Md. Code Regs. 10.09.24.11

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

Section 10.09.24.11 - Certification Periods

A. This regulation specifies the time periods for certifying eligible members of an assistance unit. Certification periods for retroactive and current coverage will be based on consideration periods established in accordance with the provisions of Regulations .09 and .10 of this chapter.

B. Certification of Eligible Noninstitutionalized Persons.

(1) The following eligible noninstitutionalized persons shall be certified for a one-time-only period of 6 months or less and scheduled redetermination for continued eligibility may not be made:

(a) Those who are certified for a retroactive period only, including retroactive spend-down;

(b) Those who are certified under the spend-down provision; and

(c) Those whose anticipated circumstances preclude eligibility beyond the current period.

(2) Section B(1)(c) of this regulation is limited to:

(a) A person who dies before the completion of the eligibility determination;

(b) A migrant worker whose date of departure or expected date of departure from the State is known; and

(c) A coverable inmate of a public institution who leaves the institution solely for admission to a medical facility.

(3) Eligible persons not certified under §B(1) of this regulation shall be certified for a one-time-only period of 6 months and scheduled redetermination of eligibility shall be made.

C. Date for Certification to Begin and End for Noninstitutionalized Persons.

(1) Persons Eligible for Retroactive Coverage Under Spend-Down.

(a) Certification begins on the day in the period under consideration on which retroactive spend-down eligibility was met.

(b) Certification ends on the last day of the most recent month in the retroactive period in which coverable expenses were incurred.

(c) Only persons who have coverable medical expenses during the period under consideration shall be certified.

(d) Certification under this provision shall cover only those incurred medical bills that are not subject to third-party payment and remain the liability of persons in the assistance unit.

(2) Persons Eligible for Retroactive Coverage Without Spend-Down.

(a) Certification begins on the first day of the earliest month of the retroactive period under consideration in which coverable medical expenses were incurred.

(b) Certification ends on the last day of the most recent month in the retroactive period in which coverable medical expenses were incurred.

(c) Only persons who have coverable medical expenses during the period under consideration shall be certified.

(d) Certification under this provision shall cover only those incurred medical bills that are not subject to third-party payment and remain the liability of persons in the assistance unit.

(3) Persons Eligible for Current Coverage Under Spend-Down.

(a) Certification begins on the day in the period under consideration on which medical expenses for services already received equal or exceed the amount of excess income. The beginning date of the certification period shall be established to exclude from coverage any full day after the application date and before the certification date for which all expenses for medical services were used to establish spend-down eligibility.

(b) Certification ends on the last day of the period under consideration.

(4) Individuals Eligible for the Maryland Medicaid Managed Care Program.

(a) Initial certification shall be a period of 6 months.

(b) Section C(4)(a) of this regulation applies only if the individual:

(i) Has not been eligible for Medical Assistance any time during the calendar month immediately before the month of application; and

(ii) Has no private health insurance.

(c) An individual certified under §C(4)(a) of this regulation is not subject to the unscheduled redetermination requirements of Regulation .12C(2) of this chapter.

(d) Subsequent certification periods shall be consistent with the provisions of this subsection.

(5) All Other Persons.

(a) Certification begins on the first day of the month of application.

(b) Certification ends on the last day of the period under consideration.

(6) Notwithstanding the provisions of §D(1)-----(4) of this regulation, certification of a deceased person may not continue beyond the date of death.

(7) Notwithstanding the provisions of §D(1)-----(4) of this regulation, certification of an eligible new member of the assistance unit pursuant to Regulation .06D of this chapter may not precede the date he becomes a member of the household.

D. Date for Certification to Begin and End for Eligible Institutionalized Persons.

(1) Persons Eligible for Retroactive Coverage Under Regulation .10C(5) of this chapter.

(a) Certification begins on the first day of the period under consideration.

(b) Certification ends on the last day of the period under consideration.

(2) Persons Eligible for Retroactive Coverage Under Regulation .10C(7) of this chapter.

(a) Certification begins on the day the incurred medical expenses less health insurance and other third-party coverage equal or exceed the excess available income.

(b) Certification ends on the last day of the period under consideration.

(3) Persons Eligible for Current Coverage Under Regulation .10D(3) of this chapter.

(a) Certification begins on the first day of the period under consideration or, at the option of the person or the person's representative, on the first day of the following month if coverage is not needed in the month of application.

(b) Certification continues until the person is determined ineligible and scheduled redetermination of eligibility shall be made at least once every 12 months.

(4) Persons Eligible for Current Coverage Under Regulation .10D(5) of this Chapter.

(a) Certification begins on the day the incurred medical expenses less health insurance and other third-party coverage equal or exceed the excess available income.

(b) Eligibility ends on the last day of the period under consideration or, if it is known that eligibility should terminate before the end of the period under consideration, on the appropriate earlier date, and scheduled redetermination of eligibility may not be made.

(5) Notwithstanding the provisions of §D(1)-----(4) of this regulation, certification of a deceased person may not continue beyond the date of death.

Md. Code Regs. 10.09.24.11

Regulation .11C amended effective September 10, 1994 (11:8 Md. R. 1584) June 2, 1997 (24:11 Md. R. 793)
Regulations .11D, E amended as an emergency provision effective May 1, 1983 (10:11 Md. R. 962); adopted permanently effective September 1, 1983 (10:17 Md. R. 1521)
Regulations .11 amended effective May 1, 1986 (13:8 Md. R. 898)
Regulation .11E amended effective September 10, 1984 (11:18 Md. R. 1584)