The Health Care Programs Manual glossary contains definitions of many terms related to Minnesota Health Care Programs. These definitions are intended for general reference; for complete policy information, please refer to the relevant section(s) of the manual.
Click on a letter below to link to that section of the glossary.
10-Day Notice
Notification sent to the client at least ten calendar days before the effective date of an agency action. Most adverse actions, such as denial, reduction, or termination of health care benefits, require ten-day notice.
1619a and 1619b
Provisions of the Social Security Act which allow certain employed people who would otherwise be ineligible to retain SSI status. The Social Security Administration certifies people for 1619(a) and 1619(b) eligibility. People with 1619(a) or 1619(b) status retain their MA eligibility under the SSI related category if they received MA the month before certification for 1619(a) or 1619(b).
1619a Social Security Act
A provision allowing continued SSI and MA eligibility for people who would otherwise lose SSI because of a demonstrated ability to work.
1619b Social Security Act
A provision allowing continued MA eligibility for people who become ineligible for SSI benefits under 1619(a) due to excess income.
18-Month Rule
One of the insurance barriers for MinnesotaCare. The 18-month rule requires that some people can not have current coverage or access to ESI. It also restricts eligibility for some people who have had access to ESI in the past 18 months if the client stopped the insurance or if the employer chose to drop coverage.
4-Month Rule
One of the insurance barriers for MinnesotaCare. The four-month rule requires some people to have been uninsured for four months before they can enroll in MinnesotaCare.
60-Day Postpartum Period
The period of coverage that begins the last day of the pregnancy and ends the last day of the month in which a 60-day period, beginning on the last day of the pregnancy, ends.
AC
Alternative Care. A state-funded program, administered by county social services agencies, which provides home and community-based services for clients age 65 or older in an effort to keep the client in the community and avoid a nursing facility placement.
Access Services
Transportation and services needed to help clients obtain medically necessary health care. These services may be provided by a health plan, a county agency or MinnesotaCare Operations.
Acknowledgment of Paternity
A legal Declaration of Parentage (DOP) or Recognition of Parentage (ROP) signed by both the mother and father of a child born to a woman who was not married to the child's father when the child was conceived nor when the child was born, declaring that they are the biological parents of the child. The DOP is valid only if it was executed before August 1, 1995. For documents executed on or after August 1, 1995, only the ROP is valid.
Actual Income
Income a client concretely receives.
Addendum
Obsolete.
Adequate Compensation
Receipt of the fair market value, or other compensation equal to the fair market value, in exchange for the transfer or sale of real or personal property.
Adequate Notice
A notice sent no later than the date of action.
Adjudication of Paternity
Determination of the identity of a child's father by a court.
Adoption Assistance
An adoption assistance grant provided to adoptive parents. It is funded either federally through Title IV-E of the Social Security Act or by the State under Minnesota Statutes, section 259.67.
AFB
Annuity-Funded Burial. An annuity contract with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the contract is to be paid to a funeral provider in exchange for agreed-upon goods and services.
AFDC
Aid to Families with Dependent Children. The program formerly authorized under Title IV-A of the Social Security Act to provide financial assistance and social services to needy families with dependent children. AFDC was replaced by the Temporary Assistance to Needy Families (TANF) block grant in 1996. Minnesota's TANF program is the Minnesota Family Investment Program (MFIP).
Affidavit of Collection of Personal Property
A method of recovering MA payments from the estate of a deceased person.
Aged
Age 65 or older. Used interchangeably with elderly.
Aid to Families with Dependent Children (AFDC)
The program formerly authorized under Title IV-A of the Social Security Act to provide financial assistance and social services to needy families with dependent children. AFDC was replaced by the Temporary Assistance to Needy Families (TANF) block grant in 1996. Minnesota's TANF program is the Minnesota Family Investment Program (MFIP).
Alimony
Obsolete term for spousal maintenance. An allowance for support that a court orders a person to pay to his or her current or former spouse.
