Glossary G-L

*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***

Glossary G - L

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.

General Assistance. A program authorized under Minnesota Statutes 256D to provide cash assistance to needy individuals and couples without children.

A program authorized under Minnesota Statutes 256D to provide cash assistance to needy individuals and couples without children.

Also known as Open Enrollment. A term used by the insurance industry, as well as by DHS, for a time period during which a person can change coverage or enroll in a health plan.

The circumstances beyond a person's control which keep the person from following program requirements or specific eligibility conditions, such as premium payment or cooperation with medical support.

Group of people who evaluate, approve or deny good cause claims for medical and child support referrals.

A document which lists the merchandise and services the owner of a burial agreement has agreed to purchase from a funeral provider. A goods and services statement must accompany all burial agreements regardless of the funding source.

The individual who provides the trust corpus, also called a settler or trustor. The individual funding the trust is the grantor even if an agent (such as, power of attorney or conservator) establishes the trust with funds or property that belong to the individual and even in situations where the trust agreement shows a person legally empowered to act on the individual’s behalf as the grantor.

Group Residential Housing. A group living situation which has a fixed rate contract with a county to provide room and board for MSA or GA clients. This includes foster care settings. It does not include battered women's shelters or medical care (Title XIX) facilities.

Total earned and unearned income that is available before any deductions or disregards are applied.

The RSDI benefit amount before deducting the Medicare premium and other withholdings.

Other health care coverage that is available to individuals who are members of a defined group, such as eligible employees and former employees of a particular employer or members of a union and their eligible dependents. Group health care coverage also includes COBRA coverage.

A specialized facility providing 24-hour care for no more than 10 children, including the group home parents' own children under age 21.

A public or private non-profit facility certified under Section 1616(e) of the Social Security Act or a comparable state law or rule which serves no more than 16 people. This may include ICF/MRs.

A group living situation which has a fixed rate contract with a county to provide room and board for MSA or GA clients. This includes foster care settings. It does not include battered women's shelters or medical care (Title XIX) facilities.

A person appointed by the court to provide for the care, comfort and maintenance needs of a minor or incapacitated person who is known as the ward.

An account established at a financial institution in the name of a guardian who acts on behalf of and administers the funds for the benefit of a minor under age 18 or a person who is incapacitated or otherwise unable to handle financial transactions.

A place that provides a temporary residence for people waiting for an institutional placement or for people who have left an institution and are preparing to re-enter the community.

Health Care Application. A form which people can use to apply for Minnesota Health Care Programs.

A group of health coverage programs available through the State of Minnesota to people who qualify including: MinnesotaCare, Medical Assistance (MA) which includes QMB, QWD, SLMB, QI, MA-EPD, and federally funded waiver programs.

A DHS form (DHS-1922 or -1922B) used to gather other health care coverage information.

A federal law passed in 1996 that protects health insurance coverage for workers and their families when they change or lose their jobs. Title II Administration Simplification provides national uniformity of transaction coding and national identifiers for providers. Data privacy is included in Title II.

An organization licensed by the Department of Health to provide all defined health care benefits to people in return for a capitated payment.

An organization contracting with the State to provide health services to enrollees covered by a Minnesota Health Care Program in exchange for a monthly capitation payment. A health plan may be a HMO or other defined group of medical providers. Also referred to as a managed care organization (MCO).

An employer-established benefit plan where employees are reimbursed tax free for qualified medical expenses. These may be offered in conjunction with other employer-provided health benefits. Employees may not make contributions and the contribution cannot be paid through a voluntary salary reduction agreement. Only employers may make contributions to the HRA. See IRS Publication 969 for more information.

A tax-exempt trust or custodial account (an account managed for eligible employees by a custodian) that an individual sets up with a qualified HSA trustee to pay or reimburse certain medical expenses. To qualify for an HSA an individual must have a high deductible health plan. See IRS Publication 969 for more information.

The automated system for submitting health care program policy and procedural questions to DHS.

Sometimes referred to as a ”catastrophic” health insurance plan, an HDHP is an inexpensive health insurance plan that generally does not pay for the first several thousand dollars of health care expenses. It has a higher annual deductible than typical health plans and a maximum limit on the sum of the annual deductible and out-of-pocket medical expenses that an individual must pay for covered expenses. In 2012, the HDHP minimum annual deductible is $1,200 for individual coverage and $2,400 for family coverage. In 2012, the HDHP maximum annual deductible and other out-of-pocket expenses is $6,050 for individual coverage and is $12,100 for family coverage. A HDHP is required to have a Health Savings Account. See IRS Publication 969 for more information.

