469 NAC 1-004
For use within AABD, NMAP, and SDP, the following definitions of terms will apply unless the context in which the term is used denotes otherwise.
AABD/MA: A categorical program consisting of financial assistance and medical assistance or medical assistance only. Two types of cases are included in the medical assistance only category:
1. Medical Assistance With No Share of Cost (MA only): A case in which there is income sufficient to meet daily maintenance needs but insufficient to meet medical needs. The case is opened for medical assistance only with no grant payment; and
2. AABD/Medical Assistance Share of Cost Case (MA with Share of Cost): A case in which there is sufficient income to meet daily maintenance needs and a portion but not all of the unit's medical needs. The case is opened for medical assistance with no payment for medical services made until the Share of Cost is obligated toward medical services.
Adequate Notice: Notice of case action which includes a statement of what action(s) the worker intends to take, the reason(s) for the intended action(s), and the specific manual reference(s) that supports or the change in federal or state law that requires the action(s), (see also 469 NAC 1-008.03C).
Aged: A client who is age 65 or older.
Applicant: An individual who applies for assistance.
Application: The action by which the individual indicates the desire to receive assistance by submitting an application.
Application Date: For new and reopened cases, the date a properly signed application is received. When adding a program to a properly signed application, this is the date that the new program is requested.
Application Signature: Applications may be signed in writing or by electronic signature.
Application Submission: Applications may be submitted in person, by mail, by fax or by electronic transmission.
Approval/Rejection Date: The date that the new or reopened case is determined eligible or rejected by the Nebraska Department of Health and Human Services.
Assignment: The legal transfer of an individual's right to benefits to the Nebraska Department of Health and Human Services.
Blind: A category of eligibility for clients who are age 64 and younger and who are blind in accordance with program standards.
Categorical Assistance: Assistance administered by the Nebraska Department of Health and Human Services. For the purposes of this definition, it includes Aid to Dependent Children (ADC)/MA, Child Welfare Payment and Medical Services Program/MA, AABD/MA, SDP/MA, Refugee Resettlement Program/MA; and Children's Medical Assistance Programs.
Client: An individual either applying for or receiving assistance. This term is used when the same policies apply to an applicant and a recipient.
Deeming: The process of determining the amount of income and resources of a parent or sponsor which must be considered available to meet the client's needs.
Disabled: A category of eligibility for clients who are age 64 and younger and who are disabled in accordance with program standards.
Equity: The fair market value of property minus the total amount owed on it.
Essential Person (EP): A needy individual:
1. Who lives in the home of the client;
2. Who is not eligible for assistance in his/her own right;
3. Who is necessary to the well-being of the client; and
4. Whose needs are included in the client's budget.
This determination is made by SSI or by the client.
For EP's included in determining a payment budget, see 469 NAC 3-006.02 ff. For EP's included in determining eligibility for NMAP, see 469 NAC 4-007.
Fair Market Value: The price an item of a particular make, model, size, material, or condition will sell for on the open market in the geographic area involved.
Regulations for fair market value relating to deprivation of resources are found at 469 NAC 2-009.10. Procedures for property contract sales are at 469-000-324.
Grant Case: A case receiving a state supplement payment, or eligible to receive a grant payment which is nullified by an SSI payment.
Inquiry: Any question received by phone, letter, or personal contact without any indication that the individual wishes to apply. This may or may not be followed by a request or application for assistance.
Need: A condition of eligibility referring to economic need.
Needy Individual: One whose income and resources for maintenance are found under assistance standards to be insufficient for meeting the basic requirements (see also 469 NAC 2-009 ff. and 2-010 ff.).
Payment Effective Date: The month and year that the grant payment is to be effective.
Pending Case: A case in which the application has been taken and eligibility is yet undetermined. All pending cases must be entered on N-FOCUS within two working days.
Power of Attorney: A written statement allowing one person to act for another person. A power of attorney may be authorized generally for the management of a specified business or enterprise or more often specifically for the accomplishment of a particular transaction. There is no court involvement or supervision in the appointment. The statement does not have to be notarized.
A standard or non-durable power of attorney automatically becomes null and void when the appointing individual becomes incompetent. A durable power of attorney continues in effect even when the appointing individual becomes incompetent. The power of attorney document should clearly specify if it is a durable power of attorney.
Prospective Eligibility for Medical Assistance: The date of eligibility beginning the first day of the month of the date of request if the client was eligible for MA in that same month.
Prudent Person Principle: The practice of assessing all circumstances regarding case eligibility and using good judgment in requiring further verification or information before determining initial or continuing eligibility (see also 469 NAC 1-010).
Recipient: An individual who is receiving assistance.
Rejected Case: A case in which an application was completed and signed but the applicant did not meet the categorical, procedural, or financial requirements of the program.
Request: An action by which an individual's desire to receive assistance is made known to the local office. A request may be made by telephone, letter, or an interview.
Request Date: The date the client requests assistance. For reopened cases, this is the date of the new request. For program changes, this is the request date for the new program.
Retroactive Eligibility for Medical Assistance: The date of eligibility beginning no earlier than the first day of the third month before the month of request if the following conditions were met:
1. Eligibility was determined and a budget computed separately for each of the three months;
2. A medical need existed; and
3. Eligibility requirements were met at some time during each month.
Retroactive Payment: Any payment made during the current month but for a prior month.
Share of Cost: A client's financial out-of-pocket obligation for medical services when countable income exceeds the medical maintenance income level. The Share of Cost amount is the difference between the unit's countable income and the appropriate medical maintenance income level. This amount must be obligated or paid to medical providers before Medicaid will pay on the remaining medical bills.
SDP/MA: A categorical program consisting of financial assistance and medical assistance or medical assistance only. Two types of cases are included in the medical assistance only category:
1. Medical Assistance With No Share of Cost (SOC) (MA only): A case in which there is income sufficient to meet daily maintenance needs but insufficient to meet medical needs. The case is opened for medical assistance only with no grant payment; and
2. SDP/Medical Assistance SOC Case : A case in which there is sufficient income to meet daily maintenance needs and a portion but not all of the unit's medical needs. The case is opened for medical assistance with no payment for medical services made until the SOC is obligated toward medical services.
SSI Federal Benefit Rate: The maximum SSI benefit payable based on the individual's living arrangement, e.g., own home, nursing home, living in another's home.
Supplemental Payment: Any payment made for and during the current month after major payroll has run.
Third Party Medical Payment: A payment from any health insurance plan, individual, or group for medical expenses.
Timely Notice: A notice of case action dated and mailed at least ten calendar days before the date the action becomes effective (see 469 NAC 1-008.03A2).
Unit: Eligible/needy individuals considered in determining the grant and/or medical assistance.
Withdrawal: A voluntary written retraction of an application.