The date that the hospital district issues Form 109, Notice of Eligibility, and HCAP Form 110,  Identification Card, is issued to the client.

Assets

All items of monetary value owned by an individual.

Budgeting

The method used to determine eligibility by calculation income and deductions using the best estimate of the household's current and future circumstances and income.

 Candidate

Person who is applying for  benefits who has NEVER been on the plan before.

HCFA-1500, UB-92, or pharmacy statement.

The date that the county writes a check to pay a claim.

Client

Eligible resident who is actively receiving healthcare benefits.

Common Law Marriage

Relationship in which the parties age 18 or older are free to marry, live together , and hold out to the public that they are husband and wife.  A man and a woman who want to establish a common-law marriage must sign a form provided by the county clerk.  In addition, they must:

1. agree to be married,

2. cohabit,

3. represent to others that they are married.

A minor child in Texas is not legally allowed to enter a common law marriage unless the claim of common law marriage began before September 1, 1997.

A complete application includes validation of these components:

• The applicant's full name and address.

• The names of everyone who lives in the house with the applicant and their relationship to the applicant.

• The type and value of the household's resources.

• Information about any health care assistance that household members may receive.

• The applicant's Social Security number.

• The applicant's/spouse's signature with the date the Form 100 is signed.

• All needed information, such as verifications.

If the applicant is married and his spouse is a household member, the spouse must also sign and date the Form 100 even if the spouse is a disqualified household member.

The date that Form 100 and all information necessary to make an eligibility determination is received is the application completion date.

Co-payments

The amount requested from the client to help contribute to their healthcare expenses.  Also known and referenced as "co-pays" in some documents.

• A county not fully served by a public facility, namely, a public hospital or a hospital district; or

• A county that provides indigent health care services to its eligible residents through a hospital established by a board of managers jointly appointed by a county and a municipality.

DADS

The Texas Department of Aging and Disability Services (DADS) was established as a result of House Bill 2292 which consolidated:

• mental retardation services and state school programs of the Department of Mental Health and Mental Retardation

• community care, nursing facility, and long-term care regulatory services of the Department of Human Services, and

•  aging services and programs of the Department of Aging

DARS

The Department of Assistive and Rehabilitative Services, or DARS, administers programs that ensure Texas is a state where people with disabilities, and children who have developmental delays, enjoy the same opportunities as other Texans to live independent and productive lives. 

All days are calendar days, except as specifically identified as workdays.

Denial Date

The date that Form 117, Notice of Ineligibility, is issued to the candidate.

DHS

Department of Human Services

Disabled Person

Someone who is physically or mentally unfit for employment.  This includes:

• A person approved for SSI, Social Security disability, or blindness.

• A veteran who receives VA benefits because he/she is rated a100% service-connected disability or who according to the VA needs regular aid and attendance or is permanently housebound.

• A surviving spouse of a deceased veteran who meets one of the following criteria according to the VA:

1. Needs regular aid and attendance

2. Permanently housebound

3. Approved for VA benefits because of the veteran's death and could be considered permanently disabled for social security purposes.             

• A surviving child (any age) of a deceased veteran who the VA has determined is:

1. Permanently incapable of self-support, or

2. Approved for benefits because of the veteran's death and could be considered permanently disabled for social security purposes.

• A person receiving disability retirement benefits from any government agency for a disability that could be considered permanent for social security purposes.

• A person receiving Railroad Retirement Disability, who is also covered by Medicare.

Note: Permanent disability for Social Security purposes is any of the following condiitons that may be obvious by observation or may require a physician's opinion:

• Permanent loss of use of both hands, both feet, or one hand and one foot;

• Amputation of leg at hip;

• Amputation of leg or foot because of diabetes mellitus or peripheral vascular diseases;

• Total deafness, not correctable by surgery or hearing aid;

• Statutory blindness, unless caused by cataracts or detached retina;

• IQ 59 or less, established after the person becomes 16 years old;

• Spinal cord or nerve root lesion resulting in paraplegia or quadriplegia;

• Multiple sclerosis in which there is damage to the nervous system caused by scattered areas of inflammation.  The inflammation recurs and has progressed to varied interferences with the function of the nervous system, including severe muscle weakness, paralysis, and vision and speech defects.