Health Insurance Information Form. A DHS form (DHS-1922 or -1922B) used to gather other health care coverage information.

A federal act that gives hospitals and other health facilities money to build and remodel in return for providing a limited volume of services to people living in their area who cannot pay for health care.

Health Insurance Portability and Accountability Act. A federal law passed in 1996 that protects health insurance coverage for workers and their families when they change or lose their jobs. Title II Administration Simplification provides national uniformity of transaction coding and national identifiers for providers. Data privacy is included in Title II.

Property an applicant or enrollee owns in whole or in part or has an ownership interest in, and in which he or she occupies, or occupied immediately prior to receiving LTC services, as the primary dwelling. A home includes the primary dwelling, all surrounding land and any building on that land, provided the land is not separated from the dwelling by property owned by another person. Land separated from the dwelling by a public right-of-way is included in the definition of the home.

Services not normally covered by MA which are covered under a waiver program, including case management, homemaker services, home health aide, personal care, adult day health treatment, habilitation, respite care, and day treatment for individuals with chronic mental illness. Also known as waivered services.

A benefit that offers comfort, care, and support to clients who are terminally ill with a life expectancy of less than six months. It also provides support to the client's family.

Each day an LTCF is eligible for MA payment even though the client has transferred to an inpatient hospital for medically necessary health care.

A form (DHS-2120) used by enrollees to report changes in income, assets and circumstances.

Items of personal property found in or near a home that are used on a regular basis; items needed by the household for maintenance, use and occupancy of the premises as a home.

The number of people included in a health care household. This number is used to determine income and asset eligibility and premium amount, if applicable.

A community living arrangement commonly referred to as assisted living, that provides supportive services.

Household Report Form. A form (DHS-2120) used by enrollees to report changes in income, assets and circumstances.

A person who presides over an appeal hearing and issues a recommendation on the appealed matter to the Commissioner of DHS. Also known as a Referee. An appeal is also known as a fair hearing.

Irrevocable Burial Agreement. A burial agreement with an unalterable assignment to any funeral home. The irrevocable portion of this type of agreement cannot be withdrawn before the depositor’s death.

Interstate Compact on Adoption and Medical Assistance. The Interstate Compact on Adoption and Medical Assistance (ICAMA) is a federal contract between Minnesota and other states designed to prevent and overcome barriers to interstate adoptions and to coordinate services to adopted children with special needs.

Intermediate Care Facility for the Developmentally Disabled. A residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for persons with developmental disabilities who require active treatment.

Individual Development Account. A special bank account established under the Family Assets for Independence in Minnesota (FAIM) program that helps a person save for education, purchase of a first home, or to start a business. Eligible people must have earned income and have low income and assets.

Income and Eligibility Verification System. A set of data exchanges with other state and federal sources used to verify income and assets of MA applicants and enrollees.

Insurance-Funded Burial. A life insurance policy with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the policy is to be paid to a funeral provider in exchange for agreed-upon goods and services.

Institution for Mental Diseases. A facility for the treatment of mental diseases.

An annuity contract under which the periodic payments will begin within one payment interval following the payment of the annuity premium. A payment interval is the period that will elapse between payments (a month, a calendar quarter, a year).

Any person, or public or private agency or organization, who signed an affidavit agreeing to support an immigrant (who is not the dependent child or the spouse of the sponsor) as a condition of the immigrant's entry into the U.S. Also referred to as Sponsor.

The Act (INA) which, along with other immigration laws, treaties, and conventions of the United States, relates to the immigration, temporary admission, naturalization, and removal of aliens.

The former name of U.S. Citizenship and Immigration Services (USCIS). The federal agency responsible for immigration and citizenship.

Immigration and Nationality Act. The Act (INA) which, along with other immigration laws, treaties, and conventions of the United States, relates to the immigration, temporary admission, naturalization, and removal of aliens.

A set of data exchanges with other state and federal sources used to verify income and assets of MA applicants and enrollees.

Also known as Certification Period. The period of time a client can be active 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.

Also known as Six-Month Renewal. A review of income and/or assets to redetermine program eligibility for the next six-month period.

The method through which child support payments are made for most employed non-custodial parents. The non-custodial parent's employer must withhold the child support amount from the non-custodial parent's paycheck. The employer can either mail that amount to the Child Support Payment Center in St. Paul or electronically transfer the funds to the state.

Data or other information received that does not match the information provided by the client or other information on file.

An insurance policy that pays benefits directly to people for each day of hospitalization or for a specified injury. Indemnity payments may cover costs not covered by other insurance but do not always limit benefits to paying for medical expenses. Consider indemnity payments as third party liability unless the insurance company designates them as income replacement.

