Authorized Representative — For medical programs, the individual designated by an applicant or recipient to:
- sign an application on the applicant’s behalf,
- complete and submit a renewal form,
- receive copies of the applicant’s/individual’s notices and other communications from the agency, and
- act on behalf of the applicant/individual in all other matters with the agency.
Applicant — A person seeking benefits under MEPD who is not currently receiving MEPD services.
Applied Income – See Co-payment.
Certification — HHSC's official authorization of approved eligibility.
Community Spouse — The spouse of an institutionalized spouse who is not living in a setting that provides medical care and services.
Co-payment — The amount of personal income a person must pay toward the cost of his or her care. Co-payment was also known as the applied income
DAC — Disabled adult child.
Excluded — Income or resources not counted for the purpose of determining eligibility only.
Exempt — Income or resources not counted for the purpose of determining eligibility or calculating a co-payment.
HHSC — The Texas Health and Human Services Commission
Income — Any item a person receives in cash or in-kind that can be used to meet his or her need for food or shelter. For purposes of determining MEPD financial eligibility, income includes the receipt of any item that can be applied, either directly or by sale or conversion, to meet the basic needs of food or shelter.
Institutional Setting — A living arrangement in which a person applying for or receiving Medicaid lives in a Medicaid-certified long-term care facility or receives services under a Home and Community-Based Services waiver program. Formerly known as a vendor living arrangement.
Liquid Resource — Cash or other property that can be converted to cash within 20 working days.
Long-Term Care Facility — A nursing facility, ICF/IID or IMD in which medical services are provided.
Medicaid — A state and federal cooperative program, authorized under Title XIX of the Social Security Act (42 U.S.C. §1396 et seq.) and Chapter 32 of the Texas Human Resources Code, that pays for certain medical and health care costs for people who qualify. Also known as the medical assistance program.
Medical Necessity (MN) — The determination that a person requires the services of a licensed nurse in an institutional setting to carry out a physician's planned regimen for total care.
Medicare — Medical coverage available under Title XVIII of the Social Security Act to people age 65 or older and to certain people with disabilities under age 65.
MEPD — Medicaid for the Elderly and People with Disabilities. A public assistance program providing medical assistance, institutional and community-based health-related care, and Medicare cost-sharing assistance for the elderly and people with disabilities. MEPD does not provide cash assistance. Examples of MEPD services and programs are:
- primary home care services;
- Home and Community-Based Services waiver programs, which provide community-based care as an alternative to institutional care;
- care in a Medicaid-certified long-term care facility;
- the Program of All-Inclusive Care for the Elderly (PACE);
- Medicaid Buy-In programs; and
- Medicare Savings Programs.
Miller Trust— also known as a Qualified Income Trust. Irrevocable trust established for the benefit of an individual or their spouse, the corpus of which is composed of only the individual’s income.
Nursing Facility (NF) — An entity that provides organized and structured nursing care and services, and is subject to licensure under Texas Health and Safety Code, Chapter 242.
Personal Needs Allowance (PNA) — An amount of the recipient's income that a recipient in an institutional setting may retain for personal use.
QIT — Qualified income trust. See also Miller Trust. Typically used to overcome the state’s income limit for MEPD eligibility for Institutional Medicaid programs
Resources — Cash, other liquid assets, or any real or personal property, that a person (or spouse or parent, as appropriate):
- has the right, authority or power to convert to cash (if not already cash); and
- is not legally restricted from using for his or her support and maintenance.
Retirement, Survivors, and Disability Insurance (RSDI) — Federal benefits (Social Security Check) provided under Title II of the Social Security Act to workers, their dependents, and survivors. Also known as "Old Age, Survivors and Disability Insurance Program” (OASDI).
Retroactive Coverage – See Three Months Prior.
SPRA — Spousal Protected Resource Amount. An assessment is done to determine the portion of total resources reserved for the community spouse.
Spouse — A person who is legally married or considered common law married to another person.
Three Months Prior — The three calendar months before the month of application. Also known as retroactive coverage.
VA — U.S. Department of Veterans Affairs.