Provisions of the Social Security Act which allow certain employed people who would otherwise be ineligible to retain SSI status. The Social Security Administration certifies people for 1619(a) and 1619(b) eligibility. People with 1619(a) or 1619(b) status retain their MA eligibility under the SSI related category if they received MA the month before certification for 1619(a) or 1619(b).1
1619b
Provisions of the Social Security Act which allow certain employed people who would otherwise be ineligible to retain SSI status. The Social Security Administration certifies people for 1619(a) and 1619(b) eligibility. People with 1619(a) or 1619(b) status retain their MA eligibility under the SSI related category if they received MA the month before certification for 1619(a) or 1619(b).
Aging and Disability Resource Center .
Adult
An adult is anyone age 18 or older.
Adverse Action
Adverse Action is another name for Cutoff . Adverse Action is a batch job that is run in CARES approximately 13 calendar days prior to the end of the month. It is run at this time to allow 10 days for negative notices to be sent as a result of any benefit reduction, denial, or closure.
Applicant
A person who has submitted a request for coverage for whom no decision has been made regarding eligibility
Arrearages
Payments of child support which were due for a prior period.
Authorized Representative
A person authorized to act on a client's behalf. An authorized representative may be designated by the client and may exercise all the rights and responsibilities of a client.
The Bureau of Enrollment Policy and Systems in the Department of Health Services, Division of Health Care Access and Accountability.
Central Application Processing Operation
Cash Surrender Value
The cash amount payable to a life insurance policy owner in the event of termination or cancellation of the policy before its maturity or the insured event.
CBRF
Community Based Residential Facility
CFAS
Citizens of the Compact of Free Association States
CMO
Care Management Organizations
CMS
Centers for Medicare and Medicaid Services- It administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA.
COLA
Cost of Living Adjustment. An increase in income to compensate for inflation.
Community Spouse
Someone who is 1) Married to an institutionalized person and 2) Not living in a nursing home or other medical institution for 30 or more consecutive days.
Copay
(AKA Copayment) A fixed amount a person is required to pay for each episode of a particular treatment, medical supply, or equipment. For example, a policy might require a $5 co-payment for each prescription while the insurance pays the remainder.
Corpus
(Re: trusts) Income and/or assets that form the main body of a trust. Assets or income in the trust corpus may be available to a person but the person no longer owns them. Also known as the trust principal.
CSA
Child Support Agency
Cutoff
Cutoff is another name for Adverse Action. Adverse Action is a batch job that is run in CARES approximately 13 calendar days prior to the end of the month. It is run at this time to allow 10 days for negative notices to be sent as a result of any benefit reduction, denial, or closure.
A state program providing payments and reimbursement of medical expenses for people injured on the job.
DDB diary date
Deed
Legal document which conveys ownership of property between parties.
Dependent 18-year-old
Anyone age 18 is a dependant 18 year-old if s/he is: Classified as a full-time student in high school, or in the equivalent level of vocational or technical training and reasonably expected to complete the program before age 19. or Carrying sufficient credits to be reasonably expected to graduate or get a GED before reaching age 19. If s/he is, for example, carrying only 3 credits, but only needs 3 credits to graduate, s/he is a full time student.
Disability
The law defines disability for Medicaid ( MA ) as: 'The inability to engage in any substantial gainful activity ( SGA ) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.' Substantial gainful activity is currently defined as gross income of $900 or more per month. See the Medicaid Purchase Plan (MAPP) chapter for the MAPP disability definition.
Disregard
An amount not counted when determining a person's total net income.
Divested Amount
The net market value minus the value received.
Anyone age 65 or older.
ERP
Estate Recovery Program
The face value of a life insurance policy is the policy’s death benefit (the amount paid out at the death of the insured) at the time a life insurance policy is purchased.
Fair Market Value
The price an item would sell for on the open market in a local geographic area.
Fee-for-Service
A method of payment for health services. The medical provider bills the Medicaid fiscal agent rather than an HMO for specific individual services.
FMV
Fair Market Value - The price an item would sell for on the open market in a local geographic area.
Foster Care
Care given to a children or adults including emergency, interim, or permanent care that cannot be furnished by their parent or legal guardian in their home. Foster care can be federally funded by Title IV-E of the Social Security Act or it can be state-funded.
FTG
Fiscal Test Group
General Assistance Medical Program
Home and Community Based Waivers Long Term Care
HIPAA
Health Insurance Portability and Accountability Act. A federal law passed in 1996 that protects health insurance coverage for workers and their families when they change or lose their jobs. Title II Administration Simplification provides national uniformity of transaction coding and national identifiers for providers. Data privacy is included in Title II.
Homestead
A place of abode and the lands used or operated in connection with it. Homestead property may have more than one building or house on it.
Intermediate Care Facility
IEVS
Income and Eligibility Verification System - A set of data exchanges with other state and federal sources used to verify income and assets of Medicaid applicants and recipients
IHS
Indian Health Service
IRIS
\"Include, Respect, I Self-Direct\" - A Medicaid waiver program.