A special bank account established under the Family Assets for Independence in Minnesota (FAIM) program that helps a person save for education, purchase of a first home, or to start a business. Eligible people must have earned income and have low income and assets.

Other health care coverage that individuals can purchase for themselves and their dependents without having to be part of a defined group.

An Individual Retirement Arrangement (IRA) held in the form of a trust or account is commonly referred to as a Traditional IRA.

An umbrella term used to describe a personal savings plan that provides the owner tax advantages for setting aside money for retirement. IRAs can be in the form of a trust, an account, or an annuity.

For MinnesotaCare, the first month in which an individual or household has MinnesotaCare coverage. The initial enrollment month does not change unless there is a break in coverage of more than one full calendar month. For managed care, this term refers to the first time an individual is enrolled in a managed care organization (MCO).

The first monthly premium payment which an applicant must make before coverage begins.

Payment for a service in a form other than money, or receipt of non-cash gifts or non-cash contributions such as food or clothing.

A person admitted to a hospital. Inpatient applies to a person temporarily absent from the hospital with the approval of a physician. Inpatient does not apply to a person absent from the hospital against medical advice.

Immigration and Naturalization Service. The former name of U.S. Citizenship and Immigration Services (USCIS). The federal agency responsible for immigration and citizenship.

A program or facility providing food, shelter and some care to four or more people. An institution may include medical facilities, residential treatment programs and group homes. It also includes foster care homes, with the exception for children receiving IV-E foster care and adoption assistance.

A level of care that is equivalent of what would be received in a nursing facility, a hospital, or an intermediate care facility for the developmentally disabled (known as an ICF/DD).

Eligibility criteria which govern when an applicant or enrollee may have other health coverage or access to other health coverage currently or during a specified period.

A life insurance policy with an irrevocable designation of the cash surrender value (CSV) to a funeral provider as the primary beneficiary. The value of the policy is to be paid to a funeral provider in exchange for agreed-upon goods and services.

Latin for ”between the living.” An inter vivos transfer, for example, is a transfer made during one’s lifetime as opposed to a testamentary transfer, which takes effect at the grantor’s death.

Money charged as a borrower's fee on a loan or money earned and paid to the holder of a bank account, loan, or other investment. Earned interest may be credited to the account or paid directly to the owner.

A residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for persons with developmental disabilities who require active treatment.

The agreement between Minnesota and North Dakota to help resolve residence disputes that addresses state financial responsibility for MA eligibility for long-term care.

The Interstate Compact on Adoption and Medical Assistance (ICAMA) is a federal contract between Minnesota and other states designed to prevent and overcome barriers to interstate adoptions and to coordinate services to adopted children with special needs.

An agreement among all 50 states that coordinates the movement of children across state lines for the purpose of placement in foster care, adoptive homes, group homes, residential treatment centers, or on a trial basis with a parent. See DHS web site for more information.

Income Review. Also known as Six-Month Renewal. A review of income and/or assets to redetermine program eligibility for the next six-month period.

Individual Retirement Arrangement. An umbrella term used to describe a personal savings plan that provides the owner tax advantages for setting aside money for retirement. IRAs can be in the form of a trust, an account, or an annuity.

A burial agreement with an unalterable assignment to any funeral home. The irrevocable portion of this type of agreement cannot be withdrawn before the depositor’s death.

A trust that may not be revoked after its creation by the grantor or the grantor’s representative.

A state, county, or private agency that is responsible for establishing paternity and collecting child support and medical support according to Title IV-D of the Social Security Act. In Minnesota, the IV-D agency is a unit within a county agency.

Adoption assistance placements funded under Title IV-E of the Social Security Act.

An ownership agreement in which two or more people own the same piece of property. Different types of joint ownership include but are not limited to joint tenancy and tenants-in-common.

Each owner has one and the same interest and must obtain the permission of the other joint owners in order to sell their share.

A tax deferred pension plan available to self-employed individuals or unincorporated businesses for retirement purposes. A Keogh plan can be set up as either a defined-benefit or defined-contribution plan, although most plans are defined-contribution plans.

An immigrant legally admitted to the U.S. on a permanent basis under the U.S. Immigration and Nationality Act.

A nonimmigrant legally admitted to the U.S. on a temporary basis under the U.S. Immigration and Nationality Act.

A noncitizen who is present in the United States in accordance with immigration laws, who has not violated the terms of his or her status. Lawfully present noncitizens include, but are not limited to Refugees, Asylees, Victims of Trafficking, Lawful Permanent Residents (LPRs), battered noncitizens, Lawful Temporary Residents, Parolees, people with a pending immigration status, and Temporary Protected Status.

