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State of Maryland Medical Assistance Manual Revised April 2014

If the recipient indicates that payment was made after the 30-day period, evaluate the circumstances regarding the delay. If extenuating circumstances existed that may reasonably have inhibited the ability to make the payment within the 30 days, eligibility may be continued without a loss of benefits. If the receipt is not received, no further action is required on the closed case. Upon reapplication, apply standard procedures and policies for determining current eligibility. F. Change in Income A change in a recipient’s income affects the recipient’s available income for the cost of care, and may affect the recipient’s eligibility. The revised income is presumed to continue until the local department is notified otherwise. A decrease in income will not affect a recipient’s MA long-term care eligibility, but will affect the amount of available income to be paid towards the cost of care. The CM must recalculate the recipient’s available income and effect the change according to the requirements for timely notice to the recipient, any representative, and the long-term care provider. When an increase in the recipient’s income is reported or discovered, the CM should initiate an unscheduled redetermination. Eligibility may not be redetermined for the current month or a prior month, but may only be redetermined prospectively beginning in an ongoing month for a new 6-month current period under consideration. Likewise, a recipient’s contribution towards the cost of care may not be increased retrospectively, just prospectively after timely and adequate notice of this adverse action. The notice must be mailed to the recipient, any representative, and the long-term care provider at least 10 days before the effective date of the action. • An increase in regular income is presumed to continue at the new rate until the local department is notified otherwise. • Lump sum income is prorated through the 6-month period under consideration that is established for the eligibility determination or redetermination. See Section 700 of this Manual for the policies and procedures for consideration of lump sum income. An increase in total income will result in an increase in available income. The CM must recalculate the recipient’s available income and compare it to the recipient’s cost of care in the long-term care facility. If the new available income is less than the cost of care, the recipient remains eligible, but must pay more towards the cost of care. The recipient, representative, and LTCF must be sent a notice to inform them of the increased amount that the recipient is to pay towards the cost of care. If the recipient’s available income is now greater than the cost of care, the recipient is no longer eligible, and the CM must give timely notice of adverse action. The MA-LTC assistance unit will trickle to spend-down (L99) due to excess income. If the individual has incurred medical expenses (not including bills for the non-covered long-term care services), the individual may qualify under spend-down for MA to cover State Plan services other than long-term care, once a spend-down of the excess income is met (coverage group L99). Effective the first day of the