ISN
IV-D Agency
A state, county, or private agency that is responsible for establishing paternity and collecting child support and medical support according to Title IV-D of the Social Security Act.
Local Coordinating Agencies for the Wisconsin Well Woman Medicaid Program.
Lien
A legal claim against property for the satisfaction of a debt. The lien is paid off at the time the property is sold.
LIFBC
Life Insurance Funded Burial Contracts
LIS
Low Income Subsidy of Medicare Part D. This is also called \"Extra Help\" by the SSA. It helps people with limited resources pay for a portion of Part D costs.
LOC
Level of Care, used in the Family Care, PACE, Partnership. and Home and Community Based Waiver Programs.
A health care delivery system under which enrollees receive most medical services through a health plan or network of providers which coordinates the services provided. DHS pays a fixed rate in advance for each enrollee.
MAPP
Medicaid Purchase Plan
MCO
Managed Care Organizations
Medicare Premium Assistance
Medicare Premium Assistance; This term is now obsolete. See MSP - Medicare Savings Programs.
Medicare Savings Programs
Medicare Savings Programs (MSP) Assistance to help pay coinsurance, premiums, and deductibles for Medicare beneficiaries who are also one of these types of medicaid recipients: QMB, SLMB, SLMB+, or QDWI. In the past, this has also called \"medicare buyin\", \"buy in\" or \"Medicare Premium Assistance (MPA).\" DHS is using the term \"MSP\" to refer to this type of assistance.
member
A recipient of Medicaid; formerly referred to as a \"client.\"
Minor
A minor is a person less than age 18.
Minor Parent
A minor parent is a minor who: 1.Is not the primary person, and 2.Is living in a household where the primary person is his/her LRR caretaker, and 3.Has his/her own child under his/her care.
MLTCP
Managed Long Term Care Program
MPA
Medicare Premium Assistance; This term is now obsolete. See MSP - Medicare Savings Programs.
MSP
Medicare Savings Programs (MSP) Assistance to help pay coinsurance, premiums, and deductibles for Medicare beneficiaries who are also one of these types of medicaid recipients: QMB, SLMB, SLMB+, or QDWI. In the past, this has also called \"medicare buyin\", \"buy in\" or \"Medicare Premium Assistance (MPA).\" DHS is using the term \"MSP\" to refer to this type of assistance.
A non-legally responsible relative ( NLRR ) child has no relatives in the household who are legally responsible for him/her. S/he meets these two conditions: 1.S/he does not have a parent in the household. 2.The primary person, the primary person's spouse, or a nonmarital parent is his/her caretaker.
Old Age, Survivors, and Disability Insurance program administered by the Social Security Administration (SSA).
“Public institution” means an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. The term“public institution” does not include a medical institution (5.8.1), a publicly operated community residence that serves no more than 16 residents, or a child care institution which foster care maintenance payments are made under title IV-E.
Qualified Disabled and Working Individual
QMB
Qualified Medicare Beneficiary
Real property means land and most things attached to the land, such as buildings and vegetation.
Revocable Trust
Allows the trustor to dissolve the trust. If the trust provides that the trust can be modified or terminated by a court it is considered to be a revocable trust since the grantor or his/her representative, can petition the court to terminate the trust.
SeniorCare
SLMB
Specified Low-Income Medicare Beneficiary
SLMB+
Specified Low-Income Medicare Beneficiary Plus
SMCP
Special Managed Care Program
SNF
Skilled Nursing Facility
Sole Proprietor
A person who is the sole owner of an unincorporated self-employment business.
Spousal Impoverishment
\"Spousal Impoverishment Protection\" refers to special financial provisions in Medicaid law regarding income and assets that affect certain married couples receiving or applying for nursing home or community waiver services.
spouse
A spouse is that person recognized by Wisconsin law as another person's legal husband or wife. Wisconsin does not recognize common law marriage.
SSA
Social Security Administration. A federal agency which administers the SSI, OASDI and Medicare programs.
SSDI
Social Security Disability Insurance (SSDI) is a benefit to disabled or blind individuals who have contributed to the Federal Insurance Contribution Act (FICA).
SSI
Supplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind or disabled.
Subsidized Guardianship
A long-term placement option for children in out-of-home care. Caretakers willing to become permanent legal guardians for children in out-of-home care, receive monthly subsidized guardianship payments, similar to foster care payments.
Tuberculosis
TPL
Third Party Liability is the obligation a third party (not Wisconsin Medicaid program or the Medicaid member), has to pay the bills for a Medicaid member’s medical services.
U.S. Citizenship and Immigration Services. The federal agency responsible for immigration and citizenship. This agency was formerly known as Immigration and Naturalization Service (INS).
A state program providing payments and reimbursement of medical expenses for people injured on the job.
WWMA
Well Woman Medicaid
WWWP
The Wisconsin Well Woman Program