Scope and Definitions

PURPOSE: The purpose of this rule is to define terms that are used in determining eligibility for Family MO HealthNet programs and the Children’s Health Insurance Program (CHIP). (1) Definitions. (A) “Applicant” is a participant as listed in 13 CSR 40-7.015 who completes and submits an application for a Family MO HealthNet Program or CHIP program, whether for themselves or on behalf of someone else. (B) “Authorized Representative” means an individual as defined in 13 CSR 402.015(2)(B). (C) “Child” or “Children” means a person or persons who are under nineteen (19) years of age. (D) “Children’s Health Insurance Program” or “CHIP” means the health assistance provided to uninsured, low income children under Title XXI of the Social Security Act and established in sections 208.631 through 208.658, RSMo. (E) “Deductions” means an allowable amount that is deducted from earned income and claimed on the participant’s federal income taxes. (F) “Division” means the Family Support Division, Department of Social Services. (G) “Earned Income” means— 1. Wages, salaries, tips, commissions, and other taxable employee pay; 2. Union strike benefits; 3. Long-term disability benefits received prior to minimum retirement age; 4. Net earnings from self-employment if— A. The participant or household member owns or operates a business or a farm; B. The participant or household member is a minister or member of a religious order; or C. The participant or household member meets the definition of a “statutory employee” under section 3121(d) of the Internal Revenue Code and has income; 5. Compensation in lieu of wages/bartering. (H) “Electronic data hub” means any electronic service established by the Secretary of the United States Department of Health and Human Services, through which the division may verify certain information with, or obtain such information from, federal agencies and other data sources. (I) “Emancipated minor” means a minor who— 1. Has been declared emancipated by a court of competent jurisdiction; or 2. Meets all of the following criteria: A. The minor is sixteen (16) or seventeen (17) years of age; and B. The minor is self-supporting, such that the minor is without the physical or financial support of a parent or legal guardian; and C. The minor’s parent or legal guardian has consented to the minor living independent of the parents’ or guardians’ control. Consent may be expressed or implied, such that— (I) Expressed consent is any verbal or written statement made by the parent(s) or guardian(s) of the minor displaying approval or agreement that the minor may live independently of the parent’s or guardian’s control; (II) Implied consent is any action made by the parent or guardian of the minor that indicates the parent or guardian is unwilling or unable to adequately care for the minor. Such actions may include, but are not limited to: (a) Barring the minor from the home or otherwise indicating that the minor is not welcome to stay; (b) Refusing to provide any or all financial support for the minor; or (c) Abusing or neglecting the minor, as defined in section 210.110, RSMo, or committing an act or acts of domestic violence against the minor, as defined in section 455.010, RSMo. (J) “Family member” means a person who meets the following relationship criteria: father, mother, grandfather, grandmother, brother, sister, stepfather or stepmother (but not step-grandparents), stepbrother, stepsister, uncle, aunt, first cousin, first cousin of a parent, nephew, niece, adoptive father or adoptive mother, grandfather-in-law or grandmother-in-law (meaning the spouse of a second marriage of one (1) of the child’s biological grandparents), great-grandfather or great-grandmother (including great-great grandfather or great-great grandmother), brother or sister of half-blood, adoptive brother or adoptive sister, brother-in-law or sister-in-law, uncle or aunt of the half-blood, uncle-in-law or aunt-in-law, great-uncle, or great-aunt (including great-great uncle or great-great aunt). Relatives by adoption not specifically mentioned in this subsection are treated in the same way as blood relatives. (K) “Family MO HealthNet programs” means MO HealthNet benefits provided to participants under the MO HealthNet for Families (MHF) program, the Adult Expansion Group (AEG) pursuant to Article IV, Section 36(c) of the Missouri Constitution, MO HealthNet for Kids (MHK) program, MO HealthNet for Pregnant Women (MPW) program, and Uninsured Women’s Health Services (UWHS) program. Family MO HealthNet programs also include presumptive eligibility for any of the above programs. (L) “Household” means individuals who make up an eligibility group under 42 CFR 45.603(f) and 13 CSR 40-7.020. (M) “Non-custodial parent” means the parent who does not have physical custody of the child. 1. If physical custody is questioned, a court order, judgment, decree, or any legally enforceable separation, divorce, or custody agreement establishing which party has physical custody shall control who is the custodial parent. 2. If there is no such order or agreement, or the order or agreement is silent, or in the event of joint custody, the custodial parent is the parent with whom the child expects to spend more than fifty percent (50%) of his or her overnight visits in the year for which eligibility is being determined. 3. In the case of true joint physical custody where the child spends an equal amount of overnight visits with both parents, the noncustodial parent is the parent who does not claim the child as part of their tax household. (N) “Non-Filer” means an individual who is not expected to file a tax return or be claimed as a tax-dependent. (O) “Parent” means a natural or biological, adopted, or stepparent. (P) “Participant” means any individual who has applied for, is receiving, or has been denied Family MO HealthNet benefits or CHIP benefits. (Q) “Sibling” means a natural or biological, adopted, half, or step sibling. (R) “Reasonable Compatibility” means the information received by the division, is not in conflict with other information known by the division. Income information is “reasonably compatible” if the sources of information are above or both are at or below the applicable income standard or other relevant income threshold limit, or the difference between the sources of the income information is ten percent (10%) or less and the sources of income are similar. (S) “Tax Dependent” means an individual for whom another individual claims a deduction for a personal exemption under Internal Revenue Code, section 151 for a taxable year. (T) “Taxpayer” means an individual who expects to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made and who does not expect to be claimed as a tax dependent by another individual. (U) “Unearned Income” means— 1. Pay received for work while an inmate is in a penal institution; 2. Interest and dividends; 3. Retirement income; 4. Social Security; 5. Unemployment benefits; 6. Alimony; and 7. Child support. AUTHORITY: sections 207.022 and 660.017, RSMo 2016.* Original rule filed July 31, 2013, effective Feb. 28, 2014. Amended: Filed Oct. 1, 2018, effective May 30, 2019. Emergency amendment filed Oct. 5, 2021, effective Oct. 20, 2021, expired April 17, 2022. Amended: Filed Oct. 5, 2021, effective April 30, 2022. *Original authority: 207.022, RSMo 2014, and 660.017, RSMo 1993, amended 1995.