Md. Code Regs. 10.09.43.05

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

Section 10.09.43.05 - Nonfinancial Eligibility Requirements

A. Citizenship. In order to be eligible for full benefits under MCHP Premium, an applicant shall be one of the following:

(1) A citizen of the United States;

(2) A person residing in the United States who is:

(a) A qualified alien as defined under Regulation .02B of this chapter;

(b) An honorably discharged veteran of the armed forces of the United States;

(c) An alien on active duty in the armed forces of the United States; or

(d) The spouse, including a surviving spouse who has not remarried, or unmarried dependent child of an honorably discharged veteran of or alien on active duty in the armed forces of the United States;

(3) An individual residing in the United States who is:

(a) An alien who has been granted asylum under § 208 of the Immigration and Nationality Act;

(b) A refugee admitted into the United States under § 207 of the Immigration and Nationality Act;

(c) An alien whose deportation has been withheld under § 243(h) of the Immigration and Nationality Act;

(d) A Cuban or Haitian entrant;

(e) An alien admitted to the country for permanent residence as an Amerasian immigrant under Title II of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1989;

(f) A legal permanent resident who first entered the country under another exempt category, that is, as a refugee, asylee, Cuban or Haitian entrant, trafficking victim, or alien whose deportation was being withheld, and who later converted to legal permanent resident status;

(g) A victim of a severe form of trafficking who has been subjected to:

(i) Sex trafficking, if the act is induced by force, fraud, or coercion, or if the individual induced to perform the act is younger than 18 years old; or

(ii) Involuntary servitude;

(h) An honorably discharged veteran of the armed forces of the United States;

(i) An alien on active duty in the armed forces of the United States; or

(j) A spouse, including a surviving spouse who has not remarried, or unmarried dependent child of an honorably discharged veteran or alien on active duty in the armed forces of the United States; or

(4) An individual residing in the United States who is a qualified alien as defined under Regulation .02B of this chapter.

B. Residency. The requirements relating to residency under COMAR 10.09.11.06BB apply to this chapter.

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

D. Inmate of a Public Institution. In order to receive benefits under this chapter, an applicant may not be an inmate of a public institution.

E. Institution for Mental Diseases or Mental Hospital. An applicant who is a patient in an institution for mental diseases or mental hospital is not eligible for benefits under this chapter.

F. Access to or Coverage under Other Health Benefit Plans.

(1) Current Coverage. Except for coverage purchased in the context of participating in MCHP Premium, an applicant or recipient is not eligible for MCHP Premium if the applicant or recipient is covered:

(a) As a dependent under an employer-sponsored group health plan; or

(b) Under health insurance coverage.

(2) Past Coverage. In order to be eligible for benefits under this chapter, an applicant may not be covered by employer-sponsored insurance or have been voluntarily terminated from an employer-sponsored insurance within 6 months before the date of the application, except for coverage purchased in the context of participating in MCHP Premium. Voluntary termination does not include:

(a) Loss of employment due to factors other than voluntary termination;

(b) Change to a new employer that does not provide an option for dependent coverage;

(c) Change of address so that no employer-sponsored health benefit plan is available;

(d) Discontinuation of health benefits to all dependents of employees of the parent's or guardian's employer; or

(e) Expiration of the applicant's continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

(3) Access to State Health Benefits Plan. Children of State employees who have access to coverage under a State employees' health benefits plan based on a family member's employment with a State agency are not eligible for MCHP Premium unless the premium contribution available from the State towards the cost of health benefits coverage for the child is not more than $10 per month.

G. Duration of Eligibility. After an individual has been determined to be eligible for MCHP Premium and is enrolled in MCHP Premium:

(1) The Department shall periodically redetermine the recipient's eligibility for MCHP Premium as specified in Regulation .15D of this chapter; and

(2) The recipient or the recipient's representative shall, within 10 days of the occurrence, notify the Department if there is a change in the recipient's, the recipient's parent's, or the recipient's guardian's:

(a) Income;

(b) Employment;

(c) Address; or

(d) Health insurance coverage status.

Md. Code Regs. 10.09.43.05

Regulations .05 adopted as an emergency provision effective July 1, 2001 (28:12 Md. R. 1102); adopted permanently effective September 3, 2001 (28:17 Md. R. 1556)
Regulation .05A amended effective November 10, 2003 (30:22 Md. R. 1580); April 19, 2010 (37:8 Md. R. 614)
Regulation .05F, G amended effective November 10, 2003 (30:22 Md. R. 1580)