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.
1619(a) and 1619(b)
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).
1619(a) 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.
1619(b) 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 cannot 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.
Absent Parent
Obsolete term for non-custodial parent. A parent who does not have physical custody of a child.
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.
Accumulation Phase
The first phase of a deferred annuity during which the contract accumulates funds from the payments made into the annuity and accrues interest and earnings on investments.
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.
Actuarially Sound
An annuity is actuarially sound if the cash value as of the date of annuitization is expected to pay out in full within the expected lifetime of the person requesting MA payment of LTC services or his or her spouse.
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.
Agency of Financial Responsibility (AFR)
See County of Financial Responsibility.
Agricultural Homestead
The property located on agricultural land that meets the definition of home and includes the dwelling, the garage, if any, and one acre of land immediately surrounding the dwelling.
Agricultural Land
A contiguous acreage, of 10 acres or more, used during the preceding year for agricultural purposes, or a contiguous acreage, of less than 10 acres, which is exclusively and intensively used for raising or cultivating agricultural products.
Agricultural Products
Examples of agricultural products include but are not limited to livestock, dairy animals and products, poultry animals and products, fur-bearing animals, horticultural and nursery stock, fruits, vegetables, forage, grains, bees, and apiary products.
Agricultural Purpose
Use of property for the production of products or services offered for sale by the owner.
Agricultural Services
Agricultural services include, but are not limited to:
l Commercial boarding of horses if the boarding is done in conjunction with raising or cultivating agricultural products.
l Fish bred for sale and consumption if the fish breeding occurs on land zoned for agricultural use.
l Property which is owned and operated by nonprofit organizations used for equestrian activities, excluding racing.
l Game birds and waterfowl bred and raised for use on a shooting preserve.
l Insects primarily bred to be used as food for animals.
l Trees, grown for sale as a crop, and not sold for timber, lumber, wood or wood products.
l Maple syrup taken from trees grown by a person licensed by the Minnesota Department of Agriculture as a food processor.
l Enrollment in the Reinvest in Minnesota program or the federal Conservation Reserve Program.
l Leasing all or a portion of the property to another person for agricultural purposes.
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(s) upon whose life expectancy annuity payments are based. Multiple annuitants in an annuity contract are commonly referred to as joint annuitants or co-annuitants. Not all annuity payments are based upon a persons life expectancy. See term certain annuity. Annuitant sometimes refers to a person who receives periodic payments from an annuity.
Annuitization
The point in time when an annuity's settlement option is chosen.
Annuitization Phase
The second phase of a deferred annuity during which the owner chooses a periodic payment option, also called a settlement option. At the time the payment option is chosen, the owner chooses the amount of each payment, how often the payments are to be made, and the length of time over which the payments are to be made. Selecting the settlement option is referred to as annuitization or annuitizing the annuity (also called the Payout Phase).
Annuity
A purchased contract in which one party (annuity issuer) agrees to pay the purchaser, or the person(s) the purchaser designates (the payee or payees), a return on money deposited with the annuity issuer (either in the form of a single lump sum or several payments deposited over several months or years) according to the terms of the annuity contract.
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.
Annuity Issuer
A person or entity (an insurance company) that manages an annuity. The annuity issuer accepts funds from the owner(s) during the accumulation phase and issues payments after the funds have been annuitized. Banks and financial planners often sell annuity arrangements; however, insurance companies issue annuity-based financial arrangements.
Annuity Owner
Person(s) who may exercise rights provided in the annuity contract. For example, the owner(s) names the payee(s) who can be an owner or other parties, chooses the settlement option, and names the beneficiaries.
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 agencys 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 or 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.
Balloon Payment
A lump-sum payment scheduled at the end of a series of smaller periodic payments that is selected as part of a payment agreement.
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.
Battered Women's Shelter
A public or private nonprofit crisis shelter, housing network or other shelter facility providing services to battered women and their children.
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). For annuities, a beneficiary is the individual, trust, or entity named by the annuity owner to receive death benefits from an annuity.
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.
Board and Lodging Facility
A facility that serves as an alternative to institutionalization and provides a program of on-site care or supervision to persons who cannot live independently because of age or physical, mental or emotional disability.
