405 IAC 2-1.1-1 - Definitions
Authority: IC 12-15
Affected: IC 12-15-2; IC 12-15-3
Sec. 1.
(a) The
definitions in this section apply throughout this rule.
(b) "Applicant" means an individual applying
for Medicaid eligibility on the basis of blindness or disability.
(c) "Change in circumstances" means any of
the following:
(1) A disabling condition
different from, or in addition to, that considered by SSA in making a previous
SSA determination.
(2) That more
than twelve (12) months after the most recent SSA determination denying
disability, an individual's condition has changed or deteriorated resulting in
a new period of disability, and such individual has not applied to SSA for a
determination with respect to these new allegations.
(3) That less than twelve (12) months after
the most recent SSA determination denying disability, an individual's condition
has changed or deteriorated, alleging a new period of disability and either the
individual:
(A) has applied to SSA for
reconsideration or reopening of its disability decision and SSA refused to
consider the new allegations; or
(B) no longer meets the nondisability
requirements for SSI but may meet the state's nondisability requirements for
Medicaid eligibility.
(d) "FPL" refers to the federal poverty
level.
(e) "MAGI" refers to the
methodology for how income is counted and how household composition and family
size are determined as set forth in
42 CFR
435.603.
(f) "Member" means the individual receiving
benefits due to age, disability, or blindness.
(g) "Special income level" refers to an
amount equal to three hundred percent (300%) of the maximum benefit payable
under the SSI program.
(h) "SSA"
refers to the federal Social Security Administration.
(i) "SSA determination" means a final agency
action by which SSA has determined an individual's eligibility or ineligibility
for SSI.
(j) "SSDI" means Social
Security disability insurance benefits provided through SSA.
(k) "SSI" means supplemental security income
provided through SSA.
(l) "State"
includes the office.
Notes
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