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.
MA
Medical Assistance. A Minnesota Health Care Program administered by county agencies that provides health care for needy people. People may receive MA as a separate program or in conjunction with an MSA grant. Known federally as Medicaid.
MA-BC
Medical Assistance for Breast and Cervical Cancer. An MA basis of eligibility for women who have been screened through the Sage Screening Program and found to need treatment for breast or cervical cancer.
MA-EPD
Medical Assistance for Employed Persons with Disabilities. Program which provides MA coverage to certain employed disabled people who would not otherwise be eligible.
Maintenance Needs Allowance
The amount of monthly income protected for people eligible under the SIS-EW program. It is determined by adding the MSA equivalent rate and the clothing and personal needs allowance and changes annually.
Managed Care
A health care delivery system under which enrollees receive most medical services through a health plan or network of providers which coordinates the services provided. DHS pays a fixed rate in advance for each enrollee.
Managed Care Organization (MCO)
An organization certified by the Minnesota Department of Health which agrees to provide all defined health care benefits to individuals in return for a capitated payment. MCOs are also referred to as "health plans."
Marriage
For health care program eligibility, marriage must be a union that is legally recognized in Minnesota (as defined in MN State Statute 517.01). See Chapter 17 of this manual (Household Composition) for further information.
Mass Change
A change brought about by a shift in federal or state policy which affects many or all clients.
Matching Grant Program
A program offered by some Voluntary Resettlement Agencies (VOLAGs). The program's goal is to help some refugees attain self-sufficiency without access to public cash assistance.
Maternity Home
A maternity home is a residential program for pregnant women that provides comprehensive services including health and wellness, safety, parenting and independent life skills.
MAXIS
Minnesota's statewide automated eligibility system for county-administered programs, including Food Support (FS), General Assistance (GA), General Assistance Medical Care (GAMC), Medical Assistance (MA), Minnesota Family Investment Program (MFIP), and Minnesota Supplemental Aid (MSA).
MCHA
Minnesota Comprehensive Health Association. A plan which provides health insurance to people who are otherwise uninsurable due to health conditions or other circumstances specified in statute.
MCO
Managed Care Organization. An organization certified by the Minnesota Department of Health which agrees to provide all defined health care benefits to individuals in return for a capitated payment. MCOs are also referred to as "health plans."
Medicaid
The federal program known in Minnesota as Medical Assistance (MA) which provides health care to needy people.
Medicaid Management Information System (MMIS)
Minnesota's statewide automated system for MinnesotaCare, and payment of medical claims and capitation payments for all Minnesota Health Care Programs.
Medical Assistance (MA)
A Minnesota Health Care Program administered by county agencies that provides health care for needy people. People may receive MA as a separate program or in conjunction with an MSA grant. Known federally as Medicaid.
Medical Assistance for Breast and Cervical Cancer (MA-BC)
An MA basis of eligibility for women who have been screened through the Sage Screening Program and found to need treatment for breast or cervical cancer.
Medical Assistance for Employed Persons with Disabilities (MA-EPD)
Program which provides MA coverage to certain employed disabled people who would not otherwise be eligible.
Medical Claim History
A listing of a client's medical expenses paid by the Minnesota Health Care Programs.
Medical Expense Account
An account which allows employees to set aside pre-tax dollars to be used to reimburse the employee for qualified medical expenses not covered by the employer’s health plan. Medical expense accounts are similar to un-reimbursed medical accounts and flexible spending accounts.
Medical Institution
A nursing facility, intermediate care facility for persons with mental retardation, or an inpatient hospital stay of 30 days or more.
Medical Support
Health insurance coverage or cash payments that a non-custodial parent provides or is court-ordered to provide to meet the medical needs of the non-custodial parent's child. Court orders generally require medical support payments until the child is 18 but may require payments beyond age 18 in some cases.
