reformatory or other correctional or holding facility for prisoners or for people pending trial. Examples of public institutions include county jails, city jails, Texas Department of Criminal Justice (TDCJ) facilities or Federal Bureau of Prisons (BOP) facilities.
Publicly Operated Community Residence — A community residence that has 16 or fewer residents. It is operated or controlled by the federal or state government, or a political subdivision of a state such as a city or county designed to serve no more than 16 residents and to provide some services beyond food and shelter, such as social services, training in socialization and life skills. An example of a publicly operated community residence is a county homeless shelter with a capacity of no more than 16 people. Residents of a publicly operated community residence are not considered inmates of a public institution.
QDWI — Qualified disabled working individual.
QI — Qualifying individual.
QIT — Qualifying income trust.
QMB — Qualified Medicare Beneficiary Program.
Qualified higher education expenses — Tuition, fees or expenses for books, supplies and equipment required for the enrollment or attendance of an individual at an eligible educational institution, including the costs of room and board, and any other higher education expenses that may be permitted under Section 529 of the Internal Revenue Code.
Railroad Retirement (RR) — Retirement and disability benefits for qualified U.S. railroad workers as well as spousal and survivor benefits for qualified family members. Benefits are administered by the Railroad Retirement Board.
Real property — Land and improvements, including buildings and structures. Real property may also include a mine or quarry, standing timber or minerals.
Recipient — A person receiving benefits under MEPD, including a person whose Medicaid eligibility is being redetermined.
Redetermination — See eligibility redetermination.
Refugee — A status granted to a person who is outside their country of nationality and who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution. Unlike asylees, refugees apply for and receive this status prior to entry into the U.S.
Representative payee — A person or an organization selected to receive benefits on behalf of a recipient, if the recipient is not able to manage or direct the management of benefit payments in their own interest.
Reasonable opportunity — The 95-day period following the date on which a notice is sent to a person to provide another source of citizenship or alien status verification.
Resources — Cash, other liquid assets, or any real or personal property, that a person, spouse or parent, as appropriate:
- has the right, authority or power to convert to cash (if not already cash); and
- is not legally restricted from using for his or her support and maintenance.
Restitution — Securing payment from a recipient when fraud is not indicated or pursued and when the recipient's co-payment has been undercharged or a recipient is ineligible because of previously unreported or underreported monthly income or resources.
Retirement, Survivors, and Disability Insurance (RSDI) — Federal benefits provided under Title II of the Social Security Act to workers, their dependents and survivors. Also known as "Old Age, Survivors and Disability Insurance Program” (OASDI).
Retroactive coverage — Payment for Medicaid-reimbursable medical services received up to three months before the month of application. Also known as three months prior.
Review — The process of redetermining a client's continued eligibility for Medicaid.
SASO — Service Authorization System Online.
SSAVERR — System for Application, Verification, Eligibility, Referrals and Reports.
Self-Service Portal (SSP) — A web-based application available to applicants and community partners assisting applicants to:
- perform initial self-screening to check for potential eligibility;
- apply for benefits online;
- check application status;
- check benefit and appointment status; and
- view general benefit program information.
Note: This is now referred to as YourTexasBenefits.com.
Severance pay — Payment made by an employer to an employee whose employment is terminated independently of their wishes or payment is made due to voluntary early retirement.
Sibling — A child's unmarried brother or sister (natural, adoptive or step) who is under 18, or if a student, under 22.
Sister — See definition of sibling.
Skilled Nursing Facility (SNF) — A special facility or part of a hospital that provides round-the-clock skilled nursing care and medically necessary rehabilitation treatment.
Social Security — A federal system of retirement and disability insurance for various categories of employed and dependent persons, funded through dedicated payroll taxes.
Social Security Act — The federal statute that provides the authority for various programs referenced in this chapter, including Medicare and Medicaid. Also see the definition in this section for certain titles in the Social Security Act.