Allocation
A deduction from the income of a long-term care facility resident or a person receiving Elderly Waiver services for the maintenance needs of certain relatives.
Alternative Care (AC)
A state-funded program, administered by county social services agencies, which provides home and community-based services for clients age 65 or older in an effort to keep the client in the community and avoid a nursing facility placement.
Amortization
A deduction for costs of starting a business that is deducted from the business income over a period of time.
Annuitant
The person who is entitled to payments under the settlement option of an annuity.
Annuitization
The point in time when an annuity's settlement option is chosen.
Annuity
A contract purchased by a person in which another party (the insurer) agrees to pay the purchaser or the person the purchaser appoints (the annuitant) a stipulated amount over a period of time.
Annuity-Funded Burial (AFB)
An annuity contract with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the contract is to be paid to a funeral provider in exchange for agreed-upon goods and services.
Anticipated Income
Income the client can reasonably expect to receive in the future.
Appeal
A client's or authorized representative's request to the State of Minnesota appeals section for review of the state or a county agency’s action or inaction or for review of a managed care health plan's medical service or payment issues. Also known as a Fair Hearing.
Applicant
A person who has submitted a request for coverage for whom no decision has been made regarding eligibility.
Application
Any of several forms prescribed by the commissioner of DHS which people must complete to apply for health care coverage.
Application Assistor
A person chosen by the applicant to assist with the application process. The application assistor performs activities such as helping complete forms and obtain verification, but cannot sign the application unless designated as the authorized representative. Require a signed release form (DHS-3549) to release information to the application assistor.
Arrearages
Payments of child support which were due for a prior period.
Asset Conversion
A change from one type of asset to another.
Asset Limit
The amount of net countable assets a client may own or have available to them and remain eligible for a health care program.
Assets
Real and personal property owned wholly or in part by the client.
Assignment
To transfer legal claim, such as assignment of benefits available through other health coverage or medical support.
Associated Recipient
A Minnesota Health Care Program household member whose health care expenses are used to meet another household member's medical spenddown.
Authorized Representative
A person authorized to act on a client's behalf for any of the Minnesota Health Care Programs (MHCP). An authorized representative may be designated by the client and may exercise all the rights and responsibilities of a client.
Auto Newborn
A basis of eligibility for a child who receives automatic MA or MCRE eligibility through the month of his/her first birthday. The child's mother must have been enrolled in a Minnesota Health Care Program during the month of birth and the child must continue to live with the mother in Minnesota.
Availability
Client's ability to gain access to income or to use, sell, or liquidate assets they own.
Basis of Eligibility
An identifying characteristic of a category of people specified as potentially eligible for MA. People without one of the specified characteristics are ineligible for MA but may be eligible for GAMC or MCRE.
Battered Noncitizen
A noncitizen who is the spouse or child of a U.S. citizen or Lawful Permanent Resident (LPR) and who has been battered or subject to extreme cruelty in the U.S. by a family member residing in the same household.
BEER
Beneficiary Earnings and Exchange Record. A monthly IEVS tape exchange between the Social Security Administration and DHS reporting wages, self-employment, and federal pension earnings from federal tax returns. The original source is the Internal Revenue Service.
Benchmark Plan
A prescription drug coverage plan that has been designated by Medicare to meet certain coverage requirements and which has a monthly premium that is fully subsidized by Extra Help.
Beneficiary
The person named to receive benefits or payments (for example, social security payments or payments from a life insurance policy or trust).
Beneficiary Data Exchange (BNDX)
A monthly IEVS tape exchange between the Social Security Administration and DHS. The report provides information on RSDI and Medicare.
Beneficiary Earnings and Exchange Record (BEER)
A monthly IEVS tape exchange between the Social Security Administration and DHS reporting wages, self-employment, and federal pension earnings from federal tax returns. The original source is the Internal Revenue Service.
Benefit Recovery Section (BRS)
A section of DHS which pursues collection of third party payments and determines if health insurance is cost-effective.