Medically Necessary
A health service rendered in response to a life-threatening condition or pain; to treat an injury, illness, or infection; to achieve a level of physical or mental function consistent with prevailing community standards for the diagnosis or condition; to care for a mother and child through the maternity period; is a preventative health service; or to treat a condition that could result in physical or mental disability. The provider's professional peer group must recognize the service as the prevailing standard or current practice and as consistent with the client's diagnosis or condition.
Medicare
A federal health insurance program for people who are age 65 or older, disabled, blind, or have permanent kidney failure.
Medicare Extension
A period of extended Medicare eligibility for some disabled people who lost their RSDI benefit because they earn more than the Substantial Gainful Activity (SGA) level.
Medicare Part D 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.
Medicare Savings Programs (MSP)
A collective term for the following MA programs: QMB, SLMB, QI and QWD. The MSPs provide payment for some Medicare premiums and other costs. Formerly known as the Medicare Supplement Programs.
Mental Retardation and Related Conditions (MR/RC)
The former name of the Developmental Disabilities (DD) waiver program.
METO
Minnesota Extended Treatment Option. A specialized short-term service designed to meet the needs of individuals with mental retardation or a related condition whose behavior or actions present a risk to public safety.
MFIP
Minnesota Family Investment Program. A program authorized under the federal Temporary Assistance to Needy Families (TANF) block grant and Minnesota Statutes 256J to provide cash assistance and employment support to needy families. MFIP replaced the Aid to Families with Dependent Children (AFDC) program.
MFPP
Minnesota Family Planning Program. A DHS-administered health care program that covers family planning services and related supplies for people who are not enrolled in Minnesota Health Care Programs.
MHCP
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, General Assistance Medical Care (GAMC), General Assistance Medical Care - Hospital Only (GHO), and Transitional MinnesotaCare.
Minnesota Comprehensive Health Association (MCHA)
A plan which provides health insurance to people who are otherwise uninsurable due to health conditions or other circumstances specified in statute.
Minnesota Extended Treatment Option (METO)
A specialized short-term service designed to meet the needs of individuals with mental retardation or a related condition whose behavior or actions present a risk to public safety.
Minnesota Family Investment Program (MFIP)
A program authorized under the federal Temporary Assistance to Needy Families (TANF) block grant and Minnesota Statutes 256J to provide cash assistance and employment support to needy families. MFIP replaced the Aid to Families with Dependent Children (AFDC) program.
Minnesota Family Planning Program (MFPP)
A DHS-administered health care program that covers family planning services and related supplies for people who are not enrolled in Minnesota Health Care Programs.
Minnesota Health Care Programs (MHCP)
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, General Assistance Medical Care (GAMC), General Assistance Medical Care - Hospital Only (GHO), and Transitional MinnesotaCare.
Minnesota Supplemental Aid (MSA)
A state-funded program that provides cash assistance to SSI recipients, blind people, people age 65 or older, and disabled people who are age 18 and older.
MinnesotaCare
A subsidized premium-based Minnesota Health Care Program for some families with children and some adults without children. It is administered by DHS and county agencies that elect to be MinnesotaCare enrollment sites. However, all county agencies, even non-enrollment sites, must administer the program for Transitional MinnesotaCare enrollees who transition to MinnesotaCare.
MinnesotaCare Operations
The organizational unit at DHS responsible for determining MinnesotaCare eligibility and providing case maintenance to clients.
Minor Caretaker
A non-emancipated child who is the parent of a child living in his/her household. For MHCP purposes a minor caretaker is under age 21. For medical support and social services referrals a minor caretaker is under age 18.
Minor Child
A child under age 18.
MMIS
Medicaid Management Information System. Minnesota's statewide automated system for MinnesotaCare, and payment of medical claims and capitation payments for all Minnesota Health Care Programs.
Month of Application
The month in which a client's application for coverage under the Minnesota Health Care Programs is received by MinnesotaCare or a county agency.
Monthly Reporting
The requirement to complete a Household Report Form (HRF) every month.
Mortality Tables
See Life Estate Mortality Table and/or Life Expectancy Table.