Break in Long-Term Care (LTC) Services
A gap of one calendar month or more in receiving MA payment of LTC services because the individual either:
1. Became ineligible for MA payment of LTC services; or
2. Stopped residing in a LTC facility or receiving services through a home and community-based waiver program.
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).
Budget Period
See Certification Period.
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 weekday (Monday through Friday) that does not fall on a state holiday.
Buy-In
The process of having some or all of the clients Medicare costs paid through MA.
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.
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.
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), 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 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 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
Cash includes currency, checks, liquid assets, and money orders.
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, including an annuity owner, would receive if the policy were cashed in.
Cause of Action
A lawsuit.
CCRC
Continuing Care Retirement Community. An organization that enters into a written agreement with a client to offer 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.
CD
Certificate of Deposit. A promissory note issued by a bank entitling the bearer to receive interest. A CD is a time deposit that restricts holders from withdrawing funds on demand. Although it is still possible to withdraw money, this action will often incur a penalty.
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.
Certificate of Deposit (CD)
A promissory note issued by a bank entitling the bearer to receive interest. A CD is a time deposit that restricts holders from withdrawing funds on demand. Although it is still possible to withdraw money, this action will often incur a penalty.
Certification Period
The period of time (up to 12 months) for which eligibility is determined. The certification period may include any retroactive months of eligibility. It is also the period of time for which income is calculated to determine income eligibility and premium or spenddown amounts.
Certified MFPP Provider
A family planning services provider who is approved by DHS to make presumptive eligibility determinations for the Minnesota Family Planning Program.
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.
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.
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.
Coinsurance
An insured person's share of the cost of treatment. For example, if an insurance policy covers 80% of the cost, the coinsurance amount is 20%.
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), and Emergency Medical Assistance (EMA).
Combination LTC/Medical Spenddown
The difference between a clients long-term care (LTC) spenddown and the cost of the clients LTC or Elderly Waiver (EW) services. A client must have incurred medical expenses, in addition to the cost of LTC or EW services, in an amount equal to or greater than the combination LTC/medical spenddown to become eligible for MA.
Commercial Annuity
An annuity that is purchased and set up via an insurance company or financial institution licensed or regulated by the Minnesota Department of Commerce or a similar agency of another state.
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 waiver services (including EW, CAC, CADI, DD or TBI) who is married to an LTC spouse. A community spouse may or may not receive MA. A spouse who is separated from a LTC spouse is still a community spouse. Marriage only ends with divorce or the death of one spouse.
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 about individuals that even the individuals themselves cannot access, such as information from an investigation about welfare fraud or adoption records.
Conservator
A person, official, or institution appointed by the court to perform financial functions such as contracting, paying bills and investing assets for a minor or incapacitated person, known as the conservatee or protected person.
Continuing Care Retirement Community (CCRC)
An organization that enters into a written contract with a client to offer 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.
Coordinated Care Plan
These plans include a network of providers that contract with a Medicare Advantage organization to deliver a federally-approved benefit package.
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.
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 Effective Coverage
Other health care coverage for which the amount paid for premiums, coinsurance, deductibles, and other costs is likely to be less than the amount paid by MA or GAMC for equivalent services.
Cost-of-Living Adjustment (COLA)
An increase in income to compensate for inflation.
Cost-Sharing
An enrollee's financial responsibility for health care program coverage, such as a co-payment, coinsurance or premium.
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 enrollees MA or GAMC.
County of Service
The county responsible for servicing the Medical Assistance (MA) or General Assistance Medical Care (GAMC) case.
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, including an annuity 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.
Day Training and Habilitation (DT&H)
Services for adults with developmental disabilities that:
1) include supervision, training, assistance, and supported employment, work-related activities, or other community-integrated activities designed and implemented in accordance with the individual service and individual habilitation plans required under Minnesota Rules, parts 9525.0015 to 9525.0165, to help an adult reach and maintain the highest possible level of independence, productivity, and integration into the community; and
2) are provided under contract with the county where the services are delivered by a vendor licensed under sections 245A.01 to 245A.16 and 252.28, subdivision 2, to provide day training and habilitation services.
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 $1,000 deductible, he or she must incur $1,000 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 IRA
A qualified employer plan that maintains a separate account or annuity to receive voluntary employee contributions to facilitate employee retirement savings planning.