BFE
Burial Fund Exclusion. Allows clients to set aside, or designate, up to $1500 in assets to cover certain burial expenses. Assets designated toward the BFE are not counted in the client's net asset total.
Blind
A basis of eligibility for a person without vision, or who meets specific limited-vision conditions.
BNDX
Beneficiary Data Exchange. A monthly IEVS tape exchange between the Social Security Administration and DHS. The report provides information on RSDI and Medicare.
Break in Long-Term Care (LTC) Services
A gap of one calendar month or more in receiving LTC services paid by MA because a client either became ineligible for MA, became ineligible for MA payment of LTC services, or stopped receiving MA-LTC services.
BRS
Benefit Recovery Section. A section of DHS which pursues collection of third party payments and determines if health insurance is cost-effective.
BS
Burial Space. Any repository for the remains of the deceased such as cemetery plots, urns, niches, crypts, and caskets.
BSI
Burial Space Items. Items which add to or improve burial spaces such as markers, engraving, vaults, opening and closing of the grave, and one time charges for preservation/care of the space (perpetual care).
Burial Agreement
An arrangement in which funds are deposited with a funeral director to be used for funeral expenses. The agreement may cover funeral and professional services, burial space items, or both. The money is usually held in trust by a bank or other financial institution unless the agreement is funded by an insurance policy or annuity. Burial agreements may be revocable or irrevocable.
Burial Fund Exclusion (BFE)
The Burial Fund Exclusion (BFE) allows clients to set aside, or designate, up to $1500 in assets to cover certain burial expenses. Assets designated toward the BFE are not counted in the client's net asset total.
Burial Funds
Funds paid or designated in advance for funeral expenses, including but not limited to burial agreements. Burial funds provide for preparation of the body, cremation, or burial services.
Burial Services
These are services which are pre-paid in a burial agreement.
Burial Space (BS)
Any repository for the remains of the deceased such as cemetery plots, urns, niches, crypts, and caskets.
Burial Space Item (BSI)
Items which add to or improve burial spaces such as markers, engraving, vaults, opening and closing of the grave, and one-time charges for preservation/care of the space (perpetual care).
Business Day
Any working day (Monday through Friday) that does not fall on a state holiday.
Buy-In
The process of having some or all of the client’s Medicare costs paid through MA.
C-Corporation
A corporation in which shareholders receive profits in the form of dividends. Shareholders who perform work for the corporation also receive wages. The corporation must file a corporate tax return.
C&TC
Child and Teen Checkups. A component of MA and MinnesotaCare that promotes preventive health care for children from birth to age 21. This program is federally known as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program.
CAC
Community Alternative Care. A federally approved home and community based services waiver program for chronically ill people under age 65.
CADI
Community Alternatives for Disabled Individuals. A federally approved home and community-based waiver program for people under age 65 who would otherwise require the level of care provided in a nursing facility.
CAF
Combined Application Form. A form on which people can apply for multiple programs administered by DHS, including but not limited to General Assistance (GA), General Assistance Medical Care (GAMC), Food Support (FS), Minnesota Family Investment Program (MFIP) Medical Assistance (MA), Minnesota Supplemental Aid (MSA), Emergency Assistance (EA) and Emergency Medical Assistance (EMA).
CAI
Cash Advance Items. Items pre-paid in a burial agreement for items above and beyond basic burial services such as flowers, music, obituary notices and motor escort.
Capital Asset
Real or personal property used in a trade or business with a useful life of one year or more.
Capital Expenditure
Payment made to purchase or improve property with a useful life of more than one year.
Capital Gain
Profit from the sale or exchange of business or personal assets. An asset owned and sold within a year is a short term capital gain. An asset owned for more than one year and is a long term capital gain.
Capital Loss
Loss from the sale or exchange of business or personal assets. An asset owned and sold within a year is a short term capital loss. An asset owned for more than one year and sold is a long term capital loss.
Capitation
A method of payment for health services that involves a monthly per person rate paid on a prospective basis to a managed care organization. Capitation occurs six working days before the end of the month.
