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State of Maryland Medical Assistance Manual Revised April 2014

1000.1 Introduction- Eligibility for Institutionalized Persons Before determining a person’s financial eligibility for a long-term care coverage category, it must first be determined that the person is considered institutionalized and that all non-financial requirements under COMAR 10.09.24.05 have been met (see Section 500). Institutionalized persons must meet the same MA non-financial requirements under COMAR 10.09.24.05 as non- institutionalized persons. Also, the application process specified under COMAR 10.09.24.04 must be followed by the CM and by the applicant or representative. The applicant is entitled to an eligibility determination within 30 days of the application date (or 60 days if a disability determination is required), unless the CM grants an extension of time limits (see Section 400). There are specific provisions for evaluation of resources for institutionalized persons, especially married couples (including separated couples). The special treatment of resources for married couples is called the “Spousal Impoverishment” provision and is addressed in this chapter. The lien provision is also briefly addressed in this chapter; however, for a thorough explanation of this provision, the CM must refer to COMAR 10.09.24.15 (see Section 1500). This chapter also deals with income eligibility for institutionalized persons, which is based on a comparison of a person’s available income to the cost of the person’s care in a Long-Term Care Facility. This comparison determines if the person is eligible for MA, as well as whether the Program will assist with payments towards the cost of care. If the Program assists with payments towards cost of care, the person is also required to contribute his available income towards this expense. This section also addresses continuing eligibility for institutionalized persons. (a) The Meaning of “Institutionalized” Persons Aged 21 or Older A person aged 21 or older is considered “institutionalized” when he/she: • Resides in a licensed and certified Long-Term Care facility (LTCF); • Has resided in an LTCF for a continuous period of 30 consecutive days or, if less than 30 consecutive days, is likely to remain there for 30 consecutive days; and • Has a medical need for Long-Term Care (LTC) as certified by the Utilization Control Agent on the DHMH 257. Note: If the CM does not receive the DHMH 257 from the LTCF by the due date for the MA- LTC eligibility determination, the application should be denied due to lack of this verification, in accordance with the provisions of COMAR 10.09.24.04J (3)—Information Required. However, before the application is denied, the applicant should be given timely notice of the need for receipt of the DHMH 257 and any other outstanding verifications, and be given a due date for return of the verifications. A person who has been admitted to a LTCF and subsequently dies is considered institutionalized for eligibility purposes.