SECTION 1, Legal Authority

Section 1 Legal Authority

03.01.000. LEGAL AUTHORITY

03.01.001. TITLE AND SCOPE

03.01.002. WRITTEN INTERPRETATIONS

03.01.003. ADMINISTRATIVE APPEALS

03.01.004. INCORPORATION BY REFERENCE

03.01.005. OFFICE – OFFICE HOURS – MAILING ADDRESS – STREET ADDRESS – TELEPHONE NUMBER – INTERNET WEBSITE

03.01.006. CONFIDENTIALITY OF RECORDS AND PUBLIC RECORDS

03.01.007. FEDERAL LAWS

03.01.008. – 03.01.009. (RESERVED)

03.01.010. DEFINITIONS (A THROUGH L)

03.01.011. – 03.01.012. (RESERVED)

03.01.013. DEFINITIONS (M THROUGH Z)

03.01.014. – 03.01.015. (RESERVED)

03.01.016. ABBREVIATIONS

03.01.017. – 03.01.099. (RESERVED)

03.01.000. LEGAL AUTHORITY.

In accordance with Sections 56-201, 56-202(b), 56-203(g), 56-209(b), 56-236, 56-237, 56-238, 56-239, 56-240, 56-242, and 56-1004(1)(a), Idaho code, the Idaho Legislature has authorized the Department of Health and Welfare to adopt and enforce rules for the administration of the Title XIX Medicaid, Children’s Health Insurance Program A (CHIP A), Children’s Health Insurance Program B (CHIP B) and the Children’s Access Card programs. (7-1-04)T

03.01.001. TITLE AND SCOPE.

01. Title. These rules will be cited as IDAPA 16, Title 03, Chapter 01, "Eligibility for Health Care Assistance for Families and Children.” (7-1-04)T

02. Scope. These rules provide standards for issuing Title XIX Medicaid, CHIP A, CHIP B and Children’s Access Card coverage to families and children qualifying under AFDC-related and Federal Poverty Guideline (FPG) coverage groups. (7-1-04)T

03. Policy. It is the policy of the Idaho Department of Health and Welfare, to serve the citizens of Idaho and to distribute Title XIX Medicaid, CHIP A, CHIP B and Children’s Access Card benefits according to acceptable standards. (7-1-04)T

03.01.002. WRITTEN INTERPRETATIONS.

In accordance with Section 67-5201(16)(B)(iv), Idaho Code, this agency has written statements which pertain to the interpretation of the rules of this chapter, or to the documentation of compliance with the rules of this chapter. The document is available for public inspection and copying at cost at the Department of Health and Welfare, 450 West State Street, P.O. Box 83720, Boise, Idaho, 83720-0036 or at any of the Department’s Regional Offices. (7-1-02)

03.01.003. Administrative Appeals.

All administrative appeals are governed by provisions of IDAPA 16.05.03, “Contested Case Proceedings and Declaratory Rulings.” (7-1-04)T

03.01.004. INCORPORATION BY REFERENCE.

No documents have been incorporated by reference into these rules. (7-1-04)T

03.01.005. OFFICE – OFFICE HOURS – MAILING ADDRESS – STREET ADDRESS – TELEPHONE NUMBER – INTERNET WEBSITE.

01. Office Hours. Office hours are 8 a.m. to 5 p.m., Mountain Time, Monday through Friday, except holidays designated by the state of Idaho. (7-1-04)T

02. Mailing Address. The mailing address for the business office is Idaho Department of Health and Welfare, P.O. Box 83720, Boise, Idaho 83720-0036. (7-1-04)T

03. Street Address. The business office of the Idaho Department of Health and Welfare is located at 450 West State Street, Boise, Idaho 83702. (7-1-04)T

04. Telephone. The telephone number for the Idaho Department of Health and Welfare is (208) 334-5500. (7-1-04)T

05. Internet Website. The Department’s internet website is found at “http://www2.state.id.us/dhw/”. (7-1-04)T

03.01.006. CONFIDENTIALITY OF RECORDS AND PUBLIC RECORDS

Any use or disclosure of Department records must comply with IDAPA 16.05.01, “Use and Disclosure of Department Records.” (7-1-04)T

