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

MA-200

DEFINITIONS

28 REISSUED 03/01/11 – CHANGE NO. 03-11 (III.) Retrospective Budgeting --- Computing income for the benefit month based on actual income in a previous month.

Revocable Trust --- A contract in which terms can be altered.

Right of Recovery --- The responsibility of an individual, institution, corporation, or public or private agency to pay for all or part of medical costs of an a/r.

Roomer --- A person who lives with the a/r and pays a set amount for a room.

SSI Standard of Disability --- A physical or mental impairment which prevents an individual from engaging in any substantial gainful activity (or for a child under 18, an impairment of comparable severity) and which has lasted or is expected to last for at least 12 months or is expected to result in death.

Sanction Period --- The period of time in which an a/r is ineligible for Medicaid payment of institutional services and in-home health services and supplies. In order to sanction in-home health services, the sanction period must have begun during a period the individual received institutional services and continues when the individual goes to private living arrangement. The sanction period is also referred to as a penalty period.

Seasonal Employment --- Employment that is engaged in for a portion of year, at a predictable time each year. The employment may cover a few weeks or several months.

Self-Employment --- Net income of the person from a business enterprise or trade controlled by oneself, i.e., produce sales, farm rental, farming, craft sales, baby-sitting in one's own home.

Self-Supporting --- Maintaining one's self without financial assistance from others.

Skilled Nursing Facility (SNF) --- A long-term care facility which provides twenty-four hour skilled nursing care with a RN or LPN on duty at all times.

Social Security Administration (SSA) --- The agency of the federal government that issues regulations for the RSDI and SSI programs, as well as Medicare and Medicaid, under the Social Security Act.

Specialty Hospitals --- Hospitals providing designated special services (i.e. North Carolina Cancer Institute at Lumberton).

Specified Person --- An individual who (1) is age 60 or over, (2) receives SSI benefits under Title XVI of the Social Security Act or disability or blindness payments under Titles I, II, XIV, XVI of the Social Security Act (such persons include those who have been certified but whose initial payments have not yet been received, or whose checks are entirely recouped to repay a prior overpayment), (3) receives a VA disability payment for a 100% service connected disability, or (4) is a disabled surviving spouse or child of a Veteran.