Social Security Administration (SSA) — The federal agency that issues Social Security numbers, administers Social Security benefit programs, and manages the Supplemental Security Income program.
Social service — A service, other than a medical service, intended to assist a person with a physical disability or social disadvantage to function in society on a level comparable to a person who does not have a disability or disadvantage. No in-kind items are expressly identified as social services.
Special Agricultural Worker (SAW) — Seasonal agricultural workers residing in the U.S. who qualify for legalization under Section 302 or 303 of IRCA. SAWs are treated as LPRs for Medicaid purposes.
Special Immigrant Iraqi or Afghan (SIV) — A special immigrant status under 101(a)(27) of the INA may be granted to Iraqi and Afghans who have worked on behalf of the U.S. government in Iraq or Afghanistan. The Department of Defense Appropriations Act of 2010, PL 111-118, enacted on Dec. 19, 2009, provides that SIVs are eligible for all benefits to the same extent and the same period of time as refugees.
Special income limit — The income limit used to test MEPD eligibility for a person or couple in an institutional setting in accordance with Section 358.433 of this chapter (relating to Special Income Limit). Formerly known as institutional income limit.
Specified Low-Income Medicare Beneficiary (SLMB) — A Medicare Savings Program (MSP) that assists people under a specific federal income limit with paying their Medicare Part B premiums.
Spousal impoverishment — Provision implemented under Section 1924 of the Social Security Act (42 USC Section 1396r-5) designed to prevent the impoverishment of a family, usually a couple, when one spouse needs care in an institutional setting.
Spouse — A person who:
- is married; or
- lives with another person and they represent themselves to the community as married.
Spousal Protected Resource Amount (SPRA) — The portion of a couple's combined countable resources reserved for the community spouse and deducted from the couple's combined countable resources in determining eligibility.
SSI federal benefit rate (FBR) — The maximum monthly payment amount for an eligible person in the SSI program.
State center — A facility operated by the Texas Department of State Health Services that HHSC contracts with. It provides services to people with intellectual or developmental disabilities who live in the facility.
State Data Exchange (SDX) — An automated data information system received from the SSA that provides eligibility, benefit, and demographic data for SSI recipients.
State Medicaid claims administrator — Company contracted with HHSC to serve as the insuring agent in providing health benefits to Medicaid clients. The current state Medicaid claims administrator is the Texas Medicaid and Healthcare Partnership (TMHP).
State mental health facility — A facility operated by the Texas Department of State Health Services that provides care for people with mental illness who need the safety, structure, and resources of an in-patient setting.
State Online Query (SOLQ)/State Online Query Internet (SOLQ-I) — An interface with the SSA that provides real-time online access to the Social Security Number (SSN) verification service and to Social Security and Supplemental Security Income (SSI) benefits.
State Plan — See Texas State Plan for Medical Assistance.
State supported living center — A facility that provides residential services and 24-hour supervision and active treatments to assist people with an intellectual or developmental disability. State supported living centers were formerly known as state schools.
Student — A person who regularly attends school, college, or job training, as determined by HHSC.
Supplemental Medical Insurance Benefits (SMIB) — Supplemental medical insurance plans that assist in paying for medical expenses not covered by the person’s health insurance.
Supplemental Nutrition Assistance Program (SNAP) — A program that provides nutrition benefits to low-income people, so they can purchase healthy food. Previously known as the Food Stamp Program.
Supplemental Security Income (SSI) — A federally funded program that provides monthly cash assistance to people with limited income and resources who are 65 or older, blind or have a disability. Eligibility for SSI is determined by the SSA. SSI recipients are automatically eligible for Medicaid.
Support and maintenance (S/M) — The term used for the countable value of food and shelter a person receives.
Temporary Assistance for Needy Families (TANF) — A program that provides temporary benefits (cash assistance) and work opportunities to families with needy dependent children, authorized under Title IV of the Social Security Act.
