Md. Code Regs. 10.09.24.03

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

Section 10.09.24.03 - Coverage Groups

A. The following individuals, including recipients of Temporary Cash Assistance, may be determined eligible for the MAGI coverage groups:

(1) Parents and other caretaker relatives whose household income is equal to or less than 123 percent of the federal poverty level;

(2) Pregnant and postpartum women of any age whose household income is equal to or less than 250 percent of the federal poverty level;

(3) Adults 19 years old or older and younger than 65 years old who are not entitled to or enrolled in Medicare Part A or Part B, whose household income is equal to or less than 133 percent of the federal poverty level, including adults living with dependent children who have provided minimum essential health care coverage for those children;

(4) Children younger than 21 years old and whose household income is equal to or less than 133 percent of the federal poverty level; and

(5) Former Foster Care individuals who:

(a) For individuals who turned 18 years old before January 1, 2023:

(i) Are younger than 26 years old;

(ii) Are not eligible and enrolled for coverage under a mandatory Medical Assistance group other than childless adult; and

(iii) Were formerly in a Maryland out-of-home placement, including categorical Medical Assistance, during the foster care period in which they either turned 18 years old or attained a higher age during extended out-of-home placement as described under COMAR 07.02.11.04B; and

(b) For individuals who turned 18 years old on or after January 1, 2023:

(i) Are younger than 26 years old;

(ii) Are not enrolled for coverage under an eligibility group described in §1902(a)(10)(A)(i)(I)-(VII) of the Act; and

(iii) Were formerly in an out-of-home placement in any state, including categorical Medical Assistance, during the foster care period in which they either turned 18 years old or attained a higher age during extended out-of-home placement as described under COMAR 07.02.11.04B.

B. An individual receiving SSI, Mandatory State Supplement, or Optional State Supplement is eligible for the MAGI Exempt coverage groups without having to file a separate application and covered as Categorically Needy.

C. Transitional Medical Assistance.

(1) If a family loses Medical Assistance solely because of increased income from employment of the caretaker relative as defined under Regulation .02B(10)(a) of this chapter, all members of the family shall be eligible for Medical Assistance during the immediately succeeding 12-month period if the parents or caretaker relatives were eligible for Medical Assistance under §A(5) of this regulation in 3 or more months of the 6-month period immediately preceding the month in which they became ineligible for Medical Assistance.

(2) Termination of Transitional Medical Assistance.

(a) Transitional Medical Assistance during the 12-month period described under §C(1) of this regulation shall terminate at the close of the first month in which the family ceases to include a child

(i) Under 18 years old; or

(ii) 18 years old if a full-time student in a secondary school or in the equivalent level of vocational or technical training, and who can reasonably be expected to complete the program before becoming 19 years old younger than 21 years old.

(b) Termination of assistance may not become effective until the Department has provided the family with notice of the grounds for the termination.

(3) Continuation in Certain Cases until Redetermination, With respect to a person who would cease to receive Medical Assistance under §C(2) of this regulation but who may be eligible for Medical Assistance under this chapter, the Department may not discontinue Medical Assistance until the Department has determined that the person is not eligible for Medical Assistance under this chapter.

D. The following individuals may be determined eligible for a MAGI Exempt coverage group after filing a separate application for Medical Assistance and, if determined eligible, are covered as Categorically Needy:

(1) An individual who would be eligible for SSI, or Optional State Supplement benefits except for a requirement of those programs that is specifically prohibited under Title XIX.

(2) A person who in December, 1973, was eligible for Medical Assistance as an essential spouse. Medical Assistance will continue if this person:

(a) Continues to meet the December, 1973, criteria of the State's approved Old Age Assistance, Aid to the Permanently and Totally Disabled, or Public Assistance to the Needy Blind plans to be considered an essential spouse; and

(b) Lives with an aged, blind, or disabled spouse who continues to meet the December, 1973, criteria of the State's approved Old Age Assistance, Public Assistance to the Needy Blind, or Aid to the Permanently and Totally Disabled plans.

(3) A person who in the month of December, 1973, was eligible for Medical Assistance and was an inpatient in a long-term care facility qualified to receive Medical Assistance payments, and, if not institutionalized, would have been eligible for Old Age Assistance, Public Assistance to the Needy Blind, or Aid to the Permanently and Totally Disabled. Medical Assistance will continue if this person:

(a) Needed and received inpatient care continuously since December, 1973;

(b) Continues to need and receive inpatient care; and

(c) Continues to meet the eligibility criteria of the Old Age Assistance, Public Assistance to the Needy Blind, or Aid to the Permanently and Totally Disabled plan for December, 1973.

(4) A person who:

(a) Meets all current requirements for Medical Assistance eligibility except the criteria for blindness or disability;

(b) Was eligible for Medical Assistance in December, 1973, as a blind or disabled person, whether or not he was receiving cash assistance in December, 1973; and

(c) For each consecutive month after December, 1973, continues to meet the criteria for blindness or disability and the other conditions of eligibility used under the Medical Assistance plan in December, 1973.

E. The following individuals may be determined eligible for a MAGI Exempt coverage group after filing a separate application, and if determined eligible, are covered as Medically Needy;

(1) A pregnant woman who has been denied AFDC solely because her income or resources exceed the cash assistance level;

(2) A person younger than 21 years old;

(3) A caretaker relative (and spouse);

(4) An aged, blind, or disabled person; and

(5) A person who was eligible as Medically Needy in December, 1973, on the basis of the blindness or disability criteria of Aid to the Permanently and Totally Disabled or Public Assistance to the Needy Blind and who continues to meet current requirements except for blindness or disability criteria.

F. Continuous Eligibility for Pregnant Women. The Department will provide Medical Assistance through the last day of the month in which the postpartum period ends for a pregnant woman who:

(1) Was eligible and enrolled under §A(2) of this regulation; and

(2) Because of a change in household income, will not otherwise remain eligible.

Md. Code Regs. 10.09.24.03

Regulations .03C amended as an emergency provision effective May 1, 1983 (10:11 Md. R. 962); adopted permanently effective September 1, 1983 (10:17 Md. R. 1521)
Regulation .03 amended as an emergency provision effective May 4, 1990 (17:11 Md. R. 1339); amended permanently effective August 13, 1990 (17:15 Md. R. 1858); amended effective 46:10 Md. R. 485, eff. 5/20/2019; amended effective 49:7 Md. R. 465, eff. 4/4/2022; amended effective 51:15 Md. R. 706, eff. 8/5/2024.