Md. Code Regs. 10.67.02.01

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

Section 10.67.02.01 - Eligibility

A. Criteria. Except as provided in §B of this regulation, a Program recipient shall be enrolled in the Maryland Medicaid Managed Care Program, described in this chapter, if the recipient is eligible for receipt of Medical Assistance benefits by qualifying:

(1) As categorically needy or medically needy under COMAR 10.09.24, unless the participant is:

(a) 65 years old or older;

(b) Newly eligible and 64 1/2 years old or older;

(c) Eligible to receive Medicare benefits,

(d) Determined medically needy under a spend down, or

(e) Otherwise certified for a period of less than 9 months;

(2) For the Pregnant Women and Children's Program on or after January 1, 1997; or

(3) For the Maryland Children's Health Program on or after July 1, 1998; or

(4) For the Separate CHIP Program and CHIP Health Services Initiative on or after July 1, 2023.

B. A participant is not eligible for the Maryland Medicaid Managed Care Program if the participant:

(1) Has been, or is expected to be, continuously institutionalized for more than:

(a) 90 successive days in a long-term care facility; or

(b) 30 successive days in an institution for mental disease (IMD);

(2) Is institutionalized in an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID);

(3) Is enrolled in:

(a) Home Care for Disabled Children under a Model Waiver, pursuant to COMAR 10.67.27;

(b) An institution for mental disease (IMD);

(c) The Employed Individuals with Disabilities Program pursuant to COMAR 10.67.41;

(4) Is a child receiving adoption subsidy who is covered under the parent's private insurance;

(5) Is a child under State supervision receiving adoption subsidy who lives outside of the State;

(6) Is a child in an out-of-State placement; or

(7) Is an inmate as defined in COMAR 10.67.62.01.

Md. Code Regs. 10.67.02.01

Regulations .01 recodified from 10.09.63.01 effective 46:22 Md. R. 976, eff. 11/1/2019; amended effective 50:22 Md. R. 974, eff. 11/13/2023; amended effective 51:12 Md. R. 620, eff. 6/24/2024.