03.01.007. FEDERAL LAWS.

Federal and public laws applicable to IDAPA 16, Title 03, Chapter 01 are listed in Subsections 006.01 through 006.19. (7-1-04)T

01. Alaska Native Claim Settlement Act. This Federal Law is contained in Title 43 of the U.S. Code. (7-1-98)

02. Adoptions And Safe Families Act Of 1997. This Federal law is contained in Public Law 105-89, November 19, 1997. (7-1-04)T

03. Child Citizenship Act Of 2000. This Federal Law is contained in Title 8 of the U.S. Code. (7-1-04)T

04. Child Nutrition Act Of 1966. This Federal Law is contained in Title 42 of U.S. Code. (7-1-98)

05. Domestic Volunteer Service Act Of 1973. This Federal Law is contained in Titles 5 and 42 of the U.S. Code. (7-1-98)

06. Higher Education Amendments Of 1968. This Federal Law is contained in Titles 12 and 20 of the U.S. Code. (7-1-98)

07. Housing Act Of 1949. This Federal Law is contained in Titles 12 and 42 of the U.S. Code. (7-1-98)

08. Housing And Urban Development Act Of 1965. This Federal Law is contained in Titles 12, 15, 20, 38, 40, 42, and 49 of the U.S. Code. (7-1-98)

09. Immigration And Nationality Act. This Federal Law is contained in Titles 8, 18, 22, 31, 49, and 50 of the U.S. Code. (7-1-98)

10. Manpower Development And Training Act Of 1962 As Amended By The Manpower Act of 1965. This Federal Law is contained in Title 42 of the U.S. Code. (7-1-98)

11. National Housing Act. This Federal Law is contained in Titles 10, 12, 15, 41, 48, 49, and 50 of the U.S. Code. (7-1-98)

12. National School Lunch Act. This Federal Law is contained in Title 42 of the U.S. Code. (7-1-98)

13. Older Americans Act Of 1965. This Federal Law is contained in Title 42 of the U.S. Code. (7-1-98)

14. Personal Responsibility And Work Opportunity Reconciliation Act of 1996. This Federal Law is contained in Public Law 104-193. (7-1-98)

15. Rehabilitation Act Of 1973. This Federal Law is contained in Title 29 of the U.S. Code. (7-1-98)

16. Tax Reduction Act Of 1975, As Amended By The Tax Reduction And Simplification Act Of 1977. This Federal Law is contained in Titles 5, 15, 26, and 42 of the U.S. Code. (7-1-98)

17. Uniform Relocation Assistance And Real Property Acquisition Policies Act Of 1970. This Federal Law is contained in Title 42 of the U.S. Code. (7-1-98)

18. United States Housing Act Of 1937, As Amended By Public Law 92-213. This Federal Law is contained in Title 42 of the U.S. Code. (7-1-98)

19. Violence Against Women Act Of 2000 (VAWA 2000). This Federal Law is contained in Public Law 106-386 Div. B, October 28, 2000, 114 Stat. 1491. (7-1-04)T

03.01.008. – 009. (RESERVED).

03.01.010. DEFINITIONS (A Through L).

For the purposes of these rules the following terms are used as defined below: (7-1-04)T

01. Adult. Any individual who has passed the month of his nineteenth (19^th) birthday. (7-1-04)T

02. Application Date. The date the Application for Assistance (AFA) is received by the Department in a local office or the date the application is postmarked if mailed. (7-1-04)T

03. Budget Unit. Individuals living with the participant who are the participant’s family members and considered in the household size when eligibility is determined. (7-1-04)T

04. Child. Any individual who has not passed the month of his nineteenth (19^th) birthday. (7-1-04)T

05. Children’s Access Card. The insurance premium assistance program for children in families who qualify for CHIP A or CHIP B. (7-1-04)T