Capitation Date
The monthly date on which DHS sends capitation payments to health plans.
Caregiver
Obsolete term for caretaker. Caretaker: A person who provides care and support to a minor child. The person may or may not be coverage through the Minnesota Health Care Programs and may or may not be considered part of the child's household.
Caretaker
A person who provides care and support to a minor child. The person may or may not be covered and may or may not be considered part of the child's household.
Carry Forward Net Operating Loss (NOL)
A federal tax deduction used when allowable business deductions exceed gross receipts for the tax year. The business loss may be carried over into future years.
Case Management
1. A method of providing health care in which the managed health care organization (MCO) coordinates the provision of health services to a managed care enrollee. 2. Services not normally covered by MA that may be covered under a waiver for people with severe and persistent mental illness.
Cash Advance Items (CAI)
Items pre-paid in a burial agreement for items above and beyond basic burial services such as flowers, music, obituary notices and motor escort.
Cash Assistance Programs
General Assistance (GA), Group Residential Housing (GRH), Minnesota Family Investment Program (MFIP), Minnesota Supplemental Aid (MSA), Refugee Cash Assistance (RCA) and emergency cash programs.
Cash Surrender Value (CSV)
The amount the life insurance policy owner would receive if the policy were cashed in.
Cause of Action
A lawsuit.
CCRC
Continuing Care Retirement Community. An organization which contractually offers a range of continuing care services while providing flexible accommodations, which may change with the client's needs. A CCRC may also be referred to as a life care community.
Center for Victims of Torture (CVT)
A Minnesota-based private, nonprofit, nonpartisan organization founded in 1985. CVT exists to heal the wounds of government-sponsored torture on individuals, their families, and communities and to stop its practice.
Centers for Medicare and Medicaid Services (CMS)
Administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA.
Certificate of Coverage (COC)
A summary of a health insurance plan's covered services, grievance and appeal processes for the policyholder. Also referred to as member contract or evidence of coverage, provided by the managed care organization.
Certificate of Creditable Coverage (COCC)
Documentation of a person's creditable coverage. People can present certificates of creditable coverage to their new health plans to prove that they had previous coverage.
Certification Period
The period of time for which a client is eligible before the next renewal is processed. It is also the period of time for which income is calculated to determine income eligibility as well as premium or spenddown amounts.
CHAMPUS
Former name of TRICARE. A Department of Defense health insurance program providing coverage to active-duty and non-active duty members of the armed forces and their dependents, and certain civilian employees. This program was formerly known as CHAMPUS.
CHAMPVA
A Department of Veterans' Affairs program that provides health care coverage for the spouse and children of certain disabled or deceased veterans. This coverage is provided for these family members if they are not eligible for TRICARE benefits.
Child
A person under age 21.
Child & Teen Checkups (C&TC)
A component of MA and MinnesotaCare that promotes preventive health care for children from birth to age 21. This program is federally known as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program.
Child Care Assistance
Program available to help low- and moderate-income families pursue employment or education leading to economic self-sufficiency by subsidizing their child care.
Child Support
A voluntary or court-ordered payment by non-custodial parents for the support of their children.
Children's Health Plan (CHP)
The forerunner of the MinnesotaCare program. CHP began in 1988 and provided comprehensive outpatient health care coverage for children ages 1-17. It was discontinued in 1993, and all children covered at that time were converted to MinnesotaCare.
CHP
Children's Health Plan. The forerunner of the MinnesotaCare program. CHP began in 1988 and provided comprehensive outpatient health care coverage for children ages 1-17. It was discontinued in 1993, and all children covered at that time were converted to MinnesotaCare.
Civil Recovery
Recovery of an overpayment through the civil judicial process rather than the criminal process.
Claims History Profile
A list of amounts the State of Minnesota has paid for medical services, whether it be the capitation amount or the actual cost of fee-for-service expenses.
Client
A person who is an applicant or enrollee.
Client Option Spenddown
A method for clients to pre-pay a medical spenddown to DHS. Is only available to clients with an automated monthly spenddown.