MSA
Minnesota Supplemental Aid. A state-funded program that provides cash assistance to SSI recipients, blind people, people age 65 or older, and disabled people who are age 18 and older.
MSP
Medicare Savings Programs. A collective term for the following MA programs: QMB, SLMB, QI and QWD. The MSPs provide payment for some Medicare premiums and other costs. Formerly known as the Medicare Supplement Programs.
Naturalized Citizen
A person who was not born in the United States, but who became a citizen by meeting legal requirements for citizenship and taking an oath of allegiance to the United States.
Net Income
Income remaining after subtracting each program's deductions and disregards from gross income.
Next Available Month - Managed Care
For initial managed care enrollment, the next available month is defined as the current month plus one if prior to managed care enrollment cut-off or the current month plus two if after managed care enrollment cut-off.
NMED
Noncitizens Medical Assistance. A state-funded program that provides MA coverage for some noncitizens who do not meet immigration status requirements for federally funded MA. NMED was enacted by the legislature in 1997 in response to the federal Personal Responsibility and Work Opportunity Act (PRWORA) of 1996. PRWORA brought about the end of federally funded MA for noncitizens with certain immigration statuses.
Non-Custodial Parent
A parent who does not have physical custody of a child.
Nonimmigrant
A noncitizen who seeks temporary entry to the United States for a specific purpose. The person must have a permanent residence abroad (for most classes of admission) and qualify for the nonimmigrant classification sought. The nonimmigrant classifications include foreign government officials, visitors for business and for pleasure, noncitizens in transit through the United States, treaty traders and investors, students, international representatives, temporary workers and trainees, representatives of foreign information media, exchange visitors, fiancé(e)s of U.S. citizens, intracompany transferees, NATO officials, religious workers, and some others.
Non-Liquid Asset
Property that has a cash value only when sold, or is not easily converted to cash such as a home, a vehicle or a piece of property.
Non-Reimbursable Medical Expense
An expense that is not eligible for payment under Minnesota Health Care Programs but that is prescribed or recommended in writing by the enrollee’s physician or dentist and of direct benefit to the enrollee and available but not necessarily obtained through a licensed medical provider. These expenses, which are medically necessary, may be used to meet a spenddown.
Noncitizen
A person present in the United States who has not attained U.S. citizenship by birth or naturalization.
Noncitizens Medical Assistance (NMED)
A state-funded program that provides MA coverage for some noncitizens who do not meet immigration status requirements for federally funded MA. NMED was enacted by the legislature in 1997 in response to the federal Personal Responsibility and Work Opportunity Act (PRWORA) of 1996. PRWORA brought about the end of federally funded MA for noncitizens with certain immigration statuses.
Notice of Privacy Practices
A statement of rights given to people who are asked to provide private or confidential data about themselves. The Notice of Privacy Practices was formerly referred to as ”r;Tennessen Notice,” ”r;Practices Rights Statement,” or ”r;Privacy Act Notice.”
Open Enrollment
A term used by managed care organizations, DHS, and other entities to designate a period during which a person may make a change in coverage or health plan enrollment.
Operating Assets
Assets used in a trade or business such as bank accounts, stocks, bonds, mutual funds, certificates of deposit, trusts or property agreements.
Overpayment
Benefits clients receive that exceed the amount for which they are eligible.
Parent
A child's legal biological or adoptive mother or father whose parental rights have not been terminated. MinnesotaCare also includes a stepparent as a parent.
Parental Fee
An amount assessed to the parents of a minor child as reimbursement for the cost of care of a child under 18 receiving MA without consideration of parental income.
Partnership
A self-employment enterprise in which two or more people share in the profits and losses of the business according to their individual shares of ownership.
PASS
Plan to Achieve Self Support. A plan approved by the county agency for MA or MSA recipients or approved by the Social Security Administration for SSI recipients which allows certain assets or income of the client to be excluded in determining benefits for some assistance programs.
