Sec. 10.09.11.02. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Affordable Care Act” means the Patient Protection and Affordable Care Act of 2010 (Pub.L.111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub.L.111-152), as amended by the Three Percent Withholding Repeal and Job Creation Act (Pub.L.112-56).

(2) Applicant.

(a) "Applicant" means an individual whose written application for the Maryland Children's Health Program has been submitted to the local health department or the local department of social services but has not received final action.

(b) "Applicant" includes an individual whose application is submitted through a representative.

(3) "Application" means the filing of a written, telephonic, or electronic signed application for health coverage in an Insurance Affordability Program to the Department or its designee.

(4) "Application date" means the date on which a written, telephonic, or electronic signed application is received by the Department or its designee.

(5) “Authorized Representative” has the meaning stated in COMAR 10.01.04.12.

(6) "Child" means an individual younger than 21 years old.

(7) "Child recipient" means a child younger than 19 years old who is certified as eligible for the Program.

(8) “Children’s Health Insurance Program” means the program for uninsured targeted low-income children established under Title XXI of the Social Security Act.

(9) "Department" means the Maryland Department of Health.

(10) “Designee” means any entity designated to act on behalf of the Department such as:

(a) Baltimore City or a county social services department under the supervision of the Department of Human Services;

(b) Baltimore City Health Department and its subgrantees, or a county health department; and

(c) The Maryland Health Benefit Exchange.

(11) "Determination" means a decision regarding an applicant's eligibility for the Maryland Children's Health Program.

(12) "Eligibility worker" means an employee of the local health department, or the local department of social services, responsible for determining the eligibility of applicants and recipients.

(13) Emergency Medical Condition.

(a) "Emergency medical condition" means a condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(b) "Emergency medical condition" includes labor and delivery.

(c) "Emergency medical condition" does not include services related to an organ transplant procedure.

(14) "Family members" means those individuals living with the applicant whose income is counted, or would be counted if there were any, as household income under Regulation .07B of this chapter.

(15) "Federal poverty level" means the nonfarm income official poverty level as defined by the Office of Management and Budget and revised annually in accordance with §673(2) of the Omnibus Budget Reconciliation Act of 1981.

(16) "Inpatient services" means services received by a recipient while in a medical institution, birthing center, or clinic for which Medical Assistance is provided.

(17) "Institution for mental diseases" means an institution which falls within the jurisdiction of Health-General Article, §19-307(a)(1), Annotated Code of Maryland, and is licensed under COMAR 10.07.04.

(18) “Insurance Affordability Program” means a program that is one of the following:

(a) The Maryland State Medicaid program;

(b) The Maryland Children’s Health Insurance Program (CHIP), including the program known as Maryland Children’s Health Program (MCHP) Premium;

(c) An optional state basic health program established under §1331 of the Affordable Care Act;

(d) A program that makes available to qualified individuals coverage in a qualified health plan through the Maryland Health Benefit Exchange with advance payments of the premium tax credit established under §36B of the Internal Revenue Code; or

(e) A program that makes available coverage in a qualified health plan through the Maryland Health Benefit Exchange with cost-sharing reductions established under §1402 of the Affordable Care Act.

(19) "Living together" means sharing a common household.

(20) "Local health department (LHD)" means the Baltimore City Health Department and its subgrantees, or a county health department.

(21) ”MAGI” means modified adjusted gross income, as calculated for purposes of determining eligibility for insurance affordability programs under the Affordable Care Act.

(22) “MAGI Exempt Coverage Group” means coverage groups such as Aged, Blind, Disabled; Categorically Needy; and Medically Needy as defined under COMAR 10.09.24.02, whose eligibility is not determined by MAGI.

(23) "Maryland Children's Health Program (Program)" means the program established in Health-General Article, §15-301 et seq., Annotated Code of Maryland, to provide comprehensive medical care and other health care services to certain children.

(24) “Maryland Health Benefit Exchange” means the unit of State government that determines initial and continuing eligibility for the MAGI based insurance affordability programs, including, by delegation, certain eligibility in the program.

(25) "Maryland Medicaid Managed Care Program" means the Health Choice Program authorized by:

(a) Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland; and

(b) A waiver issued by the federal government under §1115 of the Social Security Act.

(26) "Medical Assistance (Medicaid)" means the program administered by the State under Title XIX of the Social Security Act which provides comprehensive medical and other health-related care for eligible individuals.

(27) "Period under consideration" means the specific months which are assessed in order to determine eligibility.

(28) Public Institution.

(a) "Public institution" includes an:

(i) Institution that is the responsibility of a government unit or over which a government unit exercises administrative control; or

(ii) An establishment that furnishes, in single or multiple facilities, food, shelter, and some treatment or services to four or more individuals unrelated to the proprietor.

(b) "Public institution" does not mean a medical institution, a skilled nursing facility, or a publicly operated community residence that serves not more than 16 residents.

(29) "Qualified alien" means an individual who:

(a) Has been fully admitted for permanent residence in the United States under the Immigration and Nationality Act (INA);

(b) Has been granted asylum in the United States as a refugee under §208 of the INA;

(c) Has been admitted into the United States as a refugee under §207 of the INA;

(d) Has been paroled into the United States under §212(d)(5) of the INA for a period of at least 1 year;

(e) Has had deportation withheld under §243(h) of the INA;

(f) Has been granted conditional entry into the United States under §203(a)(7) of the INA which was in effect before April 1, 1980;

(g) Is a documented or undocumented immigrant who has been battered or subjected to extreme cruelty by the individual's U.S. citizen or lawful permanent resident spouse or parent, or by a member of the spouse's or parent's family residing in the same household as the alien, if:

(i) The spouse or parent consented to, or acquiesced in, the battery or cruelty;

(ii) The immigrant has filed a Violence Against Women Act (VAWA) immigration case or a family-based visa petition with Immigration and Naturalization Service (INS); and

(iii) In the opinion of the agency providing benefits, there is a substantial connection between the battery or cruelty and the need for the benefits to be provided;

(h) Is a victim of a severe form of trafficking who has been subjected to:

(i) Sex trafficking if the act is induced by force, fraud, or coercion, or the individual induced to perform the act is younger than 18 years old; or

(ii) Involuntary servitude;

(i) Is a member of a federally recognized Indian tribe, as defined in 25 U.S.C. §450b(e); or

(j) Is an American Indian born in Canada to whom §289 of the INA applies.

(30) "Recipient" means an individual who is certified as eligible for the Maryland Children's Health Program.

(31) "Redetermination" means a determination regarding the continuing eligibility of a recipient.

(32) "Spouse" means an individual who has been determined to be the husband or wife of another person under State law and for the purpose of determining eligibility for Social Security benefits.

(33) "Title XIX" means the title of the Social Security Act, 42 U.S.C. §1396 et seq., which governs establishment of a medical assistance program for low income individuals.

(34) "Title XXI" means the title of the Social Security Act through which funding is provided, in part, for the Maryland Children's Health Program.