Clothing and Personal Needs Allowance
The amount of monthly income institutionalized clients may keep or receive for their day-to-day expenses.
CMS
Centers for Medicare and Medicaid Services. Administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA.
Co-Insurance
An insured person's share of the cost of treatment. For example, if an insurance policy covers 80% of the cost, the co-insurance amount is 20%.
Co-Payment
A fixed amount a person is required to pay for each episode of a particular treatment, medical supply, or equipment. For example, a policy might require a $5 co-payment for each prescription while the insurance pays the remainder.
COBRA Coverage
A provision of the Consolidated Omnibus Budget Reconciliation Act (COBRA) which requires employers to allow former employees to continue coverage through the employer's group plan for 18 months after the employment has ended (29 months if the employee is disabled). In most cases, the former employee must pay the full cost of COBRA coverage.
COC
Certificate of Coverage. A summary of a health insurance plan's covered services, grievance and appeal processes for the policyholder. Also referred to as member contract or evidence of coverage, provided by the managed care organization.
COCC
Certificate of Creditable Coverage. Documentation of a person's creditable coverage. People can present certificates of creditable coverage to their new health plans to prove that they had previous coverage.
COLA
Cost of Living Adjustment. An increase in income to compensate for inflation.
Combined Application Form (CAF)
A form on which people can apply for multiple programs administered by DHS, including but not limited to General Assistance (GA), General Assistance Medical Care (GAMC), Food Support (FS), Minnesota Family Investment Program (MFIP) Medical Assistance (MA), Minnesota Supplemental Aid (MSA), Emergency Assistance (EA) and Emergency Medical Assistance (EMA).
Community Alternative Care (CAC)
A federally approved home and community based services waiver program for chronically ill people under age 65.
Community Alternatives for Disabled Individuals (CADI)
A federally approved home and community-based waiver program for people under age 65 who would otherwise require the level of care provided in a nursing facility.
Community Spouse
A person who does not reside in an LTCF or receive Elderly Waiver (EW) services who is married to an LTC spouse. A community spouse may or may not receive MA.
Comprehensive Coverage
A term used by insurance companies to describe a broad range of covered services including the diagnosis and treatment of most illnesses and injuries. Coverage may vary under individual policies.
Confidential Data
Data that is not available to the public nor the subject of the data under MN State Law.
Conservator
A person, official, or institution designated to protect the interests of an incompetent person. A conservator has some, but not all, of the duties and powers of a legal guardian and is not counted in the person's household for any of the health care programs.
Continuing Care Retirement Community (CCRC)
An organization which contractually offers a range of continuing care services while providing flexible accommodations, which may change with the client's needs. A CCRC may also be referred to as a life care community.
Continuous Enrollment
Enrollment in MinnesotaCare, Medical Assistance (MA) or General Assistance Medical Care (GAMC) without a break in coverage of one month or more.
Continuous LTC/EW Period
A 30-consecutive-day period beginning on or after October, 1989, in which a person meets either of the following conditions:
l Resides in a long-term care facility.
l Receives a nursing facility level of care provided by home and community-based services that meets all of the following conditions:
n Was determined to be necessary by a long-term care consultation completed within the past 60 days.
n Is paid by or would qualify for payment by the EW program or the AC program if the person were otherwise eligible for either program.
n Is delivered by a licensed provider qualified to provide home and community-based services.
The term used by the federal Medicaid program is Continuous Period of Institutionalization.
Continuous Period of Institutionalization
Obsolete term for Continuous LTC/EW Period.
Contract for Deed
A written obligation by a seller to deliver the deed to the property when certain conditions have been met, such as completion of payments by the purchaser. A contract for deed is a type of mortgage in that it places an encumbrance on the land.
Corpus (re Trusts)
Income and/or assets that form the main body of a trust. Assets or income in the trust corpus may be available to a person but the person no longer owns them. Also known as the trust principal.
Cost-Sharing
An enrollee's financial responsibility for health care program coverage, such as a co-payment, premium or spenddown.
