Maryland Register

Issue Date:  December 21, 2018

Volume 45 • Issue 26 • Page 1253-1255

Title 10 
MARYLAND DEPARTMENT OF HEALTH

Subtitle 09 MEDICAL CARE PROGRAMS

10.09.24 Medical Assistance Eligibility

Authority: Health-General Article, §15-103, Annotated Code of Maryland

Notice of Proposed Action

[18-340-P]

     The Secretary of Health proposes to amend Regulations .02, .03, and .08-2 under COMAR 10.09.24 Medical Assistance Eligibility.

Statement of Purpose

The purpose of this action is to make the following amendments in order to comply with federal Medicaid requirements:

(1) Define the term “postpartum period”;

(2) Clarify eligibility criteria for transitional Medical Assistance coverage for low-income parents and caretaker relatives;

(3) Add language to explain continuous eligibility for pregnant women; and

(4) Clarify that a participant may establish the participant’s own special needs trust.

Comparison to Federal Standards

There is a corresponding federal standard to this proposed action, but the proposed action is not more restrictive or stringent.

Estimate of Economic Impact

The proposed action has no economic impact.

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Jake Whitaker, Acting Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 22, 2019. A public hearing has not been scheduled.

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(45) (text unchanged)

(45-1) “Postpartum period” means the period of time beginning on the date a pregnancy ends and ending on the last day of the second month following the end of pregnancy.

(46)—(63) (text unchanged)

.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]:

(a) Greater than 123 percent of the federal poverty level and equal to or less than 133 percent of the federal poverty level; or

(b) Equal to or less than 123 percent of the federal poverty level.

(2)—(5) (text unchanged)

B. (text unchanged)

C. [Extended] Transitional Medical Assistance.

(1) [Initial 6-Month Extension.] If a family loses [AFDC] Medical Assistance solely because of increased income from[, or increased hours of,]employment of the caretaker relative as defined under Regulation [.02B(11)] .02B(10)(a) of this chapter, [or because of the discontinuance of the 4-month earned income disregards described under COMAR 07.03.02.06, Medical Assistance shall be provided to] all members of the family shall be eligible for Medical Assistance during the immediately succeeding [6-month] 12-month period if the [family received AFDC] 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 [it] they became ineligible for [AFDC] Medical Assistance.

(2) Termination of [Extension] Transitional Medical Assistance.

(a) [Extension of assistance] Transitional Medical Assistance during the [6-month] 12-month period described under [§B(1)] §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) (text unchanged)

[(c) With respect to a child who would cease to receive Medical Assistance under §B(2)(a) 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 child is not eligible for Medical Assistance under this chapter.

(3) Additional 6-Month Extension.

(a) Each family who has received Medical Assistance during the entire 6-month period under §B(1) of this regulation and who satisfies the reporting requirement of §B(3)(b)(i) of this regulation shall be provided Medical Assistance coverage for the succeeding 6-month period.

(b) Reporting Requirements.

(i) During Initial Extension Period. As a condition of receiving additional extended assistance under §B(3)(a) of this regulation, a family shall report to the local department of social services, not later than the 21st day of the 4th month of the period of extended assistance described under §B(1) of this regulation, on the family’s gross monthly earnings and on the family’s costs for such child care as is necessary for the employment of the caretaker relative in each of the first 3 months of the period.

(ii) During Additional Extension Period. A family receiving additional extended assistance under §B(3)(a) of this regulation shall report to the local department of social services, not later than the 21st day of the 1st and 4th months of the period of additional extended assistance, on the family’s gross monthly earnings and on the family’s costs for such child care as is necessary for the employment of the caretaker relative in each of the 3 preceding months.

(c) Termination of Extension. Extension of Medical Assistance during the 6-month period described under §B(3)(a) of this regulation shall terminate at the close of the first month in which the family ceases to include a child under 18 years old, or 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, or at the close of the 1st or 4th month of the 6-month period if the:

(i) Family fails to report to the local department, by the 21st day of the 1st or 4th month, the information required under §B(3)(b)(ii) of this regulation, unless the family has established, to the Department’s satisfaction, good cause for the failure to report on a timely basis;

(ii) Caretaker relative had no earnings in one or more of the previous 3 months, unless the lack of any earnings was due to an involuntary loss of employment, illness, or other good cause, established to the Department’s satisfaction; or

(iii) Department determines that the family’s average gross monthly earnings, less such costs for child care as are necessary for the employment of the caretaker relative, during the immediately preceding 3-month period exceed 185 percent of the official poverty line applicable to a family of the size involved.

(d) Termination of Medical Assistance may not become effective under §B(3)(c) of this regulation until the Department has provided the family with notice of the grounds for termination. The notice shall include, in the case of termination under §B(3)(e)(ii) of this regulation, a description of how the family may reestablish eligibility for Medical Assistance.]

[(e)] (3) Continuation in Certain Cases until Redetermination.

[(i) With respect to a child who would cease to receive Medical Assistance under §B(3)(c) 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 child is not eligible for Medical Assistance under this chapter.

(ii)] With respect to a person who would cease to receive Medical Assistance under [§B(3)(c)(i), (ii), or (iii)] §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.

[(4) Disqualification for Fraud. Extended Medical Assistance may not be provided to a person who is a member of a family who received AFDC if the Department determines that, at any time during the last 6 months in which the family was receiving AFDC before otherwise receiving Medical Assistance under this section, the person was ineligible for AFDC because of fraud.]

D.—E. (text unchanged)

F. Continuous Eligibility for Pregnant Women. The Department will provide Medical Assistance through the last day of the month in which the 60-day post-partum 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.

.08-2 Treatment of Trust Amounts.

A. (text unchanged)

B. Treatment of Trusts Established after August 10, 1993.

(1)—(5) (text unchanged)

(6) The following trusts may not be counted in determining eligibility for Medical Assistance:

(a) (text unchanged)

(b) A pooled special needs trust containing the assets of an individual who is disabled, and which meets all of the following conditions:

(i)—(iv) (text unchanged)

(7) (text unchanged)

C. Special Needs Trust. The following criteria shall define a single, stand-alone special needs trust that is funded with assets that belonged to the beneficiary:

(1)—(3) (text unchanged)

(4) The trust has been established by [the]:

(a) The beneficiary;

(b) The beneficiary’s parent[,];

(c) The beneficiary’s grandparent[,];

(d) The beneficiary’s legal guardian[,]; or

(e) [a] A court;

(5)—(12) (text unchanged)

ROBERT R. NEALL
Secretary of Health

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