GLOSSARY: A-D

Effective Date: October 31, 2021

Access to ESI	"Access" means an employee is eligible to complete or file forms to enroll in their employer's sponsored health insurance. An individual may have access even if there is a 90-day waiting period before coverage becomes effective.
Accountable Care Organization (ACO)	A group of health care providers that have entered into a formal arrangement to assume collective responsibility for the care of a specific group of patients and that receive financial incentives to improve the quality and efficiency of health care.
Actively Engaged	Actively engaged in self-employment means the individual contributes significant time and talents in the daily activities of a business owned wholly by the individual or in a partnership with others, with the intent to produce a profit.
Actuarially Sound	The expected return on an annuity corresponds to a reasonable estimate of the life expectancy of the beneficiary. The average number of years of expected life remaining for the individual must coincide with the life of the annuity. If the individual is not reasonably expected to live longer than the guarantee period of the annuity, the individual will not receive fair market value for the annuity based on the projected return. In this case, the annuity is not actuarially sound.
Adjudication	The administrative process, civil process, or criminal process that the eligibility agency follows under state law to establish the validity of a medical assistance overpayment or understatement of liability and to establish the reason for the overpayment. The adjudication process also provides a legal basis for enforcing the collection of the overpayment or understated liability error.
Advanced Premium Tax Credit (APTC)	Refundable tax credits, paid in advance, that are used for the purchase of health insurance through a Marketplace health insurance exchange.
Adverse Action	When the agency makes a change that will decrease or stop benefits. The term is used most frequently for policy that requires advance notice when the agency intends to take an adverse action.

Aged Waiver (AW)	Provides services in the community to members age 65 or older who would be in nursing homes without those services.
Agency Error	A mistake made by DHHS or the eligibility agency in determining eligibility or the amount of the member’s liability.
Agency Conference	An informal way to resolve individual’s complaints or disagreements between workers and individuals. The individual, the worker, and the worker's supervisor meet to discuss the problem.
Aid to Families with Dependent Children (AFDC)	AFDC was the cash assistance program for families with children prior to July 1, 1997. It has been replaced by the Temporary Assistance for Needy Families Program (TANF-effective July 1, 1997). Utah’s TANF program is called FEP. We still use AFDC standards from July 1996 in Family related medically needy Medicaid programs.
Allocation	A deduction for children, parents and spouses. This deduction is used in the Aged, Blind and Disabled programs.
Allowable Medical Bill	An allowable medical bill is one that meets all of the rules for medical bills as defined in 461-5.
Ancillary Services	Services not included as part of nursing facility coverage. These services must be billed by the supplier and not the long-term care provider.
Annuity	An investment from which an individual receives regular payments for a period of time or for life.
Applicant	Any person who has submitted an application for assistance if the application has not yet been approved or denied.
Acquired Brain Injury Waiver (ABIW)	A program to provide home and community based care services to people with acquired brain injury who would otherwise need institutional level care.
American Indian and Alaska Native	An individual having origins in any of the original peoples of North and South America (including Central America) who maintains tribal affiliation or community attachment. The affiliated tribe must be federally recognized.
Assessment of Assets	The total value of assets owned by the institutional and community spouse as of the beginning of the first continuous period of institutionalization.
Asset	Any real or personal property that has a monetary value.
Asset Limit	The maximum value of countable assets a household can own and still be eligible for certain Medicaid programs.
Authorized Representative	Any individual selected by an applicant or recipient to conduct business on his behalf. An authorized representative may make application, provide verifications, complete forms, and be the payee for the individual. The authorized representative CANNOT sign the application, review or TPL forms instead of the individual, unless the agency determines the individual is unable to sign forms for himself.
Office of Eligibility Policy (OEP)	This is the part of Division of Integrated Healthcare responsible for Medicaid eligibility policy, disability reviews, Quality Control and the BUYOUT program.
Beneficiary Earning Exchange Record (BEER)	This is a report of individual earnings that is based on the employer's report to SSA when FICA is paid on the behalf of the individual. Workers may use the report to identify individuals who are working and to get basic information about the individual's earnings.
Beneficiary Data Exchange (BENDEX)	A file that is produced by SSA. The file contains information about SSA payment status, SSI payment status, and Medicare entitlement dates. BENDEX provides verification of Social Security Numbers. SSA gives us this information only for individuals that we identify.