Cost of Living Adjustment (COLA)
An increase in income to compensate for inflation.
County-Based Purchasing
An option that allows counties to choose to assume the responsibility for purchasing health services for enrollees who are eligible for PMAP.
County Agency
The local human services office responsible for determining eligibility for Minnesota Health Care Programs.
County of Financial Responsibility
The county responsible for the county costs of an enrollee’s MA or GAMC.
Creditable Coverage
Creditable coverage gives people credit for previous health insurance coverage when they move to new health plans to reduce the exclusion period that may be imposed due to pre-existing conditions. A person with creditable coverage must be allowed special enrollment in a health plan at a time other than the employer's open enrollment period.
Cremation Society Agreement (CSA)
This type of burial agreement is an agreement in which funds are pre-paid for burial through a cremation society.
CSV
Cash Surrender Value. The amount the life insurance policy owner would receive if the policy were cashed in.
Current Contact
The household of a MinnesotaCare applicant in which at least one other household member is eligible for MHCP, Food Support, or a cash assistance program; is being terminated from MHCP or MFIP; or is being denied MHCP coverage.
Custodial Parent
A parent who has physical custody of his or her minor child.
Cutoff Date
The date by which information must be entered in the health care eligibility system to effect a change for the following month.
CVT
Center for Victims of Torture. A Minnesota-based private, nonprofit, nonpartisan organization founded in 1985. CVT exists to heal the wounds of government-sponsored torture on individuals, their families, and communities and to stop its practice.
Declaration of Parentage (DOP)
A form that serves as an acknowledgement of paternity. This form may be signed before or after the child's birth. To be valid it must have been executed before August 1, 1995. Notarized signatures of both parents must be on the form.
Deductible
The amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance policy. For example, if an insured person has a $1000 deductible, he or she must incur $1000 in medical costs before the policy begins paying benefits.
Deduction
An amount allowed to reduce a person's total net income because its use or intended use is for certain specific expenses.
Deed
Legal document which conveys ownership of property between parties.
Deem
To count the income or assets of one person when determining the eligibility of another.
Deemed SSI Recipient
An individual who for MA purposes is considered to be receiving SSI. This includes people eligible under 1619(a) and (b); children eligible under the TEFRA waiver; people eligible for the Pickle disregard; Disabled Adult Children; Disabled Widows and Widowers; and people not receiving SSI payment because of recoupment or 1-month suspension due to excess income.
Denial
The act of disapproving an application, a request to add a person to coverage, or a request for specific medical services.
Dependent Care Deduction
An income deduction based on the cost of caring for a child or adult.
Dependent Child
A child who lives with a parent, legal guardian, relative caretaker or foster parent and is under age 18 or 18 years old, a full-time student, expected to graduate by age 19.
Dependent Health Insurance
Health insurance coverage offered or provided to the insured's specified dependents.
Depreciation
A federal income tax deduction for the cost of a business asset that gradually loses value through the wear and tear of use.
Designated Provider
A method for clients to pay their waiver obligation or medical spenddown to a chosen provider. Clients who receive certain types of services may choose the designated provider option. Clients with long-term care spenddowns must use this option.
Developmentally Disabled
People diagnosed with mental retardation or a related condition who have substantial functional limitations or deficits in adaptive behavior and who manifest these conditions before their 21st birthday.
DHS
The Minnesota Department of Human Services.
Disability
A basis of eligibility based on the Social Security Administration (SSA) disability standards. Disability may be determined by the SSA or the State Medical Review Team (SMRT).
Disability Insurance
A policy which pays a fixed amount of income to a person who becomes disabled under the terms of the policy. Disability insurance is intended as an income replacement and is not health insurance.
Discretionary Trust
A trust authorizing the trustee to use full discretion to determine how much is paid out from the trust.
Disregard
An amount not counted when determining a person's total net income.
Dividend
The amount of the profit distribution a shareholder receives or the amount of the surplus distribution a policyholder of a participating insurance policy receives.