06. CHIP A (Children’s Health Insurance Program A). The health insurance program described in IDAPA 16.03.18 for children whose income exceeds the Title XIX Medicaid threshold, but is less than or equal to one hundred fifty percent (150%) of the Federal Poverty Guidelines (FPG). (7-1-04)T

07. CHIP B (Children’s Health Insurance Program B). A limited health insurance program described in IDAPA 16.03.18 for children in families whose income is greater than one hundred fifty percent (150%), but is less than or equal to one hundred eighty five percent (185%) of the current FPG. (7-1-04)T

08. Choice Agreement. An agreement that allows individuals to make a choice between CHIP B and the Children’s Access Card programs. (7-1-04)T

09. Co-Payments (co-pays). The amount a participant is required to pay for specified services as set forth in IDAPA 16.03.18, “Chip B and Children’s Access Card Rules”. (7-1-04)T

10. Cost-Sharing. A payment the participant is required to make toward the cost of their health care. (7-1-04)T

11. Coverage Group. One of the following service categories an individual is eligible for: Title XIX Medicaid, CHIP A, CHIP B or Children’s Access Card program. (7-1-04)T

12. Department. The Idaho Department of Health and Welfare. (7-1-04)T

13. Disenrollment. Ending an individual’s participation in a health insurance program. (7-1-04)T

14. Eligibility. The determination of whether or not an individual is eligible for a public program. (7-1-04)T

15. Enrollment. The process of adding eligible individuals to a health insurance program. (7-1-04)T

16. Enrollment Cap. The combined total of openings for the CHIP B and Children’s Access Card programs. (7-1-04)T

17. Extended Medicaid for Spousal Support Increase. Extended Medicaid is medical assistance for a parent or relative caretaker who becomes ineligible for Title XIX Medicaid due to spousal support payments. (7-1-04)T

18. Federal Poverty Guidelines (FPG). The federal poverty guidelines issued annually by the Department of Health and Human Services (HHS). (7-1-04)T

19. Field Office. An office of the Idaho Department of Health and Welfare authorized to accept and process applications for Medicaid. (7-1-04)T

20. Health Care Assistance (HCA). Title XIX Medicaid, CHIP A, CHIP B or Children’s Access Card benefits granted by the Department for persons or families under the authority of Title 56, Chapter 2, Idaho Code. (7-1-04)T

21. Health Insurance Premium Program (HIPP). The premium assistance program in which Title XIX Medicaid and CHIP A participants may participate. (7-1-04)T

22. Low Income Families With Children. Medical assistance for one (1) or two (2) parent or relative caretaker families. (7-1-04)T

23. Low Income Child. Medical assistance for children. (7-1-04)T

24. Low Income Pregnant Woman. Medical assistance for a pregnant woman that is limited to pregnancy-related services for the period of the pregnancy and 60 days after the pregnancy ends. (7-1-04)T

03.01.011. – 012. (RESERVED)

03.01.013. DEFINITIONS (M Through Z).

For the purposes of these rules the following terms are used as defined below: (7-1-04)T

01. Open Enrollment. A time-period during which an eligible participant may enroll in a medical benefit plan. (7-1-04)T

02. Participant. A person who is applying for or receiving Title XIX Medicaid, CHIP or Children’s Access Card benefits. (7-1-04)T

03. Premium. A regular, periodic charge or payment for health coverage as set forth in IDAPA 16.03.18. (7-1-04)T

04. Premium Assistance. The partial or total premium paid to an insurance company or employer by the State to supplement the cost of enrolling eligible individuals in a health insurance plan. (7-1-04)T

05. Qualified Pregnant Woman. Medical assistance for a pregnant woman who is eligible for AFDC related Title XIX Medicaid but chooses to apply for herself only. (7-1-04)T

06. Relative of Specified Degree. Relatives of specified degree include: father, mother, (natural or adoptive), child, grandfather or grandmother, brother or sister, stepfather or stepmother, stepbrother or stepsister, aunt or uncle, first cousin, first cousin once removed, niece, nephew, person of preceding generations denoted by grand, great or great-great. (7-1-04)T