Benefit Month	The calendar month, or partial month, for which the medical eligibility is approved.
Best Estimate	A calculation of the household's anticipated income, deductions and size during the certification period in all benefit months based on the most current information available.
Blind Medicaid	A Medicaid program for people who are blind.
Basic Maintenance Standard (BMS)	The BMS is an income standard that is used to determine the spenddown amount for some Medicaid programs.
Business Day	For the purposes of medical assistance eligibility, business day means any Monday, Tuesday, Wednesday, Thursday or Friday that is not a state holiday.
Buy-In	Automated payment by the state of the Part B Medicare premium for Medicaid, QMB, SLMB and QI-1 recipients. After individuals are first identified for BUY‑IN, they will be reimbursed for Part B Medicare premiums which are deducted from their SSA checks after their approval for medical assistance and before the BUY-IN becomes effective. Then the premiums are no longer deducted from their SSA checks.
Buy-Out	Payment by the Medicaid program for a recipient’s private group health insurance. The Medicaid program may choose to pay a recipient’s health insurance if it appears to be cost-effective for the Medicaid program.
Cash Value	The amount of money that an individual can receive from an insurance company for terminating a whole life insurance policy issued by that company.
Collateral Contact	Agencies, organizations, or persons other than the customer, from whom information or verification of reported information is obtained.
Community Spouse	The spouse who is not living in a medical institution or nursing home, and is not on an HCB Waiver. The other spouse is living in a medical institution, nursing home or is on an HCB Waiver.
Community Spouse Asset Allowance	The dollar value of the assets that are protected for the community spouse. The allowance will be equal to the greater of: • the minimum spousal asset allowance at time of application or • the spousal share not to exceed the maximum spousal asset allowance or • an amount determined at a fair hearing or • the amount determined by a court.
Conditional Payments	Payments made for medical services issued pending the completion of a fair hearing (125-3) or pending an appeal of an SSA denial of disability (303-7). Payments for medical services issued because of a hardship waiver while the individual takes all reasonable actions to make a transferred asset available (371-9) or to make the equity value of home worth more than $500,000 available (371-3, 371-9)
Conditional overpayment or understated liability error	The fair hearing or the SSA appeal supported the agency when the individual chose to receive continued benefits or chose not to pay the agency’s stated liability amount pending the hearing decision or the eligibility agency decides that the individual didn’t take all reasonable actions to make the asset available.
Conditional underpayment or overstated liability error	The fair hearing decision supported the individual who chose not to receive continued benefits or chose to pay the agency’s stated liability amount pending the hearing decision(125-3, #5) or SSA reversed the denial of disability (303-7) or the eligibility agency decided that the individual qualified for a hardship waiver (371-3, 371-9).
Confidential Information	Information that identifies individuals such as: • Names, addresses, telephone numbers, and social security numbers. • Income, assets, medical reports and data, names of persons obligated to provide financial and medical support. • Individuals’ benefits, medical conditions, and medical services.
Contiguous Property	Contiguous property is all property owned by the individual that is not separated from the individual's residence by property belonging to another person. It is contiguous if the only separation from the home is a river, road, or public right of way. Contiguous property includes lots and the buildings on the lots.
Co-Payment	A payment required by health insurance, Medicaid, CHIP, or Medicare to be paid by the patient to offset some of the cost of care. Also called co-insurance.
Countable Income	Countable income is gross income minus exemptions, allowable disregards, deductions, and earned income expenses. The various programs allow different disregards and deductions. This means "countable income" to decide eligibility for one program can be different than the "countable income" used to decide eligibility for another program.
Deductible	The amount of medical expenses that a individual is responsible to pay before the health insurance company will begin to pay claims. For example, if the deductible is $200, the individual's health insurance will not pay most medical bills until the individual has incurred at least $200 in service costs. Certain services are not subject to the deductible (such as certain preventive care.)
Deemed Income	The amount of the spouse's or parent’s income that must be considered available to the individual because of the financial responsibility of a spouse or parent. In some situations, income of the sponsor of a lawful permament resident must be deemed to the individual.