Dividend Accumulation
Dividends that the policy holder has left in the custody of the insurer to accumulate interest.
Dividend Addition
Amounts of additional life insurance purchased with dividends.
DOP
Declaration of Parentage. A form that serves as an acknowledgement of paternity. This form may be signed before or after the child's birth. To be valid it must have been executed before August 1, 1995. Notarized signatures of both parents must be on the form.
Dual Eligibles
People enrolled in Medicare Part A or B simultaneously with MA or any of the Medicare savings programs.
Earned Income
Money received from employment or self-employment. This includes but is not limited to salaries, wages, tips, commissions, vacation, and sick pay.
Earned Income Credit (EIC)
A federal tax credit given to low income people. Household members may receive an EIC once a year as a refund or as an advance payment or tax reduction with each paycheck.
Earned Income Disregard
An amount deducted from earned income, as an employment incentive, when determining a client's total net income.
Earned Income Disregard Cycle
The time period during which the earned income disregard is applied.
Effective Date
The begin date of a specific action such as an approval, denial, closure or other change in eligibility or coverage.
Eighteen-Month Rule
One of the insurance barriers for MinnesotaCare. The 18-month rule requires that some people can not have current coverage or access to ESI. It also restricts eligibility for some people who have had access to ESI in the past 18 months if the client stopped the insurance or if the employer chose to drop coverage.
Elderly
Age 65 or older. Used interchangeably with aged.
Elderly Waiver (EW)
An MA waiver program providing home and community-based services for clients age 65 or older who need a nursing home level of care to enable them to stay in the community.
Eligibility Begin Date
The date a client is eligible for coverage under the Minnesota Health Care Programs.
Eligibility Group
One of four groups assigned to a MinnesotaCare enrollee based on certain characteristics.
Eligibility Verification System (EVS)
DHS's system to verify an enrollee's coverage and eligibility dates under the Minnesota Health Care Programs. Providers contact EVS by phone or online to confirm eligibility.
Emancipated Minor
A person under the age of 18 who is or was married, is on active duty in the uniformed services, or has been declared emancipated by a court.
Employer Subsidized Insurance (ESI)
Insurance coverage offered to employees or dependents for whom the employer pays at least 50% of the cost of coverage.
EMV
Estimated Market Value. The value assigned to real estate by the county assessor for the purpose of levying property taxes. EMV is found on the annual property tax assessment statement.
Encumbrance
A legal claim against real or personal property payable when the property is sold.
Enrollee
A person receiving coverage through a Minnesota Health Care Program or a managed care organization (MCO).
Entrance Fee
The total amount of payments, and/or the value of property, made or promised as full or partial consideration for acceptance into or maintaining residence in a continuing care retirement community (CCRC).
EOMB
Explanation of Medical Benefits. A statement from DHS, an insurance company, or a health plan reporting amounts paid, reduced, or denied for the client's health care expenses.
Equity
The fair market value of real or personal property minus any encumbrances.
Escrow
A deed, bond, money, or piece of property held in trust by a third party to be turned over to the grantee only on fulfillment of a condition.
Estate Claim
A method of recovering MA from the estate of a deceased person.
Estimated Market Value (EMV)
The value assigned to real estate by the county assessor for the purpose of levying property taxes. EMV is found on the annual property tax assessment statement.
EVS
Eligibility Verification System. DHS's system to verify an enrollee's coverage and eligibility dates under the Minnesota Health Care Programs. Providers contact EVS by phone or online to confirm eligibility.
EW
Elderly Waiver. An MA waiver program providing home and community-based services for clients age 65 or older who need a nursing home level of care to enable them to stay in the community.
Excess Assets
The amount of total countable assets which exceed the client's asset limit.
Excluded Income
Income not counted in determining a client's total net income.
Excluded Time
A service or living arrangement which is a factor in determining a client's county of financial responsibility.
