Md. Code Regs. 07.03.07.03

Current through Register Vol. 51, No. 17, August 23, 2024

Section 07.03.07.03 - Eligibility Criteria

A. An individual is eligible when, in any month, the individual:

(1) Is a resident of the State;

(2) Is receiving a federal benefit for age, blindness, or disability;

(3) If not receiving a federal retirement or disability benefit, has filed an application for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), in accordance with §B of this regulation;

(4) Is in an assisted living program, in a CARE home, or in a DHMH rehabilitative residence while continuing to cooperate with all technical and financial requirements of eligibility; and.

(5) Continues to cooperate with all technical and financial requirements of eligibility.

B. Social Security Administration Disability Benefits Applications and Appeals.

(1) Applicants who are not receiving a federal retirement or disability benefit shall fully cooperate with the Social Security Administration (SSA) application and appeals processes.

(2) Failure to cooperate shall render the applicant or recipient ineligible and result in application denial or case closure.

C. If SSA makes a final unfavorable decision, the customer is no longer eligible for assisted living benefits from the PAA program, unless:

(1) Good cause exists for continued PAA eligibility, which the DHR Appointing Authority or its designee shall determine following a review; or

(2) Disability Services Operations (DSO) decides that the person meets the definition of disabled following a consultative exam or coordination with the State Disability Determination Services Agency.

D. Determination of Medical Justification for Placement into an Assisted Living Facility.

(1) The Department of Human Resources shall establish a process through DSO to determine when medical justification for placement into a protected living environment is sufficient to support an individual's eligibility for the PAA-Assisted Living program.

(2) This provision does not apply to individuals participating in PAA-CARE homes and PAA-DHMH rehabilitative residences.

E. Temporary Absence from Maryland.

(1) An individual remains a resident of the State despite temporary absence from the State if the individual intends to return when the purposes of the absence have been accomplished.

(2) The local department shall verify, after 30 consecutive days of absence and monthly after that, whether the absence is temporary or permanent.

F. Cooperation with the Eligibility Process.

(1) An individual shall:

(a) Provide all necessary information needed for initial or continued program eligibility and ensure that the information is true, correct, and complete; and

(b) Cooperate with the Agency in all aspects of program administration.

(2) The individual and the individual's authorized representative are subject to the requirements in COMAR 07.03.14 if they provide false information.

G. After meeting all other program requirements, an individual is eligible for Public Assistance to Adults:

(1) While the application for other benefits is pending; and

(2) After the application for other benefits is denied if the individual meets the conditions described in §A(3) of this regulation.

H. Interim Payment Reimbursement Authorization.

(1) Assisted living program and CARE home applicants and recipients shall sign an Interim Payment Reimbursement Authorization which:

(a) Permits the Social Security Administration to mail the initial SSI payment to the local department providing the Public Assistance to Adults; and

(b) Allows the local department to reimburse itself for the assistance granted the recipient.

(2) If the initial SSI payment mailed to the local department is less than or equal to the amount of Public Assistance to Adults received for the months the individual was entitled to SSI, the local department may retain the full amount of the SSI payment.

(3) If the amount of SSI received by the local department is greater than the amount of assistance paid, the local department shall pay the excess amount to the individual within 10 days of the receipt of the SSI payment and the Supplemental Security Income Notice of Interim Assistance Reimbursement Eligibility and Accountability Report.

Md. Code Regs. 07.03.07.03

Regulations .03 amended effective July 27, 1979 (6:15 Md. R. 1270)
Regulations .03A amended effective January 5, 1977 (4:1 Md. R. 15)
Regulation .03A amended effective May 24, 1982 (9:10 Md. R. 1019)
Regulation .03B amended effective March 20, 1981 (8:6 Md. R. 561)
Regulation .03D amended effective October 30, 1989 (16:21 Md. R. 2261)
Regulation .03 adopted effective December 10, 2001 (28:24 Md. R. 2127)
Regulation .03 amended effective 41:25 Md. R. 1477, eff.12/22/2014