• Muscular dystrophy with irreversible wasting of the muscles, impairing the ability to use arms or legs;

• Impaired renal function caused by chronic renal disease, resulting in severely reduced function which may require dialysis or kidney transplant;

• Amputation of a limb of a person at least 55 years old;

• Acquired Immune Deficiency Syndrome (AIDS) progressed so that it results in extensive and/or recurring physical or mental impairment.

Disproportionate Share Hospital program

The DSH program reimburses hospitals serving large numbers of Medicaid beneficiaries, uninsured patients, and patients with no means to pay for care. A state makes a DSH payment to a hospital to help the hospital cover the additional costs of providing care to Medicaid patients that are not otherwise paid through Medicaid or the costs of providing care to patients unable to pay. The federal government then reimburses the state for a portion of the payment made to the hospital.

Domicile

A residence.

DSHS

Department of State Health Services

Earned Income

INcome a person receives for a certain degree of activity or work.  Earned income is related to employment and, therefore, entitles the person to work-related deductions not allowed for unearned income.

ECI

ECI is a statewide program for families with children, birth to three, with disabilities and developmental delays. ECI supports families to help their children reach their potential through developmental services. Services are provided by a variety of local agencies and organizations across Texas.

The date that a household’s eligibility begins.

The date that a household’s eligibility ends.

Emancipated Minor

A person under age 18 who has been married.  The marriage must not have been annulled.

Emergency Medical Condition

A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical atteniotn could reasonably be expected to result in:

• Placing the patient's health in serious jeopardy,

• Serious impairment of bodily functions, or

• Serious dysfunction of any bodily organ or part.

Equity

The amount of money that would be available to the owner after the sale of a resource.  Determine this amount by subtracting from the fair market value any money owed on the item and the costs normally associated with the sale and transfer of the item.

Funds spent on basic or department-established optional health care services.

A county should track monthly basic and department-established optional health care expenditures.

Extended Services

County or district approved, extended health care services that the district determines to be necessary and cost-effective and chooses to provide.

FMV

Fair market value; the amount a resource would bring if sold on the current local market.

FPIL

Federal Poverty Income Limit. Click here for FPIL by program.

Gross Income

Income before deductions.

A county, municipality, or other political subdivision of the state, excluding a hospital district or hospital authority.

The county’s General Revenue Tax Levy (GRTL) is used to determine eligibility for state assistance funds. For information on determining and reporting the GRTL, contact Dennis Hart, Property Tax Division of the Texas State Comptroller of Public Accounts at 800/252-9121 or at 512/305-9845.

HHSC

Health and Human Services Commission

HIPAA

Health Insurance Portability and Accountability Act. A law mandating that anyone belonging to a group health insurance plan must be allowed to purchase health insurance within an interval of time beginning when the previous coverage is lost. The law protects employees, especially those with long term health conditions who may be reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan, from losing health insurance due a change in employment status

HOP

The Health Opportunity Pool Trust Fund would be administered by HHSC on behalf of state residents without private health insurance and health-care providers providing uncompensated care.  The trust fund is intended to:

A hospital authority created under

• Article 4437E, Sec. 3, City-created Hospital Authorities, or

• Article 4494R, Sec. 3, County-created Hospital Authorities.

Hospital authorities have no obligation under Chapter 61, Health and Safety Code, to provide indigent health care assistance.

A hospital district created under the authority of the Texas Constitution Article IX, Sections 4 – 11.

An application is identifiable if it includes: the applicant’s name, the applicant’s address, The applicant's social security number, the applicant's date of birth,  the applicant’s signature, and the date the applicant signed the application.

Identifiable Application Date

The date on which an identifiable application is received from an applicant.

Inaccessible Resources

Resources not legally available to the household. Examples include but are not limited to irrevocable trust funds, property in probate, security deposits on rental property and utilities.

Income

Any type of payment that is of gain or benefit to a household.

Intergovernmental transfers (IGTs)

IGTs involve a transfer of funds among or between different levels of government. Under statutory authority, state-owned or operated facilities or "units" of local government (city, county, special purpose district or other governmental unit within a state) can make an IGT.

Managing Conservator

A person designated by a court to have daily responsibility for a child.