Exculpatory Clause
A provision in a trust that provides for the suspension, termination, limitation or diversion of the principal, income or beneficial interest of a beneficiary if the beneficiary applies for, and is determined eligible for or receives public assistance.
Explanation of Medical Benefits (EOMB)
A statement from DHS, an insurance company, or a health plan reporting amounts paid, reduced, or denied for the client's health care expenses.
Face Value (FV)
The face value of a life insurance policy is the policy’s death benefit (the amount paid out at the death of the insured) at the time a life insurance policy is purchased.
Fair Market Value (FMV)
The price an item would sell for on the open market in a local geographic area.
Family Support Grant Program
A state-funded program that provides funds to help families provide home care for dependents with mental retardation or related conditions.
FBR
Federal Benefit Rate. The maximum federal benefit rate for the Supplemental Security Income (SSI) program. This amount is updated each January and is used to determine the Pickle Disregard and the Special Income Standard (SIS) for the Elderly Waiver (EW) program.
Federal Benefit Rate (FBR)
The maximum federal benefit rate for the Supplemental Security Income (SSI) program. This amount is updated each January and is used to determine the Pickle Disregard and the Special Income Standard (SIS) for the Elderly Waiver (EW) program.
Federal Financial Participation (FFP)
Federal reimbursement to DHS for some of the cost of a client's health care services. People must meet certain criteria to be eligible for health care programs with FFP.
Federal Income Tax Forms
The Internal Revenue Service (IRS) forms that people who are not exempt must file annually to establish their federal income tax liability. Federal tax forms usually consist of Form 1040 and various supplemental schedules depending on the taxpayer's circumstances.
Federal Poverty Guidelines (FPG)
The amount of income below which a household of a given size is considered impoverished. The federal government updates the FPG annually. All Minnesota Health Care Programs income standards are based on the FPG.
Fee-for-Service
A method of payment for health services. The medical provider bills the insurer and is paid for specific individual services.
FFP
Federal Financial Participation. Federal reimbursement to DHS for some of the cost of a client's health care services. People must meet certain criteria to be eligible for health care programs with FFP.
FICA
Social Security payroll taxes that are collected under the authority of the Federal Insurance Contributions Act (FICA).
First Year Change Option
A managed care enrollee's opportunity to change health plans once during the first year of enrollment in a health plan.
FMV
Fair Market Value. The price an item would sell for on the open market in a local geographic area.
Food Stamps
Former term for Food Support. A program authorized by the U.S. Department of Agriculture to provide food assistance to low-income individuals or families. Benefits may be issued in the form of coupons, electronic benefits, or in cash to certain people who receive MFIP or MSA. The Food Stamp program is known as Food Support in Minnesota.
Food Support
A program authorized by the U.S. Department of Agriculture to provide food assistance to low-income individuals or families. Benefits may be issued in the form of coupons, electronic benefits, or in cash to certain people who receive MFIP or MSA. The Food Stamp program is known as Food Support in Minnesota.
Foster Care
Care given to a children or adults including emergency, interim, or permanent care that cannot be furnished by their parent or legal guardian in their home. Foster care can be federally funded by Title IV-E of the Social Security Act or it can be state-funded.
Foster Child
A dependent child who has been placed in a foster home or facility by a social services agency.
Foster Home
A home licensed to provide care to dependent children and/or adults.
Foster Parent
A person giving care to a child in foster care.
Four Month Rule
One of the insurance barriers for MinnesotaCare. The four-month rule requires some people to have been uninsured for four months before they can enroll in MinnesotaCare.
FPG
Federal Poverty Guidelines. The amount of income below which a household of a given size is considered impoverished. The federal government updates the FPG annually. All Minnesota Health Care Programs income standards are based on the FPG.
Full-Time Student
A person who is enrolled in a graded or ungraded primary, intermediate, secondary, GED preparatory, trade, technical, vocational, or post-secondary school and who meets the school's standard for full-time attendance. Summer vacations and school holidays do not affect the student's full-time status. Consider people who are enrolled and attending but do not meet the school's standard for full-time attendance to be part-time students.