Md. Code Regs. 14.35.19.03

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.19.03 - Eligibility Requirements for Subsidies Through the Program

A. An enrollee is eligible to receive subsidies from the Program during a month if:

(1) The enrollee is a member of a tax filer's tax household and the tax filer has met the eligibility requirements for APTC in accordance with the requirements in COMAR 14.35.07.08A-C, E, and G;

(2) The enrollee is a member of a tax filer's tax household and the tax filer attests to a household income, as defined in 26 CFR § 1.36B-1(e), greater than or equal to 138 percent but not more than 400 percent of the FPL for the benefit year for which coverage is requested;

(3) The enrollee is at least 18 years old; and

(4) The enrollee is under the age of 35 years.

B. Eligibility under this regulation is contingent upon verification of the enrollee's attestation that the enrollee meets the criteria in §A of this regulation.

C. The enrollee's age as of the effective date of coverage shall be used in determining the enrollee's eligibility to receive subsidies from the Program.

D. In any calendar year of the program:

(1) The Board may limit the availability of subsidies, regardless of eligibility, if the costs of the program are projected to exceed the budgeted allowance for that calendar year;

(2) The limit described in §D(1) of this regulation may take the form of:

(a) A limit on the number of enrollees eligible for the subsidy;

(b) A limit on increases in subsidies during a plan year for enrollees after enrollment; or

(c) Any other limit or combination of limits as the Board deems appropriate;

(3) Any limit on the availability of subsidies for enrollees in the program shall be applied uniformly to all enrollees after the effective date of the Board's decision; and

(4) The Exchange shall monitor the data outlined in Regulation .05 of this chapter to determine, in consultation with the Maryland Insurance Administration, the recommended limits to the Program.

E. Effective Dates for Changes in Subsidy Eligibility.

(1) Except as otherwise specified under this regulation, changes in eligibility for subsidies determined by the Individual Exchange are effective the first day of the month following the date on which the determination is made.

(2) When an applicant is determined newly eligible for Medicaid or MCHP, the applicant shall be ineligible for subsidies beginning the first of the month after the enrollee is determined newly eligible for Medicaid or MCHP.

(3) When an applicant is eligible for a special enrollment period under COMAR 14.35.07.12-.19, the applicant or enrollee shall be in accordance with the applicable effective date specified for each special enrollment period under COMAR 14.35.07.12-.19.

(4) When an enrollee's enrollment is terminated by the enrollee as set forth in 45 CFR § 155.430(b)(1) or terminated by the Exchange under 45 CFR § 155.430(b)(2)(i)-(vii) the applicant or enrollee shall be in accordance with the applicable effective date of the termination set forth in 45 CFR § 155.430(d).

Md. Code Regs. 14.35.19.03

Regulation .03 adopted effective 48:24 Md. R.1025, eff. 11/29/2021; amended effective 50:20 Md. R. 889, eff. 10/16/2023