Life Care Community. An organization that contractually offers a range of continuing care services while providing flexible accommodations, which may change with the client's needs. An LCC may also be referred to as a continuing care retirement community (CCRC).

The health plan, county or tribal agency staff person who provides case coordination or case management services.

A person who is granted legal custody of a minor child by the court but who does not have legal guardianship.

Any instrument that exhibits the general characteristics of a trust, but is not called a trust, is treated in the same way for MA purposes as a trust. This can include, but is not limited to, escrow accounts, investment accounts, pension funds and other similar devices managed by an individual or entity with fiduciary obligations.

Limited English Proficiency. People with limited English proficiency, or ”LEP,” are not able to speak, read, write, or understand the English language well enough to allow them to interact effectively with health and social services agencies and other providers.

Life Insurance. A type of policy which pays a beneficiary a designated sum upon the death of the insured person. There are two basic forms of life insurance policies: term and non-term.

A legal claim against property for the satisfaction of a debt. The lien is paid off at the time the property is sold.

An organization that contractually offers a range of continuing care services while providing flexible accommodations, which may change with the client's needs. An LCC may also be referred to as a continuing care retirement community (CCRC).

An interest in real property held only for the duration of a specified person’s life (usually for the life of the person or people who have the life estate interest). A life estate is a form of legal ownership that is usually created through a deed, will, or by operation of law.

An interest in real property that is limited to the duration of the lifetime of a specified person or people.

A table used to compute the value of a life estate based on a person's age. It is issued by the Social Security Administration.

The person with an interest in real property subject to the duration of a specified person's life. Unless the instrument establishing the life estate places restrictions on the rights of the life estate owner(s), the life estate owner has the right to possess, use and obtain profits from the property and to sell the life estate interest. The life estate owner cannot take any action concerning the interest of the remainderman. A life estate owner is also referred to as ”r;life tenant” or ”r;tenant for life.”

A chart used to determine whether annuitizing an annuity is a transfer for less than fair market value. It is issued by the Social Security Administration.

A type of policy which pays a beneficiary a designated sum upon the death of the insured person. There are two basic forms of life insurance policies: term and non-term.

People with limited English proficiency, or ”LEP,” are not able to speak, read, write, or understand the English language well enough to allow them to interact effectively with health and social services agencies and other providers.

Cash or other types of assets that can be easily converted to cash, such as bank accounts, stocks, bonds, certificates of deposit, some retirement accounts and money market accounts.

A screening program that prevents inappropriate nursing home or boarding care placement.

A place such as a skilled nursing facility, Intermediate Care Facility for the Developmentally Disabled (ICF/MR) or medical hospital in which the individual receives skilled nursing services. Group Residential Housing (GRH) and Housing with Services Establishments are not long-term care facilities.

LTC services include skilled nursing facility (SNF) care, nursing facility care in an inpatient medical hospital or intermediate care facility (ICF, ICF/DD), or services covered by home and community-based waiver programs (CAC, CADI, DD, EW, and BI).

Amount of income an enrollee is responsible for paying toward the cost of LTC services as determined by a LTC income calculation.

l resides in a long-term care facility (LTCF) and has resided, or is anticipated to reside, in an LTCF for at least 30 consecutive days, or

l requests services through the Elderly Waiver (EW) or Alternative Care (AC) programs and has received a long-term care consultation (LTCC) that demonstrates the individual requires an institutional level of care and the individual has received, or is anticipated to receive, EW or AC services for at least 30 consecutive days.

A specific period for evaluating transfers prior to the date a person requests MA payment of LTC services.

Lawful Permanent Resident. An immigrant legally admitted to the U.S. on a permanent basis under the U.S. Immigration and Nationality Act.

Long-Term Care Consultation. A screening program that prevents inappropriate nursing home or boarding care placement.

Long-Term Care Facility. A place such as a skilled nursing facility, Intermediate Care Facility for the Developmentally Disabled (ICF/DD) or medical hospital in which the individual receives skilled nursing services. Group Residential Housing (GRH) and Housing with Services Establishments are not long-term care facilities.

Lawful Temporary Resident. A nonimmigrant legally admitted to the U.S. on a temporary basis under the U.S. Immigration and Nationality Act.

Cash received on a non-recurring or irregular basis that cannot be reasonably anticipated. Examples of lump sums include winnings, insurance settlements, inheritances, and retroactive payments of RSDI.

Glossary	Effective: September 1, 2012
Glossary G-L	Archived: June 1, 2016 (Previous Versions)