07. Self Reliance Specialist. An individual employed by the State of Idaho, Department of Health and Welfare, whose duties include the determination of eligibility and payments of benefits. (7-1-04)T

08. State. The State of Idaho. (7-1-04)T

09. Title XIX Medicaid. Medicaid programs regulated by Title XIX of the Social Security Act. (7-1-04)T

10. Title XXI State Children’s Health Insurance Program (SCHIP). Programs regulated by Title XXI of the Social Security Act. (7-1-04)T

11. Transitional Medicaid. Medical assistance for families who become ineligible for AFDC related Title XIX Medicaid due to an increase in earned income or loss of income disregards. (7-1-04)T

12. Working Day. A calendar day in which regular hours of Department activity occur. Weekends and State holidays are not considered working days. (7-1-04)T

03.01.014. -- .015 (RESERVED)

03.01.016. ABBREVIATIONS.

01. AFA. Application for Assistance. (7-1-04)T

02. AFDC. Aid to Families with Dependent Children, the cash assistance program for families and children in effect through June 30, 1997. (7-1-04)T

03. AG. Office of the Attorney General, Health and Welfare Division. (7-1-04)T

04. AIM. Department’s Advanced Information Management system for Medicaid. (7-1-04)T

05. ASVI. Alien Status Verification Index. (7-1-04)T

06. CHIP. Child Health Insurance Program. Includes CHIP A and CHIP B coverage groups. (7-1-04)T

07. CSS. Child Support Services. (7-1-04)T

08. DHW. Department of Health and Welfare. (7-1-04)T

09. DOL. Department of Labor. (7-1-04)T

10. DVR. Department of Vocational Rehabilitation. (7-1-04)T

11. EITC. Earned Income Tax Credit. (7-1-04)T

12. EPICS. DHW Eligibility Programs Integrated Computer System. (7-1-04)T

13. EPSDT. Early and Periodic Screening, Diagnosis, and Treatment. (7-1-04)T

14. ESI. Employer Sponsored insurance. (7-1-04)T

15. FmHA. The Farmer's Home Administration of the U.S. Department of Agriculture. (7-1-04)T

16. FPG. Federal Poverty Guideline. (7-1-04)T

17. HHS. U.S. Department of Health and Human Services. (7-1-04)T

18. HIPP. Health Insurance Premium Payment program. (7-1-04)T

19. HUD. The U.S. Department of Housing and Urban Development. (7-1-04)T

20. ICF/MR. Intermediate Care Facility/Mentally Retarded. (7-1-04)T

21. ICSES. Idaho Child Support Enforcement System. (7-1-04)T

22. IEVS. Income and Eligibility Verification System. (7-1-04)T

23. INA. Immigration and Naturalization Act. (7-1-04)T

24. IRS. Internal Revenue Service. (7-1-04)T

25. PRWORA. Personal Responsibility Work Opportunity Reconciliation Act of 1996. (7-1-04)T

26. RSDI. Retirement, Survivors, and Disability Insurance. (7-1-04)T

27. SAVE. Systematic Alien Verification for Entitlement. (7-1-04)T

28. SIE. Self-Insured Employer. (7-1-04)T

29. SOLQ. State Online Query. (7-1-04)T

30. SRS. Self Reliance Specialist. (7-1-04)T

31. SSA. Social Security Administration. (7-1-04)T

32. SSI. Supplemental Security Income. (7-1-04)T

33. SSN. Social Security Number. (7-1-04)T

34. TAFI. Temporary Assistance for Families in Idaho. (7-1-04)T

35. TANF. Temporary Assistance to Needy Families. (7-1-04)T

36. TPL. Third Party Liability. (7-1-04)T

37. TM. Transitional Medicaid. (7-1-04)T

38. UIB. Unemployment Insurance Benefits. (7-1-04)T

39. VA. Veterans Administration. (7-1-04)T

40. VRS. Vocational Rehabilitation Services, Department of Education. (7-1-04)T

03.01.017. -- 03.01.099. (RESERVED).