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Title 8: Medicaid Page 5 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Overview Revised January 13, 2023 Definitions “Medicare savings programs” is a limited Medicaid coverage group assisting low-income people with the payment of Medicare premiums, coinsurance, and deductibles. These groups include QDWP, QMB, SLMB, and E-SLMB. “Member” means a person who has been determined eligible and has been enrolled to receive Medicaid. Member may be used interchangeably with “recipient”. “MEPD” means the NonMAGI-related coverage group for employed people with disabilities. “Minimum Essential Coverage” (MEC) means any insurance plan that meets the Affordable Care Act requirement for having health coverage. Examples of plans that qualify include: Marketplace plans; job-based plans; Medicare; and Medicaid & CHIP. “Modified Adjusted Gross Income” (MAGI) is the tax-based methodology used to determine income eligibility and household size for Medicaid coverage groups for pregnant women, children under 19, parents and caretakers, and the adult population (IHAWP). “Needy specified relative,” means a non-parental specified relative, as listed in 8-C, Specified Relatives, who meets all the eligibility requirements to be included in the family-related Medically Needy eligible group. “NonMAGI-related” describes Medicaid coverage groups whose eligibility criteria are derived from the Supplemental Security Income (SSI) program for people who are aged, blind, or disabled, except for income and resource limits. “Nursing facility” or “NF” means a medical institution that provides care for people who need nursing care and other services in addition to room and board because of their mental or physical condition. “PACE” means a program for all-inclusive care for the elderly. A PACE provider receives a monthly capitated payment for enrollees and is responsible for ensuring that enrollees receive any services determined necessary for their health and well-being. “Parent” means a natural or biological parent, an individual legally recognized as the parent of a child based on the conception, gestation, or birth of the child during a legal marriage, an adoptive parent, or the spouse of another parent (step-parent), unless parental rights have been legally terminated. “PMIC” means a psychiatric medical institution for children. “Prudent-person concept” refers to the authority given to the income maintenance workers to review and analyze information given by the client and decide whether the information is sufficient for making an eligibility determination, or if further checking should be done. The “prudent person” must be vigilant, cautious, perceptive, and guided by generally sound judgment. “QDWP” means the NonMAGI-related coverage group for qualified disabled and working people. “QMB” means the NonMAGI-related qualified Medicare beneficiary coverage group.