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State of Maryland Medical Assistance Manual Revised April 2014

These expenses may not be considered if they are subject to third party payment or are forgiven by the provider. The date of service, type of item or service and cost must be verified by a bill or statement from the provider. Eligibility begins on the day on which incurred medical expenses equal or exceed excess available income. Certify for Medical Assistance for the remainder of the 6-month period under consideration on a one-time-only basis. (Do not redetermine eligibility. To be considered for a subsequent period, the person must reapply.) The Program will not assist with payments towards the cost of care. The cost of care paid or incurred during this period under consideration may not be used in any subsequent determination of eligibility or available income. If spend-down eligibility is not established during the application process, place the case in preserved status for the 6-month period under consideration. If spend-down eligibility is not established during the preserved period, the person must reapply to be considered for a future period. If a person becomes non-institutionalized while the institutionalized application is preserved, shorten the period under consideration and recalculate income. Consider the actual cost of care during this period. If still in need of MA, the person must file a new application as non-institutionalized and a new period under consideration must be established. 1000.9 Continuing Eligibility Eligibility is determined for the first six month period under consideration and, based on this determination, the LDSS may anticipate the person’s continued eligibility throughout the next 6- month period under consideration, unless the person has been certified under spend-down, or a change can be reasonably anticipated, or circumstances require an interim change or unscheduled redetermination.

1000.10 Scheduled Redetermination The LDSS must make a scheduled redetermination twelve months from the first month of LTC eligibility and every 12 months thereafter. All non-financial and financial factors of eligibility are reevaluated at redetermination. Any irregular or variable income that has been projected inaccurately is adjusted at the scheduled redetermination by a one-time-only adjustment to available income. The recipient and representative must be notified of the adjustment prior to the effective date. This method applies only to irregular income that has been reported and projected. This method cannot be used to adjust income that has not been reported in a timely manner or that has been reported but not acted upon in a timely manner by the LDSS. If a one-time-only adjustment to available income results in available income that exceeds cost of care, the person is responsible for the full cost of care in the month of adjustment, but MA eligibility is continued uninterrupted. For the following month, recalculate available income and resume Program payments towards COC. 1000.11 Interim Changes