Deemed Newborn Children	A child born to a mother who was eligible for and received Medicaid in the month of the child’s birth and the child received Medicaid from the month of birth through the month of their first birthday. Some states may opt to consider children born to a mother who received CHIP during the month of birth as deemed newborns. When the child receives this type of coverage, the child's citizenship is verified and no additional verification is required at any time.
Deeming	The process of considering a spouse's or parent’s income and assets to be available to the Medicaid individual. Income or assets deemed available to the individual may not actually be available to the individual. Deeming from an LPR's sponsor is a process of counting a portion of the sponsor's income or resources as being available to the individual.
Deferred Income	Any type of earned income that is to be paid later. Most often, income may be deferred by paying it into a retirement investment account such as pension or stock option plan. It may be a pre-tax or post-tax deferral.
Dependent	For Aged, Blind or Disabled Medicaid a dependent includes the person’s spouse, children under age 18 or children from age 18-22 who are full-time students who live with the individual or are temporarily absent.
Dependent Child	A child under age 18, or age 18 if attending school and expected to graduate before turning age 19. An unborn child may be considered a dependent child. For Family-related, medically-needy Medicaid, a child is still considered dependent even when the parent has no legal responsibility for the child, but the child is in his parent's home or temporarily absent. For example, a child may have been emancipated by marriage, but if the child lives in the parent's home she or he is a dependent child. When a minor parent lives with her parents, the grandchild is not a dependent child of the grandparents.
Department of Workforce Services (DWS)	This is the state agency responsible for job services, unemployment compensation, cash assistance, food stamps and child care assistance. DWS also determines eligibility for medical assistance for Medicaid and CHIP programs..
Department of Health and Human Services (DHHS)	DHHS is the state agency responsible for aging and adult services, child and family services, foster care services, substance abuse and mental health services, services for people with disabilities, child support, medical support and estate recovery services.
Disability	Meets the criteria defined by the Social Security Administration (SSA) for blindness or disability. See section 303-2.
Disabled	A person is disabled if the person has a physical or mental impairment that significantly limits the person's ability to do basic work activities for at least 12 months or will result in death. Examples of basic work activities are: • walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling; • seeing, hearing and speaking; • understanding, carrying out and remembering simple instructions; Use of judgment, responding appropriately to supervision, co-workers, and usual work situations; and dealing with changes in a routine work setting.
Disabled Adult Child (DAC)	A person who is age 18 or older, disabled or blind before age 22, and receives Childhood Disability Benefits under a parent’s or grandparent’s claim number ending with a C and a number at the end. DACs are also called Childhood Disability Beneficiaries. • Refer to 330-1 for policy on who can receive protected Medicaid status.
Disabled Medicaid	A Medicaid Program for people with disabilities.
Discretionary trust	A discretionary trust is a trust in which the trustee has full discretion as to the time, purpose and amount of all distributions. The trustee may pay to or for the benefit of the beneficiary, all or none of the trust as he/she considers appropriate. The beneficiary has no control over the trust.
Diversion Payment	A lump sum FEP payment that enables the applicant to meet basic needs until other sources of income becomes stable.
Division of Child and Family Services (DCFS)	A division of DHHS that administers child welfare services, foster care, family interventions, subsidized adoptions, and other Human Service functions in Utah communities. DCFS decides Medicaid eligibility for children in foster care and subsidized adoptions.
Division of Community and Family Health Services (DFHS)	Determines the customer’s need for the level of care provided by the Technology Dependent Waiver (TDW). Is this still called this?
Division of Integrated and Healthcare (DIH)	The Utah state agency, in the Utah Department of Health and Human Services, that is responsible for administering the Medicaid and CHIP Programs.
Division of Services for People with Disabilities (DSPD)	A division of DHHS that coordinates services to people who have disabilities.
DSPD Case Manager	The DSPD Case Manager: • Determines if the individual is medically appropriate for the Physical Disabilities Waiver, the Brain Injury Waiver or the DD/MR Waiver. • Arranges a individual's placement in a group home, sheltered workshop, supported employment project, and other services available to the disabled. • Helps the individual apply for Medicaid.
Duty of Support	• See Medical Support Enforcement.
Due Process Month	An extended month (or months) of eligibility provided to a recipient when the eligibility agency cannot redetermine eligibility and provide proper notice of its decision.