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State of Maryland Medical Assistance Manual Revised April 2014

3. In the application month the “FINL RESP” code for the child must be entered as “NM” to avoid dual participation and insure eligibility is determined correctly for any other AU members. 4. If the redetermination application is not received, the LDSS CM must update the narrative and allow CARES to close the AU due to failure to complete the redetermination. The procedures in Policy Alert 12-04 for tardy redeterminations apply if an application for continued eligibility is returned within four (4) months of the redetermination due date, or if a new application is filed within that time frame. 5. When determining community eligibility, technical and financial eligibility factors must be met for all household members for whom benefits are requested. If the LDSS CM determines that the child is eligible for MCHP and there is no associated case, change the D.O. and transfer the open case to the appropriate local health department (LHD). If the LDSS CM determines that the child is eligible in another community category or there is an associated case, the AU remains active in the LDSS. 6. If it is determined that eligibility no longer exists, the assistance unit must receive timely and adequate notification, and the right to request a hearing. NOTE: ALL CASE ACTIVITIES MUST BE FULLY NARRATED IN CARES.

i. Maryland Home and Community Based Service Waivers Applicants Who Reside In a Long- Term Care Facility (Policy Alert 10-11)

Medical Assistance (MA) recipients in a long-term care facility (LTCF) who have applied for a home and community based services waiver and meet all other medical, technical, and financial waiver requirements may not be enrolled in the waiver until they are discharged from the LTCF to a community-based setting. The DHMH Division of Eligibility Waiver Services (DEWS) is responsible for processing the MA waiver application and pending it in CARES. The following procedures will be used for institutionalized MA recipients who apply for a waiver. If the applicant has received a “Notice of Ineligibility” for MA waiver eligibility from DEWS, the applicant must re- apply if the applicant wants waiver eligibility to be reconsidered. For pending waiver applicants, if the waiver administering agency (the State agency or other designated entity responsible for administration of the waiver) determines that the applicant meets all the non-financial waiver eligibility requirements except that the applicant still resides in a LTCF, the waiver administering agency will send an “advisory” Authorization to Participate (ATP) to DEWS. This ATP will specify that it is an advisory ATP because the applicant still resides in a LTCF. Upon receipt of the advisory ATP, DEWS will determine MA waiver eligibility. If the applicant is not MA waiver eligible, DEWS will send the applicant a waiver denial notice, specifying the reason(s) for MA waiver ineligibility. If DEWS determines that the applicant appears to be MA waiver eligible based on the information provided so far, DEWS will send the applicant a waiver eligibility advisory opinion. The notice will inform the applicant that he/she may qualify for the waiver without reapplying, if he/she moves from