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North Carolina Department of Health and Human Services AGED, BLIND, AND DISABLED MEDICAID MANUAL

MA-200

DEFINITIONS

14 REISSUED 03/01/11 – CHANGE NO. 03-11 (III.) Cost of Care ---- The amount of money charged to an individual for NF or ICF-MR level of care, a swing bed, or inappropriate level of care bed in a hospital, or waiver services for the Community Alternatives Program (CAP).

County Case Transfer --- The process of referring a case from one county to another based upon the client's new residence. (See County Reassignment)

County Reassignment --- Case action taken when an a/r moves from one county to another.

Court-Ordered Guardianship Fees --- A fee owed to an a/r’s guardian due to a court order and which is deducted from the a/r’s income.

Court-Orders --- Decisions made by judges of courts of competent jurisdiction that specify changes and/or procedures the county DSS's must follow (i.e. Blue v. Craig, child support, custody).

Coverage Group --- The category under which an individual is determined eligible for assistance.

Current Market Value --- The value of an asset if sold on the open market. For real and personal property it is the tax assessed value of the property, unless that value is rebutted and a different value established. Refer to MA-2230, Financial Resources, for instructions on establishing and rebutting the tax value.

Deductible --- An amount for medical expenses that must be paid or incurred by the applicant/recipient or a current budget unit member before Medicaid can be authorized. A deductible results when the countable income of the budget unit members exceeds the established income or maintenance level for the number of persons in the budget unit. (Sometimes called a "spenddown.")

Deductible Balance --- The amount of the deductible remaining to be met on the date Medicaid is authorized and which the applicant/recipient is responsible to pay.

Deduction --- Mandatory and allowable work related expense subtracted from gross earned income for members of the budget unit.

Deemed --- The process of considering income and reserve of persons in the household, or sponsors of lawfully admitted aliens as available to the a/r.

Demonstrated Hardship – The a/r, spouse or personal representative proves through the greater weight of evidence that a denial of institutional services due to excess home equity value will cause the a/r a hardship.

Denial --- Rejection of benefits of the applicant.

Dependent --- An individual who is financially dependent upon another for his well being as defined by financial responsibility regulations for the program.