Paternity
Legal fatherhood, either adjudicated or acknowledged by the father.
Pend
The status of an applicant whose eligibility has not yet been approved or denied.
Pending Awaiting Payment
To approve an application conditioned on the receipt of the initial premium payment. For MinnesotaCare, if an application is pending awaiting payment, then the household has been found eligible for MinnesotaCare but will not have coverage until the month after DHS receives the initial payment.
Pension
A fixed sum paid regularly to retired people or their dependents.
Person Master Index (PMI) Number
A unique identification number that MAXIS assigns to each person. The PMI number is used to verify a person's eligibility under the Minnesota Health Care Programs.
Personal Needs
See Clothing and Personal Needs Allowance.
Personal Property
Property that is not considered real property.
Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA)
Federal law signed on August 22, 1996 which eliminated the federal entitlement program AFDC and created a new program called Temporary Assistance for Needy Families (TANF). PRWORA provides block grants to states to offer time-limited cash assistance. It also made major changes in the Food Support Program and delinked eligibility for Medicaid from receipt of cash assistance.
PGAMC
Prepaid General Assistance Medical Care Program. The program through which GAMC managed care enrollees receive medical services. PMAP is sometimes used to refer to both PMAP and PGAMC.
Pickle Disregard
An unearned income disregard for some MA clients who lost eligibility for 1619(a), 1619(b), SSI or MSA and would remain eligible if RSDI cost-of-living increases are not counted in the client's net income total.
Plan to Achieve Self Support (PASS)
A plan approved by the county agency for MA or MSA recipients or approved by the Social Security Administration for SSI recipients which allows certain assets or income of the client to be excluded in determining benefits for some assistance programs.
PMAP
Prepaid Medical Assistance Program. The program through which MA managed care enrollees receive medical services. PMAP is sometimes used to refer to both PMAP and PGAMC.
PMI
Person Master Index Number. A unique identification number that MAXIS assigns to each person. The PMI number is used to verify a person's eligibility under the Minnesota Health Care Programs.
Post-Secondary School
A school serving students beyond the 12th grade, such as a community college, university, or technical college.
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.
Power of Attorney
A legal document authorizing one person to act on behalf of another.
Pre-Admission Screening Program (PAS)
Former term for Long-Term Care Consultation (LTCC).
Pre-Existing Condition
A medical condition existing before an insurance policy took effect. Some health insurance policies limit or exclude coverage for pre-existing conditions.
Premium
An amount paid, usually monthly, for a contract of insurance.
Prepaid General Assistance Medical Care Program (PGAMC)
The program through which GAMC managed care enrollees receive medical services. PMAP is sometimes used to refer to both PMAP and PGAMC.
Prepaid Medical Assistance Program (PMAP)
The program through which MA managed care enrollees receive medical services. PMAP is sometimes used to refer to both PMAP and PGAMC.
Presumptive Eligibility
A temporary period of eligibility that is determined at the point of service by certain health care providers using preliminary information. Presumptive eligibility is used in the Minnesota Family Planning Program (MFPP) and MA for Breast and Cervical Cancer (MA-BC).
Preventive Coverage
A term used by insurance companies to describe services provided to keep enrollees healthy and promote continuous health care. Preventive care includes services such as routine physical exams, immunizations, and prenatal care.
Primary Dwelling
The living structure in which an applicant or enrollee, requesting MA payment of LTC services, currently lives in or lived in immediately prior to receiving LTC services. A primary dwelling can be real or personal property, fixed or mobile and can be located on land or water.
PRISM
Minnesota's automated system for the establishment and enforcement of child and medical support.
Private Data
Data about individuals which can be disclosed only to the subject of the data or to government entities, employees, and contractors whose work assignments reasonably require access to the data.
Processing Period
The time program rules allow for processing an application.
Promissory Note
A written obligation to pay a specified indebtedness to a specified individual.
Protected Health Information
See Health Insurance Portability and Accountability Act (HIPAA).
