Section 210-RICR-30-00-5.3 - DefinitionsA. As used herein, the following terms shall be defined as follows:1. "Affordable Care Act" or "ACA" means the federal Patient Protection and Affordable Care Act of 2010.2. "Attestation" means the act of a person affirming through an electronic or written signature that the statements the person made when applying for Medicaid eligibility are truthful and correct.3. "Caretaker" or "Caretaker relative" means any adult living with a Medicaid-eligible dependent child that has assumed primary responsibility for that child as defined in Part 1 of this Subchapter.4. "Continuous eligibility" or "CE" means a period of eligibility during which a member cannot be disenrolled due to changes in circumstances with certain exceptions. Exceptions include a request for disenrollment by the beneficiary, the beneficiary is no longer a resident of the state, the agency determines that eligibility was erroneously granted at the most recent determination, redetermination, or renewal due to agency error or fraud, abuse, or perjury attributed to the beneficiary, or the beneficiary is deceased.5. "Custodial parent" means a relationship that is defined by a court order or binding separation, divorce or custody agreement establishing physical custody of a minor child. If no order or agreement exists, or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.6. "Federal poverty level" or "FPL", as used herein, means the most recently published federal poverty level by the U.S. Department of Health and Human Services.7. "Federal data hub" or "Data hub" means the database of the United States population built by the U.S. Internal Revenue Service (IRS) and Health and Human Services (HHS) used to facilitate determinations for coverage, including Medicaid, under the ACA.8. "HealthSource RI" means the entity that allows persons, families, and small businesses to access insurance, as well as federal subsidies to assist in the payment of that coverage.9. "Household composition" means, for the purposes of determining MAGI eligibility, the person(s) filing taxes, whether jointly or separately, and anyone included as a tax dependent of the person(s) filing taxes. Special relationship rules for household composition may apply when the person filing taxes is not the custodial parent of the tax dependent.10. "MAGI" means modified adjusted gross income, adjusted by any amount excluded from gross income under 26 U.S.C. § 36B of the IRS Code, and any interest accrued.11. "Medicaid Affordable Care Coverage Group" or "MACC" means a classification of persons eligible to receive Medicaid based on similar characteristics who are subject to the MAGI standard for determining income eligibility.12. "Non-MAGI coverage group" means a Medicaid coverage group that is not subject to the modified adjusted gross income standard for eligibility determination.13. "Reasonable compatibility" means an allowable difference or discrepancy between the information provided in the application and the information reported by an electronic data source.14. "Reconciliation" means the point in the verification process when discrepancies between an applicant's attestation and information from data sources are resolved.210 R.I. Code R. 210-RICR-30-00-5.3
Amended effective 8/25/2020
Amended effective 10/1/2024