Medical assistance definitions—M.
"Medicaid" is the federal aid program under Title XIX of the Social Security Act under which health care is provided to eligible persons.
"Medical assistance" is the term the agency and its predecessors used prior to the implementation of the Affordable Care Act in Washington state to mean all federal and/or state-funded health care programs administered by the agency or its designee that are now known as Washington apple health.
"Medical assistance administration (MAA)" is the former organization within the department of social and health services authorized to administer the federally funded and/or state-funded health care programs that are now administered by the agency, formerly the medicaid purchasing administration (MPA), of the health and recovery services administration (HRSA).
"Medical care services (MCS)"
means the limited scope health care program financed by state funds for clients who meet the incapacity criteria defined in chapter 182-508
WAC or who are eligible for the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) program.
"Medical consultant" means a physician employed or contracted by the agency or the agency's designee.
"Medical facility" means a medical institution or clinic that provides health care services.
See "institution" in WAC 182-500-0050
"Medical services card" means the card issued by the agency at the initial approval of a person's Washington apple health (WAH) benefit. The card identifies the person's name and medical services identification number, but is not proof of eligibility for WAH. The card may be replaced upon request if it is lost or stolen, but is not required to access health care through WAH.
"Medically necessary" is a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the client that endanger life, or cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction. There is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the client requesting the service. For the purposes of this section, "course of treatment" may include mere observation or, where appropriate, no medical treatment at all.
"Medically needy (MN) or medically needy program (MNP)" is the state- and federally funded health care program available to specific groups of persons who would be eligible as categorically needy (CN), except their monthly income is above the CN standard. Some long-term care clients with income and/or resources above the CN standard may also qualify for MN.
"Medicare" is the federal government health insurance program for certain aged or disabled persons under Titles II and XVIII of the Social Security Act. Medicare has four parts:
(1) "Part A" - Covers medicare inpatient hospital services, post-hospital skilled nursing facility care, home health services, and hospice care.
(2) "Part B" - The supplementary medical insurance benefit (SMIB) that covers medicare doctors' services, outpatient hospital care, outpatient physical therapy and speech pathology services, home health care, and other health services and supplies not covered under Part A of medicare.
(3) "Part C" - Covers medicare benefits for clients enrolled in a medicare advantage plan.
(4) "Part D" - The medicare prescription drug insurance benefit.
"Medicare assignment" means the process by which a provider agrees to provide services to a medicare beneficiary and accept medicare's payment for the services.
means out-of-pocket medical expenses related to services provided by medicare. For medical assistance clients who are enrolled in medicare, cost-sharing may include Part A and Part B premiums, co-insurance, deductibles, and copayments for medicare services. See chapter 182-517
WAC for more information.
"Minimum essential coverage" means coverage defined in Section 5000A(f) of Subtitle D of the Internal Revenue Code of 1986, as added by Section 1401 of the Affordable Care Act.
"Modified adjusted gross income (MAGI)" means the adjusted gross income (as determined by the Internal Revenue Service under the Internal Revenue Code of 1986 (IRC)) increased by:
(1) Any amount excluded from gross income under Section 911 of the IRC;
(2) Any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax; and
(3) Any amount of Title II Social Security income or Tier 1 railroad retirement income which is excluded from gross income under Section 86 of the IRC. See WAC 182-509-0300
through 182-509-0375 for additional rules regarding MAGI.
[Statutory Authority: RCW 41.05.021
, Patient Protection and Affordable Care Act (P.L. 111-148), 42 C.F.R. §§ 431, 435, 457, and 45 C.F.R. § 155. WSR 14-01-021, § 182-500-0070, filed 12/9/13, effective 1/9/14. Statutory Authority: RCW 41.05.021
, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-500-0070, filed 9/13/12, effective 10/14/12. WSR 11-14-075, recodified as § 182-500-0070, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
and 2011 1st sp. sess. c 15. WSR 11-14-053, § 388-500-0070, filed 6/29/11, effective 7/30/11.]