Md. Code Regs. 10.09.11.13

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.11.13 - Post-Eligibility Requirements

A. Notice of Eligibility Determination. The local health department or the local department of social services shall inform an applicant of the applicant's legal rights and obligations and give the applicant written notification of the following:

(1) For eligible persons:

(a) A finding of eligibility,

(b) The beginning and ending dates for coverage, and

(c) The right to request a hearing;

(2) For ineligible persons:

(a) A finding of ineligibility,

(b) The reason for the finding,

(c) The regulation supporting the finding, and

(d) The right to request a hearing.

B. Recipient Responsibility.

(1) A child recipient's parent, guardian, or representative shall notify the local health department or the local department of social services within 10 working days of changes affecting the child recipient's eligibility.

(2) A recipient or the recipient's representative shall limit use of the Program card to the person whose name appears on the card.

(3) When written notice of cancellation is received, a recipient shall discontinue use of the Program card on the first day of ineligibility and return the card to the Department.

(4) Failure to comply with the provisions of §B(1)-(3) of this regulation may result in:

(a) The termination of assistance; or

(b) Referral to the Department for fraud investigation, or for criminal or civil prosecution.

(5) A recipient shall cooperate with the State's Medical Assistance quality control review process, including verification of all information pertinent to the determination of eligibility.

(6) If the recipient refuses to cooperate, the recipient's coverage shall be terminated subject to the regulation governing timely and adequate notice under COMAR 10.09.24.13B.

C. Unscheduled Redetermination.

(1) The local health department or the local department of social services shall:

(a) Promptly make an unscheduled redetermination of a child recipient's eligibility when changes in circumstances or relevant facts are:

(i) Reported by someone on the recipient's behalf, or

(ii) Brought to the attention of the local health department or the local department of social services from other responsible sources;

(b) Notify the recipient that redetermination is required to establish continuing eligibility; and

(c) Notify the recipient of the required information and verifications needed to determine eligibility and the time standards in acting in the redetermination process.

(2) Eligibility Decisions. Recipients who are determined:

(a) Eligible for the remainder of the certification period shall be sent notice in accordance with §A(1) of this regulation; or

(b) Ineligible because of a change in circumstances or failure to establish eligibility following a change in circumstance shall be sent notice in accordance with §A(2) of this regulation.

(3) A recipient whose eligibility has been canceled may reapply at any time after the cancellation of eligibility and a new period under consideration shall be established.

D. Scheduled Redetermination. Except for children eligible as newborns of eligible women, the local health department or the local department of social services shall make a scheduled redetermination of a child recipient's eligibility at least every 12 months.

Md. Code Regs. 10.09.11.13

Regulations .13 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 .13 amended as an emergency provision effective July 1, 2001 (28:14 Md. R. 1319); amended permanently October 29, 2001 (28:21 Md. R. 1856)