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  • Advocate: an individual or group of individuals that speak on behalf of a Medicaid eligible party 

  • Affordable Care Act (ACA): a healthcare reform law passed in March 2010 that makes health care coverage more accessible through lower costs. The ACA is often referred to as "Obamacare"

  • Aged, Blind, and Disabled (ABD): full coverage Medicaid eligibility classification for low-income adults aged 65 or older, blind, or disabled

  • Asset: property owned by a person or company, regarded as having value and available to meet debts, commitments, or legacies. Some examples include cash, bank accounts, real property, business accounts, some annuities and life insurance policies, and any other resource that can be converted into cash to pay debts

  • Beneficiary: an individual who both qualifies and utilizes the support services offered by Medicaid

  • Caregiver: any individual, professional or otherwise, who provides daily assistance to a person that is unable to assist themselves

  • Categorically Needy: this refers to the Medicaid eligibility pathway the patient utilizes for eligibility. Pathways include people who are financially needy and pregnant, financially needy with children, or an Aged, Blind or Disabled (ABD) individual

  • Centers for Medicare and Medicaid Services (CMS): a federal organization that provides services and programs funded under Medicare, Medicaid, and Children's Health Insurance Program (CHIP), under titles XVIII and XIX of the Social Security Act

  • Community Spouse: the spouse of an individual that requires Medicaid assistance but they themselves do not require assistance

  • Community Spouse Resource Allowance (CSRA): portion of assets the community spouse may retain in order to avoid spousal impoverishment. Please note that this value varies from state to state

  • Disability: a physical or mental impairment that limits an individual from working, learning or living independently

  • Dual Eligible: refers to when an individual is eligible for both Medicaid and Medicare

  • Fair Market Value (FMV): refers to the actual or estimated value of an object, property or asset, based on what a knowledgeable, willing and unpressured buyer would pay for said item in the market

  • Federal Poverty Level: an annual assessment of an individual's total yearly income to determine social service coverage and other benefits, such as CHIP and Medicaid

  • Federal Waivers: the Social Security Act authorizes multiple waivers to allow states flexibility in operating their Medicaid programs. These waivers provide additional resources for programs such as Medicaid Stay at Home programs

  • Gift: any resource or property freely given away for less than Fair Market Value with no chance of return

  • Home and Community Based Services (HCBS): program that provides care to Medicaid beneficiaries at home or in the community (such as hospice services), rather than institutional based care 

  • Hospice: home or facility offering care to the sick and terminally ill

  • Improper Transfer: any item or resource given, traded or sold for less than Fair market Value; often referred to an an uncompensated transfer or gift

  • Income: money received on a regular basis, usually from work or investments

  • Institutionalized Spouse: the individual that requires medical assistance in an assisted living or long-term care facility

  • Long-Term Care: variety of both institutional and community-based services that offer medical and non-medical assistance to those with chronic illness, a disability or are classified as Aged, Blind or Disabled

  • Managed Care Organization: also known as a Managed Care Entity (MCE), delivers health care benefits in an efficient, streamlined manner that emphasizes improving cost, utilization, and quality of care.

  • Medicaid: a federal and state level program that helps with medical costs for eligible, low-income adults, children, pregnant women, elderly adults, and people with disabilities.

  • Monthly Income Allowance: the amount of money the community spouse may receive in addition to their own income, if their income falls below the state standard

  • Patient Liability Amount: also referred to as share of cost, this refers to the Medicaid beneficiary's share of cost for services provided. Typically, this is calculated by adding the patient's total income together and subtracting from it any premiums they pay for medical insurance

  • Personal Needs Allowance: the amount of money the Medicaid patient gets to keep to handle personal monthly expense such as food or personal maintenance

  • Presumptive Eligibility: a process in which a Medicaid applicant can receive immediate services while their Medicaid application remains pending

  • Qualified Income Trust (QIT): also called a Miller Trust; a financial device utilized when a Medicaid applicant's gross income exceeds the state standard. Please note that not all states have an income limit so this device may not be utilized in all cases where an applicant's income is too high to receive benefits

  • Share of Cost: the amount of the Medicaid beneficiary's income that must be contributed toward monthly ongoing care costs

  • Snapshot Date: the date utilized to calculate a couple's total countable assets – typically the first date of continuous institutionalization.

  • Spend Down: process by which the Medicaid applicant will spend any remaining resources in an effort to bring their total countable assets down within the limitations set forth by the state

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