Temporary Protected Status (TPS) — DHS grants TPS to persons living in the U.S. who are from certain countries where unsafe conditions make it a hardship to return to that country. Persons who qualify for TPS are authorized to remain in the U.S. for a specified period of time and are eligible for an I-766, Employment Authorization Document (EAD). Initial TPS aliens are issued an approval notice and EAD with “A-12” or “C-19” category; re-registered TPS aliens receive an approval notice and EAD only if requested.
Testamentary trust — A trust established by a will.
Texas Health Steps (THSteps) — Services offered under Medicaid for eligible children. This program is known federally as EPSDT (Early and Periodic Screening, Diagnosis and Treatment). Find information at www.tmhp.com/programs/thsteps.
Texas Medicaid and Healthcare Partnership (TMHP) — The current state Medicaid claims administrator.
Texas State Plan for Medical Assistance — Document describing the Medicaid-funded services provided in Texas, in accordance with Section 1902 of the Social Security Act (42 U.S.C. Section 1396a).
Third-party resource (TPR) — A source of payment for medical expenses other than Medicaid.
Three months prior — The three calendar months before the month of application. Also known as retroactive coverage.
TIERS — Texas Integrated Eligibility Redesign System. A computer system that:
- stores case information as well as information about applicants and recipients;
- processes eligibility determinations for multiple programs based on data provided through direct input and interfaces with other systems;
- generates benefit issuance;
- assists users in monitoring and managing workload; and
- creates correspondence and reports based on system- and user-requested criteria.
Titles to Social Security Act — Divisions of the Social Security Act. Titles referenced in this chapter are:
- Title II, which governs RSDI benefits;
- Title XVI, which governs the SSI program;
- Title XVIII, which governs Medicare; and
- Title XIX, which governs Medicaid.
Trust — A trust includes any legal instrument, device or arrangement which may not be called a trust under state law, but is like a trust. That is, it involves a grantor who transfers property to a person or entity with fiduciary obligations intending it be held, managed or administered by the person or entity for the benefit of the grantor or others. This includes, but is not limited to, escrow accounts, investment accounts, pension funds, irrevocable burial trusts, limited partnerships and other similar entities managed by a person or entity with the fiduciary obligations.
Tuition savings programs (also referred to as a Qualified Tuition Plans [QTP], Educational Savings Accounts [ESA] or Section 529 Plans) — Tax-deferred savings plans that allow contributors to save money in an account for the purpose of paying the qualified education expenses of a designated beneficiary.
- Any fund or plan established under Subchapter G, H or I, Chapter 54, Education Code, including an interest in a savings trust account, prepaid tuition contract or related matching account; or
- Any qualified tuition program of any state that meets the requirements of Section 529, Internal Revenue Code of 1986.
Unearned income — Income that is not earned.
U.S. — United States of America.
U.S.-born Alien — A person born in the U.S. who, because of international law, is not subject to the jurisdiction of the U.S. This occurs when a person is born to a parent who is a foreign diplomatic officer such as ambassador, minister, chargé d' affaires, counselor, secretary or attaché of an embassy, legation or European Economic Community delegation.
U.S.C. — United States Code.
U.S. Citizenship and Immigration Services (USCIS) — USCIS is the government agency that oversees lawful immigration to the U.S. The former Immigration and Naturalization Service (INS) was dismantled and separated into three components within the Department of Homeland Security:
- USCIS provides immigrant services;
- Immigration and Customs Enforcement handles immigration enforcement; and
- Customs and Border Protection is responsible for border security functions.
VA — U.S. Department of Veterans Affairs.
Vendor — See provider.
Waiver — See Home and Community-Based Services waiver program.
Working day — Any day except Saturday, Sunday, a state holiday or a federal holiday.
WTPY — Wire Third-Party Query
Your Texas Benefits Medicaid ID card — A plastic card with a magnetic strip, like a credit card, that holds the individual's Medicaid ID number and verification of coverage.