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 one-month suspension due to excess income.
Deferred Annuity
An annuity contract under which periodic payments will begin sometime in the future. A deferred annuity contract provides the purchaser with the opportunity to accumulate savings over an extended period before the contract enters its payout phase. A deferred annuity has two phases: 1) the accumulation phase; and 2) the annuitization phase (also called the payout phase).
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.
DHS-SIR
The DHS Systems Information Resource (SIR) provides system availability information, announcements, and targeted links and content. A login ID and password are required for access.
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.
DT&H
Day Training and Habilitation. Services for adults with developmental disabilities that:
1) include supervision, training, assistance, and supported employment, work-related activities, or other community-integrated activities designed and implemented in accordance with the individual service and individual habilitation plans required under Minnesota Rules, parts 9525.0015 to 9525.0165, to help an adult reach and maintain the highest possible level of independence, productivity, and integration into the community; and
2) are provided under contract with the county where the services are delivered by a vendor licensed under sections 245A.01 to 245A.16 and 252.28, subdivision 2, to provide day training and habilitation services.
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 cannot 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 factors. The eligibility group determines the eligibility requirements that apply to MinnesotaCare applicants and enrollees.
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.
Emergency Hold
A person has been admitted or held for emergency care and treatment due to mental illness, developmental disability or chemical dependency and is in danger of causing injury to self or others.
Emergency Shelter
A facility that provides shelter when an individual or family loses their housing due to an emergency, such as a fire, flood or condemnation.
Employer-Subsidized Insurance (ESI)
Insurance coverage offered to employees or dependents for whom the employer or union 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
On or after August 1, 2003: Estate is defined as the probate estate under Minnesota Statutes, Chapter 524, along with all of the person's interest established on or after August 1, 2003; or proceeds from those interests in real property owned by the person as a life tenant or joint tenant with the right of survivorship at the time of death, and to the extent the following interests become part of the probate estate, all interests or proceeds of those interests in securities owned by the person in beneficiary form and all interests in joint accounts, multiple party accounts, and pay on death accounts or proceeds of those accounts are subject to estate recovery. Prior to August 1, 2003: Estate is defined as described and used in Minnesota Statutes Chapter 524, Uniform Probate Code.
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.
Extra Help
A Medicare Part D cost-sharing subsidy program. Full-benefit, dual eligible enrollees are automatically eligible for the full Extra Help subsidy. Others may apply to the Social Security Administration for full or partial Extra Help subsidies.
Face Value (FV)
The policys 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.
Fiscal Year
A 12-month accounting period. The DHS fiscal year begins July 1and ends June 30. The fiscal year is designated by the calendar year in which it ends. For example, fiscal year 2009 is the year that begins July 1, 2008, and ends June 30, 2009.
Fixed Annuity
A type of annuity in which benefits have guaranteed or fixed dollar amounts.
FMV
Fair Market Value. The price an item would sell for on the open market in a local geographic area.
Food Stamps
Federal term for the Food Support program.
Food Support Program
Minnesota's name for the Food Stamp program, a U.S. Department of Agriculture programs that issues benefits in the form of electronic benefits to increase food purchasing power.
Foster Care
Care given to a child or adult including emergency, interim, or permanent care that cannot be furnished by a parent or legal guardian in the 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.
Fractional Transfer
A transfer with an uncompensated amount less than the SAPSNF.
Full-Benefit Dual Eligibles
People who are enrolled in both federally funded MA and Medicare. People gain full-benefit dual eligible status in the first month they are enrolled in both Medicare and federally funded MA. People enrolled in Medicare and MA with a spenddown gain full-benefit dual eligible status in the first month they meet the MA spenddown. Full benefit dual eligibles automatically qualify for Extra Help through the rest of the calendar year.
Full Team Developmental Disabilities (DD) Screening
Evaluation of the level of care needed by a person who is assessed as being at risk of placement in an intermediate care facility for the developmentally disabled (ICF/MR), nursing facility, or is requesting residential, training and habilitation, or family support services.
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.
FV
Face Value. The policy's death benefit (the amount paid out at the death of the insured) at the time a life insurance policy is purchased.