C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER A—GENERAL PROVISIONS › PART 400—INTRODUCTION; DEFINITIONS › Subpart B—Definitions

42 C.F.R. § 400.203

Definitions specific to Medicaid

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As used in connection with the Medicaid program, unless the context indicates otherwise—

Applicant means an individual whose written application for Medicaid has been submitted to the agency determining Medicaid eligibility, but has not received final action. This includes an individual (who need not be alive at the time of application) whose application is submitted through a representative or a person acting responsibly for the individual.

Federal financial participation (FFP) means the Federal Government's share of a State's expenditures under the Medicaid program.

FMAP stands for the Federal medical assistance percentage, which is used to calculate the amount of Federal share of State expenditures for services.

Intellectual disability means the condition that was previously referred to as mental retardation.

Medicaid agency or agency means the single State agency administering or supervising the administration of a State Medicaid plan.

Nursing facility (NF), effective October 1, 1990, means an SNF or an ICF participating in the Medicaid program.

PCCM stands for primary care case manager.

PCP stands for primary care physician.

Provider means either of the following:

(1) For the fee-for-service program, any individual or entity furnishing Medicaid services under an agreement with the Medicaid agency.

(2) For the managed care program, any individual or entity that is engaged in the delivery of health care services and is legally authorized to do so by the State in which it delivers the services.

Services means the types of medical assistance specified in section 1905(a) of the Act and defined in subpart A of part 440 of this chapter.

State means the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.

State plan or the plan means a comprehensive written commitment by a Medicaid agency, submitted under section 1902(a) of the Act, to administer or supervise the administration of a Medicaid program in accordance with Federal requirements.

[48 FR 12534, Mar. 25, 1983, as amended at 50 FR 33029, Aug. 16, 1985; 56 FR 8852, Mar. 1, 1991; 57 FR 29155, June 30, 1992; 67 FR 41094, June 14, 2002; 77 FR 29028, May 16, 2012]
Notes of Decisions
Cited in 25 cases (4 in the last 5 years), 1994–2025 · leading case: Keup v. Wisconsin Department of Health & Family Services
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Keup v. Wisconsin Department of Health & Family Services (2004) wis · cites it 10× “The applicant/recipient distinction is reflected in 42 C.F.R. § 400.203 . [18] Under § 400.203, Keup was not an applicant at the time of her admission *82 to Mequon, as she did not have an application pending for medical assistance.”
Turner v. Md. Dept. of Health (2020) mdctspecapp · cites it 6× “Relying on 42 C.F.R. §§ 400.203 and 435.923, the Facility asserted that “[f]ederal regulation grants broad authority to authorized representatives, which survives death.”
Goldstar Medical Services, Inc. v. Department of Social Services (2008) conn · cites it 2× “304 (stating that, in accordance with 42 C.F.R. § 400.203 , “[provider . . . means any individual or entity furnishing [m]edicaid services under a provider agreement with the [m]edicaid agency” [emphasis added]); 42 C.”
Sikand v. Wilson-Coker (2006) conn · cites it 2× “” 42 C.F.R. § 400.203 . The Medical Assistance Manual issued by the federal Health Care Financing Administration provides that “[s]tates are not obligated to provide for transportation to secure medical care not included under the Medicaid plan .”
Riverside Hospital v. District of Columbia Department of Health (2008) dc “See 42 C.F.R. § 400.203 (2000). 3 . Providers of Medicaid services have: [an] obligation .”
Concilio De Salud Integral De Loíza, Inc. (CSILO) v. Perez-Perdomo (2010) ca1 “§ 1301 (a)(1) (2006); 42 C.F.R. § 400.203 (2009). To participate in Medicaid, states are required to provide specified health services for “underserved” areas or populations through “Federally-qualified health centers” (“FQHCs”) — healthcare facilities that are eligible to…”
United States Ex Rel. Black v. Health & Hospital Corp. of Marion County (2012) ca4 “” 42 C.F.R. § 400.203 . Each state must provide a prospective quarterly estimate of its anticipated Medicaid expenditures, and CMS uses that number and the FMAP to calculate the federal funds due to the state.”
United States Ex Rel. Davis v. District of Columbia (2014) dcd “42 C.F.R. § 400.203 . In the District, the federal share of Medicaid costs is approximately 70%, with the District picking up the remainder.”
Kootenai Medical Center v. Idaho Department of Health & Welfare (2009) idaho “” 42 C.F.R. § 400.203 . A “recipient” is “an individual who has been determined eligible for Medicaid.”
Minnesota Developmental Achievement Center Ass'n v. Haas-Steffen (1994) ca8 · cites it 5× “4 See 42 C.F.R. § 400.203 (1992). Before 1991, the Minnesota Medicaid program provided that the maximum rate a county could pay a developmental achievement center would increase automatically each year by a percentage no greater than that “projected percentage change in the…”
McKenzie v. District of Columbia Department of Human Services (2002) dc “See 42 C.F.R. § 400.203 . 4 . Neither party disputes that Mr.”
Conrad v. Perales (2000) nywd “42 C.F.R. § 400.203 (1999). Both Congress and the Secretary of Health and Human Services, however, have delimited the kinds of Medicaid costs for which FFP is available.”
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