PRWORA
Personal Responsibility and Work Opportunity Reconciliation Act. Federal law signed on August 22, 1996 which eliminated the federal entitlement program AFDC and created a new program called Temporary Assistance for Needy Families (TANF). PRWORA provides block grants to states to offer time-limited cash assistance. It also made major changes in the Food Support Program and delinked eligibility for Medicaid from receipt of cash assistance.
Public Data
Data which can be disclosed to anyone for any purpose, such as names and salaries of agency employees.
QI
Qualified Individual. A Medicare Savings Program which pays for the Medicare Part B premium.
QMB
Qualified Medicare Beneficiary. A Medicare Savings Program which pays for some Medicare expenses including premiums, co-payments and deductibles.
Qualified Individual (QI)
A Medicare Savings Program which pays for the Medicare Part B premium.
Qualified Medicare Beneficiary (QMB)
A Medicare Savings Program which pays for some Medicare expenses including premiums, co-payments and deductibles.
Qualified Noncitizen
A person who meets certain USCIS criteria has this legal status designation. Qualified noncitizens must meet all eligibility requirements. The qualified status does not give a noncitizen automatic MHCP eligibility or ensure federal funding. The person must meet one of the following: was lawfully admitted for permanent residence under the Immigration and Nationality Act (INA), or, was admitted to the U.S. as a refugee under section 207 of the INA, or, was granted asylum under section 208 of the INA, or, removal is being withheld under section 241(b)(3) of the INA (or deportation was withheld under section 243(h) as in effect prior to April 1, 1997), or, was paroled under section 212(d)(5) of the INA for a period of at least one year, or, was granted conditional entry pursuant to section 203(A)(7) of the INA as in effect prior to April 1, 1980, or, is a Cuban or Haitian entrant, or, is a battered noncitizen with an approved or pending petition for immigration status.
Qualified Working Disabled Adult (QWD)
A person eligible for payment of the Medicare Part A premium. The person cannot receive MA or QMB benefits.
Qualifying Work Quarter
Also referred to as "work credits" by the Social Security Administration (SSA), this is a measure of wage or self-employment earnings that SSA uses to determine Social Security benefits for people who have worked and paid Social Security taxes.
Quality Assurance
A performance evaluation system established by the Minnesota Legislature to review the accuracy of MinnesotaCare determinations.
Quality Control
A performance evaluation and reporting system established by Congress to review federal assistance programs including MA.
Quality Control Reviewer
The person designated by the state or federal government to conduct the Quality Control or Quality Assurance review according to federal and state standards.
QWD
Qualified Working Disabled Adult. A person eligible for payment of the Medicare Part A premium. The person cannot receive MA or QMB benefits.
RBA
Revocable Burial Agreement. A burial agreement which allows the value of the agreement to be cashed in by the purchaser at any time.
RCA
Refugee Cash Assistance. A program that provides financial help to refugees ineligible for both MFIP and SSI.
Real Property
Land, all buildings, structures, improvements, or other fixtures on it belonging or pertaining to the land and all mines, minerals, fossils, and trees on or under it. Also included are life estates and mobile homes that are attached to a foundation on land owned by the client.
Reasonable Compensation
Value received in exchange for transferred property which equals or exceeds the property's fair market value, less any encumbrances and sale costs.
Recertification
Former term for Renewal. The process to determine a household's continued eligibility for Minnesota Health Care Programs.
Recipient Amount
The amount of medical costs an enrollee must incur and be responsible to pay on the satisfaction date before MA will begin payment of other medical expenses.
Recognition of Parentage (ROP)
A DHS form (DHS-3159) that serves as legal acknowledgment of paternity. This form can only be signed after the child's birth and both of the parents' signatures must be notarized.
Redetermination Date
A system date used to identify when a renewal must be returned and processed. It is the last day of the month before the renewal month.
Referee
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 Human Services Judge. An appeal is also known as a fair hearing.
