Md. Code Regs. 10.09.11.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.11.06 - Nonfinancial Eligibility Requirements

A. Citizenship. In order to be eligible for full benefits under the Maryland Children's Health Program, an individual shall meet the federal requirements for Medical Assistance eligibility as a citizen or qualified alien, as specified at COMAR 10.09.24.05C.

B. Residency. In order to be eligible for benefits under this chapter, an individual shall be a resident of Maryland, in accordance with the requirements at COMAR 10.09.24.05C -3.

C. Pregnancy. In order to be eligible for benefits under this chapter, a woman shall be pregnant or be within the postpartum period.

D. Age. In order to be eligible for benefits under this chapter, a child shall be younger than 19 years old.

E. Inmate of a Public Institution. In order to receive benefits under this chapter, an individual may not be an inmate of a public institution, as specified at COMAR 10.09.24.05C -5B.

F. Institution for Mental Diseases. In order to be eligible for benefits under this chapter, an individual between 21 and 64 years old or a child applying under Title XXI of the Social Security Act may not be a patient in an institution for mental diseases, unless such individuals are eligible in accordance with COMAR 10.09.24.05C -5C.

G. No Private Health Insurance. In order to be eligible for benefits under Title XXI of the Social Security Act, an individual may not be covered by an employer-sponsored health benefit plan or have been voluntarily terminated from an employer-sponsored health benefit plan within 6 months before the application date for benefits under this chapter.

H. An alien who fails to meet the requirements under §A of this regulation, but meets all other nonfinancial and financial factors of eligibility under this chapter, may be determined eligible for coverage under COMAR 10.09.24.05C -2.

I. Documentation of Citizenship and Identity.

(1) An applicant or recipient shall be required as a condition of eligibility to provide documentary evidence of identity as well as citizenship or nationality, to the Department's satisfaction, based on federal requirements, if the individual is:

(a) Declared to be a citizen or national of the United States; and

(b) Being determined for:

(i) Initial eligibility based on an application filed on or after September 1, 2006; or

(ii) Continuing eligibility based on a redetermination with an end date on or after September 30, 2006.

(2) The requirements at §I of this regulation shall be met for all Medical Assistance coverage groups except for:

(a) Supplemental Security Income beneficiaries;

(b) Newborns who are deemed eligible, for a period of 1 year, for Medical Assistance based on the mother's Medical Assistance eligibility for the newborn's date of birth;

(c) Newborns deemed eligible who are born to an otherwise eligible non-qualified alien woman meeting the requirements of Regulation .05-2 of this chapter who has filed an application and has been determined eligible for Medical Assistance for the newborn's date of birth;

(d) Pregnant women who are determined presumptively eligible for Medical Assistance through an accelerated eligibility process;

(e) Individuals who are entitled to Medicare benefits or enrolled in any part of Medicare;

(f) Individuals receiving SSDI disability insurance benefits under § 223 of the Social Security Act, or monthly benefits under § 202 of the Act, based on the individual's disability;

(g) Children who are receiving foster care or adoption assistance under Title IV-B or Title IV-E of the Social Security Act; and

(h) Other categories of individuals who are considered by the federal government to have previously presented satisfactory documentary evidence of identity as well as citizenship or nationality.

(3) An applicant may not be determined eligible for Medical Assistance until the requirements of §I of this regulation are met.

(4) Continuing eligibility for a recipient may not be approved at redetermination until the requirements of §I of this regulation are met.

(5) If an applicant or recipient fails to meet the requirements of §I of this regulation within the time standards specified in Regulation .04I(1) of this chapter, and the time standards are not extended, the Department shall:

(a) Deny eligibility for an applicant; or

(b) Terminate eligibility for a recipient, in accordance with the requirements for timely notice in COMAR 10.09.24.13B.

(6) The reactivation requirements in Regulation .04I(6) of this chapter shall apply if the documentation requirements of §I of this regulation are subsequently met within the current period under consideration for the:

(a) Applicant's denied application; or

(b) Recipient's terminated period of continuing eligibility.

(7) If there is documentation in an applicant's or recipient's case record or a state's database that demonstrates that the individual meets the requirements of §I of this regulation, the individual shall be considered to meet the requirements of §I of this regulation, unless the:

(a) Department has cause to question the documentation previously accepted; or

(b) Federal government requires additional documentation.

Md. Code Regs. 10.09.11.06

Regulations .06 adopted as an emergency provision effective July 1, 1998 (25:15 Md. R. 1182); adopted permanently effective November 30, 1998 (25:24 Md. R. 1773)
Regulations .06 amended as an emergency provision effective July 1, 2001 (28:14 Md. R. 1319); amended permanently October 29, 2001 (28:21 Md. R. 1856)
Regulation .06 amended effective October 8, 2007 (34:20 Md. R. 1737)
Regulation .06A amended effective November 10, 2003 (30:22 Md. R. 1580)
Regulation .06C amended effective June 21, 2004 (31:12 Md. R. 911)
Regulation .06I amended effective April 19, 2010 (37:8 Md. R. 614)