MS 1010 (6)
Terms used in Non-Modified Adjusted Gross Income (Non-MAGI) Medicaid:
Actuarially Sound: A term used to determine if the average years of expected life remaining for an individual coincide with the life of a financial instrument, such as an annuity, promissory note, loan, mortgage, or land contract. If the individual is not reasonably expected to live longer than the guaranteed period of the financial instrument, it is not considered actuarially sound as the individual is not expected to receive the fair market value (FMV) of their investment back within their lifetime.
ANTICIPATED INCOME: Income, earned or unearned, which is expected to be received in the future.
ASSESSED VALUE: The value of real estate or personal property as determined by the county Property Valuation Administrator (PVA).]
BEHAVIOR HEALTH SERVICES: Medical services related to the treatment of mental disorders and substance abuse.
[BENEFICIARY IDENTIFICATION CODE (BIC): Letters or letter-number combinations at the end of the primary wage earners SSA claim number to identify specific beneficiaries who are eligible for benefits under that number. Please note: the BIC is at the beginning of the claim number for Railroad Retirement beneficiaries.
BURIAL FUND: Monies deposited in a financial institution with a contractual agreement which designates that the funds deposited are for burial purposes and are only payable upon death.
BURIAL INSURANCE: Insurance in which the terms specifically state that the proceeds can be used only to pay burial expenses of the insured.
BURIAL RESERVES: Resources which are set aside for the individual’s burial expenses. Burial reserves can be cash, life insurance policies designated for burial, prearranged funeral contracts, and any other identifiable fund/resource, or combination of funds/resources, designated as set aside for the individual’s burial expense.
BURIAL RESERVE EXCLUSION: An allowable exclusion of up to $1,500 from liquid resources, including the Cash Surrender Value (CSV) of a life insurance policy, when a client indicates these resources are to be used for burial purposes.
BURIAL SPACES: Burial plots, grave sites, crypts, and mausoleums.
BURIAL SPACE ITEMS: A casket, urn, niche, or other repository that is customarily used for the remains, as well as vaults, headstones, markers or plaques, burial containers, the opening and closing of the grave, and the care and maintenance of the grave site.
BUY-IN: A term used to describe the purchase of Medicare Part B from the Social Security Administration (SSA) for individuals determined to be eligible for the Medicare Savings Program or State Supplementation.
CASH SURRENDER VALUE (CSV): The dollar amount the individual would receive for cashing in a life insurance policy.
COINSURANCE: Money that an individual is required to pay for health related services, after a deductible has been paid. Coinsurance is often specified by a percentage. Both Medicare recipients and individuals with private health insurance may incur an expense for coinsurance.
COMMUNITY SPOUSE: An individual who resides at home, in the community, and is legally married to an institutionalized spouse receiving long term care (LTC) services such as Nursing Facility (NF), waiver, or Hospice. The individual is considered the community spouse, unless divorced from the institutionalized spouse. A spouse who is living in a Personal Care Home (PCH), Family Care Home (FCH), or is incarcerated is not considered a community spouse. Note: Kentucky does not recognize common-law marriage, however Kentucky does recognize an individual as the community spouse if the couple is considered to be legally married by a state that recognizes common-law marriage.
COMMUNITY SPOUSE INCOME ALLOWANCE: An amount for the benefit of the community spouse which is deducted from the income of the institutionalized spouse when calculating patient liability.
COMMUNITY SPOUSE RESOURCE ALLOWANCE: The calculated amount deducted from the combined countable resources of the couple prior to determining resource eligibility for the institutionalized spouse.
CONTINUING INCOME: Income, whether earned or unearned, which is expected to be received on a regular ongoing basis.
COST OF LIVING ADJUSTMENT (COLA): The increase in benefits, such as Social Security, Railroad Retirement, Black Lung, etc. to offset the effects of inflation on fixed incomes.]
DEDUCTIBLE: The amount that an individual must pay before insurance will start paying for any costs.
[DEPENDENT CHILD: A biological child, step child, or adopted child who lives with the community spouse and is claimed as a dependent by either parent for tax purposes under the Internal Revenue Service (IRS) Code.
DEPENDENT PARENT: A parent of either spouse who resides with the community spouse and is claimed as a dependent by either spouse for tax purposes under the IRS Code.
DEPENDENT SIBLING: A brother or sister of either spouse, including half-brothers and half-sisters and siblings gained through adoption, who reside with the community spouse and is claimed by either spouse for tax purposes under the IRS Code.