Refugee
A person who is a noncitizen who has permission to enter and live in the United States because of a well-founded fear of persecution in their home country due to race, religion, membership in a particular social group or political opinion.
Refugee Cash Assistance (RCA)
A program that provides financial help to refugees ineligible for both MFIP and SSI.
Refugee Medical Assistance (RMA)
A federally authorized program providing MA to refugees.
Refugee Unaccompanied Minor
A person who: is under 18 years of age (or 21, under state law on benefits to children who were in foster care at age 18) AND entered the United States unaccompanied by and not destined to (a) a parent, (b) a close non-parental adult relative who is willing and able to care for the child, or an adult with a clear and court verifiable claim to custody of the minor, AND has no parents in the United States. The U.S. Citizenship and Immigration Services (USCIS) determines Refugee Unaccompanied Minor status when a person enters the United States.
Regional Treatment Center (RTC)
State hospital for the treatment of mental diseases. RTCs are part of State Operated Services (SOS), which is the DHS division that manages and operates all state owned and operated facilities.
Reinstate
To restore coverage for a previously denied or closed time period.
Reinstatement Month
A MinnesotaCare term for the month following the month clients are closed for not paying their premium. Clients paying all billed payments by the due date in the reinstatement month will have coverage reinstated back to the effective date of closure.
Relative Caretaker
A caretaker of a dependent child who has one of the following relationships, or is the spouse of a person with one of the following relationships even if the marriage terminated by death or divorce: biological or adoptive parent, stepparent, grandparent, great-grandparent, great-great-grandparent, sister, stepsister, brother, stepbrother, aunt, great or great-great-aunt, uncle, great or great-great-uncle, nephew, niece, first cousin, first cousin once removed.
Remedial Care Expense
A deduction that can be used by a person who resides in a residential living arrangement to meet a medical spenddown or as a medical expense deduction in a LTC income calculation.
Renewal
The process to determine a household's continued eligibility for Minnesota Health Care Programs.
Renewal Month
The month for which eligibility is being renewed.
Representative Payee
A person or organization, selected by the Social Security Administration, who is designated to receive benefits on behalf of an RSDI or SSI recipient and is obligated to use those benefits for the RSDI or SSI recipient's personal care and well being.
Request for Coverage
Any written statement indicating that a person wants to apply for Minnesota Health Care Programs coverage that contains at least the applicant’s name and address or other means of contacting the applicant.
Residential Living Arrangement
Housing with services establishments such as group residential housing (GRH), assisted living, board and lodge, and corporate and foster care settings that have a GRH arrangement with a county.
Retirement, Survivors, and Disability Insurance (RSDI)
A program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people, and people with disabilities.
Retroactive Eligibility
Eligibility that is requested and determined for months prior to the month of application.
Revocable Burial Agreement (RBA)
A burial agreement which allows the value of the agreement to be cashed in by the purchaser at any time.
Revocable Trust
Allows the trustor to dissolve the trust. If the trust provides that the trust can be modified or terminated by a court it is considered to be a revocable trust since the grantor or his/her representative, can petition the court to terminate the trust.
RMA
Refugee Medical Assistance. A federally authorized program providing MA to refugees.
ROP
Recognition of Parentage. A DHS form (DHS-3159) that serves as legal acknowledgment of paternity. This form can only be signed after the child's birth and both of the parents' signatures must be notarized.
RSDI
Retirement, Survivors, and Disability Insurance. A program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people, and people with disabilities.
RTC
Regional Treatment Center. State hospital for the treatment of mental diseases. RTCs are part of State Operated Services (SOS), which is the DHS division that manages and operates all state owned and operated facilities.
Rule 24
Minnesota's Consolidated Treatment Fund.
Rule 31 Facility
Facility offering a rehabilitation program to five or more chemically dependent people at one time.
Rule 36 Facility
Facility offering residential care and program services to five or more mentally ill adults at one time.
Rule 78
A funding mechanism for community mental health grants. Rule 78 may fund placements in Rule 31 facilities or other living arrangements in the community.