Current through Register Vol. 51, No. 19, September 20, 2024
A. Citizenship. In order to be eligible for
full benefits under the Maryland Children's Health Program, an individual shall
meet the federal requirements for Medical Assistance eligibility as a citizen
or qualified alien, as specified at COMAR
10.09.24.05C.
B. Residency. In order to be
eligible for benefits under this chapter, an individual shall be a resident of
Maryland, in accordance with the requirements at COMAR
10.09.24.05C
-3.
C. Pregnancy. In order to be eligible for
benefits under this chapter, a woman shall be pregnant or be within the
postpartum period.
D. Age. In order
to be eligible for benefits under this chapter, a child shall be younger than
19 years old.
E. Inmate of a Public
Institution. In order to receive benefits under this chapter, an individual may
not be an inmate of a public institution, as specified at COMAR
10.09.24.05C
-5B.
F. Institution for Mental Diseases. In order
to be eligible for benefits under this chapter, an individual between 21 and 64
years old or a child applying under Title XXI of the Social Security Act may
not be a patient in an institution for mental diseases, unless such individuals
are eligible in accordance with COMAR
10.09.24.05C
-5C.
G. No Private Health Insurance. In order to
be eligible for benefits under Title XXI of the Social Security Act, an
individual may not be covered by an employer-sponsored health benefit plan or
have been voluntarily terminated from an employer-sponsored health benefit plan
within 6 months before the application date for benefits under this
chapter.
H. An alien who fails to
meet the requirements under §A of this regulation, but meets all other
nonfinancial and financial factors of eligibility under this chapter, may be
determined eligible for coverage under COMAR
10.09.24.05C
-2.
I. Documentation of Citizenship and Identity.
(1) An applicant or recipient shall be
required as a condition of eligibility to provide documentary evidence of
identity as well as citizenship or nationality, to the Department's
satisfaction, based on federal requirements, if the individual is:
(a) Declared to be a citizen or national of
the United States; and
(b) Being
determined for:
(i) Initial eligibility based
on an application filed on or after September 1, 2006; or
(ii) Continuing eligibility based on a
redetermination with an end date on or after September 30, 2006.
(2) The requirements at
§I of this regulation shall be met for all Medical Assistance coverage
groups except for:
(a) Supplemental Security
Income beneficiaries;
(b) Newborns
who are deemed eligible, for a period of 1 year, for Medical Assistance based
on the mother's Medical Assistance eligibility for the newborn's date of
birth;
(c) Newborns deemed eligible
who are born to an otherwise eligible non-qualified alien woman meeting the
requirements of Regulation .05-2 of this chapter who has filed an application
and has been determined eligible for Medical Assistance for the newborn's date
of birth;
(d) Pregnant women who
are determined presumptively eligible for Medical Assistance through an
accelerated eligibility process;
(e) Individuals who are entitled to Medicare
benefits or enrolled in any part of Medicare;
(f) Individuals receiving SSDI disability
insurance benefits under § 223 of the Social Security Act, or monthly
benefits under § 202 of the Act, based on the individual's
disability;
(g) Children who are
receiving foster care or adoption assistance under Title IV-B or Title IV-E of
the Social Security Act; and
(h)
Other categories of individuals who are considered by the federal government to
have previously presented satisfactory documentary evidence of identity as well
as citizenship or nationality.
(3) An applicant may not be determined
eligible for Medical Assistance until the requirements of §I of this
regulation are met.
(4) Continuing
eligibility for a recipient may not be approved at redetermination until the
requirements of §I of this regulation are met.
(5) If an applicant or recipient fails to
meet the requirements of §I of this regulation within the time standards
specified in Regulation .04I(1) of this chapter, and the time standards are not
extended, the Department shall:
(a) Deny
eligibility for an applicant; or
(b) Terminate eligibility for a recipient, in
accordance with the requirements for timely notice in COMAR
10.09.24.13B.
(6) The reactivation
requirements in Regulation .04I(6) of this chapter shall apply if the
documentation requirements of §I of this regulation are subsequently met
within the current period under consideration for the:
(a) Applicant's denied application;
or
(b) Recipient's terminated
period of continuing eligibility.
(7) If there is documentation in an
applicant's or recipient's case record or a state's database that demonstrates
that the individual meets the requirements of §I of this regulation, the
individual shall be considered to meet the requirements of §I of this
regulation, unless the:
(a) Department has
cause to question the documentation previously accepted; or
(b) Federal government requires additional
documentation.