DISABLED ADULT CHILD (DAC): A person, age 18 or older, who receives RSDI benefits based on disability which was determined prior to age 22.
EARNED INCOME: Income received due to direct involvement in a work related activity.
EARNED INCOME TAX CREDIT (EITC): A credit given to individuals who file Federal taxes as "head of household" or "married filing jointly" and who have
children. The credit is received as part of the individual's federal income tax refund.
ELECTRONIC INCOME VERIFICATION (EIV): A method of obtaining verification of a
client’s earned income online, i.e. The Work Number.
ELIGIBLE SPOUSE: The spouse of an applicant or recipient who meets the aged, blind, or disabled technical eligibility requirement.
ELIGIBILITY DETERMINATION GROUP (EDG): A method of forming groups for each individual to establish which individuals are included in the household size and what income and resources will be considered when determining eligibility.]
EPSDT LONG TERM CARE (LTC) CHILD: A child with special health care needs who receives treatment in an Early and Periodic Screening Diagnosis and Treatment (EPSDT) LTC facility, in or out-of-state, that has been certified by the Department for Medicaid Services (DMS), EPSDT program.
[EQUITY VALUE: The value of an asset minus any verified debt.
FACE VALUE (FV): The basic death benefit or maturity amount specified by the life insurance policy.
FAIR MARKET VALUE (FMV): The value of an asset if sold at the prevailing price at the time it was actually transferred.
FAMILY INCOME ALLOWANCE: An amount for the benefit of the minor or dependent child, dependent parent, or dependent sibling which is deducted from the income of the institutionalized spouse when calculating patient liability.]
GROSS INCOME: The total sum of earned or unearned income prior to any deductions.
[HOMESTEAD: The applicant’s or recipient’s principle place of residence, whether occupied or unoccupied. A homestead can be the shelter, the shelter and land, or the land only.
INCOME: Earned or unearned money received from any source such as statutory benefits, child or spousal support, labor or services, rental property, investments, business operations, trusts, annuities, or retirement accounts, including non-recurring lump sums.
INSTITUTIONALIZED SPOUSE: An individual in an LTC facility legally married to a spouse who is not in an LTC facility. Individuals receiving waiver services and non-institutionalized Hospice are considered institutionalized spouses if married to and living in the home with a spouse not receiving those services. An individual in a
Personal Care Home (PCH) or Family Care Home (FCH is not considered an institutionalized spouse.
LAND CONTRACT: A contract between a seller and buyer of real property in which the seller provides financing to the buyer to purchase the property for an agreed-upon purchase price and the buyer repays the loan in installments.
LEGAL GUARDIAN: A person appointed through the state district courts to care for the personal and financial interests of another person.
LIFE ESTATE: When a person has a legal right to use property during their lifetime, but does not own the property outright.
LIQUID ASSETS: Cash on hand or resources which can be readily converted to cash, such as savings accounts, checking accounts, certificates of deposit (CD), stocks, bonds, mutual fund shares, etc.
LONG TERM CARE FACILITIES (LTC): Licensed Nursing Facilities, and Mental Hospitals (MH), and licensed Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF IID).
LOOK BACK PERIOD: During a property and asset check, this is the time period reviewed for a prohibited transfer of resources. The look back period for a transfer of resources is 60 months from the application date.
MEDICAID: Benefits provided to individuals who are categorically or medically needy. The Medicaid program is in compliance with Title XIX of the Social Security Act as administered by the Department for Medicaid Services (DMS). Kentucky’s Medicaid program is a health insurance program for low-income and needy individuals, which is jointly funded by Federal and State funds.
MEDICARE: The Federal program of health insurance for aged individuals and certain disabled persons which provides for Hospital Insurance Benefits (HIB or Medicare Part A), Supplementary Medical Insurance (SMI or Medicare Part B), and which covers additional medical costs and prescription drugs (Part D) for eligible individuals.
MINERAL RIGHTS: Rights to oil, gas, coal, timber, or other natural resources on land not owned by the individual.
MINOR CHILD: Child age 21 or younger who lives with the community spouse and is claimed as a dependents by either member of the couple for tax purposes under the IRS Code.
MODEL II WAIVER: Provides up to 16 hours a day for nursing services approved by DMS. "Model Waiver II services" means 1915(c) home and community based waiver program in-home ventilator services provided to an MA eligible recipient who is dependent on a ventilator and would otherwise require a nursing facility level of care.
MODIFIED ADJUSTED GROSS INCOME (MAGI): Taxable income minus specific deductions, for example, alimony, student loan interest, and educator expenses.
