Md. Code Regs. 10.09.41.05

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

Section 10.09.41.05 - Application Requirements - Determination and Redetermination of Eligibility

A. Application.

(1) To any individual requesting information, the Department shall provide oral or written information about:

(a) EID eligibility requirements;

(b) The coverage, scope, and related services of the Medical Assistance Program; and

(c) Applicants' and recipients' rights and obligations under the Medical Assistance Program.

(2) The Department shall issue an EID application form to any individual upon request.

(3) An applicant or recipient may apply for a determination or a redetermination of eligibility for the EID coverage group by submitting to the Department:

(a) The application form designated by the Department and signed in accordance with the signature requirements of COMAR 10.09.24;

(b) The social security numbers of each member of the assistance unit, in accordance with §A(5) of this regulation; and

(c) Signed consent forms as specified in §A(4) of this regulation.

(4) Consent Forms. An applicant or recipient, or, if necessary and consistent with the signature requirements specified in COMAR 10.09.24, a representative or other individual acting on behalf of the applicant or recipient, shall sign consent forms as needed to authorize the Department's verification of information needed to establish eligibility through sources such as employers, banks, and public or private agencies.

(5) Social Security Number.

(a) As required in COMAR 10.09.24 for each assistance unit member requesting benefits under this chapter, an applicant or recipient shall:

(i) Provide the Department with the individual's Social Security number; or

(ii) Verify that the individual has applied to the Social Security Administration for a Social Security card.

(b) An applicant's or recipient's failure to meet the requirements of §A(5)(a) of this regulation shall result in a determination of ineligibility under this chapter.

(6) An applicant or recipient shall provide to the Department information and verifications needed for the determination of all elements of nonfinancial, income, and resource eligibility, including but not limited to information relating to health insurance coverage or potential third-party payments.

(7) Additional Information Requirements. An applicant or recipient shall, at the Department's request:

(a) Be available for and participate in an interview; and

(b) Answer questions and provide information relevant to:

(i) The applicant's eligibility for the EID coverage group; or

(ii) The recipient's continuing eligibility for the EID coverage group.

(8) An individual temporarily absent from the State who intends to return to the State:

(a) May apply to the Department by mail for the EID coverage group; and

(b) To establish eligibility for the EID coverage group, shall:

(i) Demonstrate continued residency in the State; and

(ii) Meet all technical and financial requirements of eligibility under this chapter.

(9) An applicant or recipient shall cooperate and assist with the Department's eligibility determination or redetermination process under this chapter, including but not limited to the requirements of §A of this regulation.

B. The Department shall:

(1) Maintain a case record for the applicant or recipient, including documentation of all required elements of eligibility;

(2) Conduct a wage-screening inquiry to determine wages, benefits, and claimant history for each assistance unit member;

(3) Verify all factors of eligibility under this chapter for each assistance unit member applying for the EID coverage group; and

(4) Restrict disclosures of information concerning applicants and recipients to purposes directly connected with the administration of the EID coverage group of the Medical Assistance program.

Md. Code Regs. 10.09.41.05

Regulations .05 adopted as an emergency provision effective April 1, 2006 (33:9 Md. R. 795); adopted permanently effective July 3, 2006 (33:13 Md. R. 1063)
Regulation .05 amended as an emergency provision effective October 1, 2008 (35:22 Md. R. 1955); amended permanently effective February 9, 2009 (36:3 Md. R. 208)