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State of Maryland Medical Assistance Manual Revised April 2014

For current eligibility, determine average monthly cost of care by multiplying the private per diem rate by 30.3. For retroactive eligibility, determine monthly cost of care by multiplying the actual number of days in each month that are not subject to third party payment or reimbursement by the private per diem rate. 1000.3 Eligibility Determination and Certification To determine current eligibility, compare the monthly available income to the average monthly cost of care. To determine retroactive eligibility, compare the actual monthly available income for each month to the actual cost of care for each retroactive month. If eligible, certification is under Section 1200. 1000.4 Available Income Less than Cost of Care If the available income is less than the average monthly cost of care, the person is eligible for MA and the Program will assist with payments towards cost of care. Certification begins on the first day of the period under consideration. If the institutionalized person is not in need of MA in the month of application, certification may begin in the following month. Certify for a twelve month period. For a person for whom the Program will assist with payments towards cost of care, all available income for the month is to be contributed to the cost of care for that month. Notify the person, their representative, and the LTCF of eligibility and of the amount of available income that must be paid towards the cost of care. Any income not applied to cost of care due to hospitalization or insurance coverage becomes a countable resource if maintained into a subsequent period under consideration. 1000.5 Available Income Equal to Cost of Care If the available income is equal to the average monthly cost of care, the person is eligible for Medical Assistance, but is not eligible for Program payments towards cost of care. Certification begins on the first day of the period under consideration. Certify for a twelve month period. Notify the person, their representative, and the LTCF of eligibility. 1000.6 Available Income Greater than Cost of Care If the monthly available income is greater than the average monthly cost of care, the Program will not assist with payments towards the cost of care, but the person may be eligible for MA under spend- down. To determine whether the person is eligible, compare the excess available income for the entire period under consideration to the incurred medical expenses for the period. If the incurred expenses equal or exceed the excess available income, the person is eligible for MA and certification begins on the day spend-down is met. 1000.7 Determine Excess Available Income