MORTGAGE: A legal agreement that conveys the conditional right of ownership on an asset or property by its owner (the mortgagor) to a lender (the mortgagee) as security for a loan.
NON-HOME PROPERTY: Real property other than homestead property, such as rental property, business property, homestead property after 6 months of institutionalization, etc.]
NON-RECURRING LUMP SUM INCOME: Income received at one time and not expected to continue.
[NURSING FACILITY (NF): A licensed facility which provides residential care for people who require long term care above room and board, such as skilled nursing due to a mental or physical condition or rehabilitation due to injury, disability, or illness.
PASS THROUGH: A program which allows the receipt of Medicaid for individuals who lost their SSI or State Supplementation benefits due to an increase in, entitlement to, or recomputation of RSDI benefits.
PEER REVIEW ORGANIZATION (PRO): The organization responsible for conducting level of care (LOC) determinations for recipients in need of NF or waiver services.
PERSONAL NEEDS ALLOWANCE (PNA): A basic amount for maintenance deducted from the gross income when determining the patient liability of recipients in NF, waiver services, or Hospice.
PERSONAL PROPERTY: Property of a personal nature, such as jewelry, clothing, or furniture.
PREARRANGED FUNERAL CONTRACT: A contractual agreement between an individual and funeral home to preselect goods and services for an individual’s funeral.
PROMISSORY NOTE: A written promise to pay on demand, or on a specified date, a certain sum of money to a seller or lender.
QUALIFYING INCOME TRUST (QIT): A means of excluding income in order to establish Medicaid eligibility for individuals who are receiving LTC services and have income exceeding the special income standard.]
REAL PROPERTY: Land, including the buildings or improvements, natural assets, and mobile homes or trailers when used as a dwelling.
[Resource Assessment: An evaluation of the combined countable resources of the institutionalized spouse and community spouse completed at the beginning of the continuous period of institutionalization, whether or not a Medicaid application is completed.
RESOURCES: Assets which can be used, to meet basic needs of food, clothing, and shelter, including liquid assets, property, vehicles, etc.
RETIREMENT, SURVIVORS, DISABILITY INSURANCE (RSDI): Social Security benefits payable under Title II of the Social Security Act. RSDI refers to the three types of benefits that the SSA pays. These payments are made to individuals who
are at full retirement age (62-67), survivors (children, widows, widowers), or to individuals (and qualified dependents) who are now disabled.
SELF SERVICE PORTAL (SSP): A web-based system where an individual can create an account and apply for benefits.]
SEPARATION MONTH: The month a couple ceases living together in a household.
[SPEND DOWN: Time-Limited MA issued to an individual or a family who meets all technical and resource eligibility criteria but has income in excess of the MA scale for the family size.
STABLE ACCOUNT: Tax-advantaged savings accounts for individuals with disabilities.
STATE SUPPLEMENTATION: The payment from state funds made to an aged, blind or disabled individual who has insufficient income to meet special needs for care in a licensed Personal Care Home (PCH), licensed Family Care Home (FCH), Community Integration Supplementation (CIS) living arrangement, or to purchase caretaker services to prevent institutionalization.
SUBSTANTIAL GAINFUL ACTIVITY (SGA): A term used by the SSA to describe a level of work and earnings. It is considered in situations involving disabled or blind individuals. Work can be classified as “substantial” if it involves physical or mental activity or a combination of both. Full or part-time work can be classified as substantial.
SUPPLEMENTAL SECURITY INCOME (SSI): A federally funded program that makes monthly payments to individuals who have limited income and resources if they are aged, blind, or disabled.
TERM LIFE INSURANCE: Life insurance that covers a specified period of time during which premiums are paid. The face value is payable only if death occurs within that time period. There is generally no loan value or cash surrender value on a term life insurance policy. Modified Term Life policies may have a cash surrender value.
TRANSFER OF RESOURCES: Any cash, liquid asset, or property which is voluntarily transferred, sold, given away or otherwise disposed of at less than fair market value.
UNCOMPENSATED EQUITY VALUE: The difference between the fair market value, less any outstanding debt owed on the resource, and the amount received for the resource.
UNDUE HARDSHIP: When the denial of Medicaid, due to a transfer of resources penalty or consideration of funds placed in a trust, deprives an individual of medical care to the extent the individual's health and life would be endangered or the individual would be deprived of food, clothing, shelter, or other necessities of life.
WHOLE LIFE INSURANCE: Life insurance that pays a benefit on the death of the insured and also accumulates a cash value.]