Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.11 - Maryland Children's Health Program
Section 10.09.11.13 - Post-Eligibility Requirements
Universal Citation: MD Code Reg 10.09.11.13
Current through Register Vol. 51, No. 19, September 20, 2024
A. Notice of Eligibility Determination. The local health department or the local department of social services shall inform an applicant of the applicant's legal rights and obligations and give the applicant written notification of the following:
(1) For eligible persons:
(a) A finding of eligibility,
(b) The beginning and ending dates for
coverage, and
(c) The right to
request a hearing;
(2)
For ineligible persons:
(a) A finding of
ineligibility,
(b) The reason for
the finding,
(c) The regulation
supporting the finding, and
(d) The
right to request a hearing.
B. Recipient Responsibility.
(1) A child recipient's parent, guardian, or
representative shall notify the local health department or the local department
of social services within 10 working days of changes affecting the child
recipient's eligibility.
(2) A
recipient or the recipient's representative shall limit use of the Program card
to the person whose name appears on the card.
(3) When written notice of cancellation is
received, a recipient shall discontinue use of the Program card on the first
day of ineligibility and return the card to the Department.
(4) Failure to comply with the provisions of
§B(1)-(3) of this regulation may result in:
(a) The termination of assistance;
or
(b) Referral to the Department
for fraud investigation, or for criminal or civil prosecution.
(5) A recipient shall cooperate
with the State's Medical Assistance quality control review process, including
verification of all information pertinent to the determination of
eligibility.
(6) If the recipient
refuses to cooperate, the recipient's coverage shall be terminated subject to
the regulation governing timely and adequate notice under COMAR
10.09.24.13B.
C. Unscheduled Redetermination.
(1) The local health
department or the local department of social services shall:
(a) Promptly make an unscheduled
redetermination of a child recipient's eligibility when changes in
circumstances or relevant facts are:
(i)
Reported by someone on the recipient's behalf, or
(ii) Brought to the attention of the local
health department or the local department of social services from other
responsible sources;
(b)
Notify the recipient that redetermination is required to establish continuing
eligibility; and
(c) Notify the
recipient of the required information and verifications needed to determine
eligibility and the time standards in acting in the redetermination
process.
(2) Eligibility
Decisions. Recipients who are determined:
(a)
Eligible for the remainder of the certification period shall be sent notice in
accordance with §A(1) of this regulation; or
(b) Ineligible because of a change in
circumstances or failure to establish eligibility following a change in
circumstance shall be sent notice in accordance with §A(2) of this
regulation.
(3) A
recipient whose eligibility has been canceled may reapply at any time after the
cancellation of eligibility and a new period under consideration shall be
established.
D. Scheduled Redetermination. Except for children eligible as newborns of eligible women, the local health department or the local department of social services shall make a scheduled redetermination of a child recipient's eligibility at least every 12 months.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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