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State of Maryland Medical Assistance Manual Revised April 2014
MARYLAND MEDICAL ASSISTANCE PROGRAM
NOTICE OF NON-COVERAGE OF NURSING FACILITY SERVICES DUE TO SUBSTANTIAL HOME EQUITY
Date
Re:
Name
CID #
Dear
,
This is to notify you that based on the application/redetermination filed on______________________ , you are determined ineligible for Medical Assistance coverage of nursing facility services. This is because you did not meet the Program's requirements related to home equity. However, you are eligible for medical services covered under the red and white Medical Care Program Identification Card. Your eligibility for Medical Assistance:
began effective _________________________________. is re-approved and will continue unless you receive a cancellation notice.
You reported that you have $
in equity interest in your home property (after deducting any encumbrances secured by the home). So long as your home equity exceeds the current home equity limit by any amount, Medical Assistance will not pay for your nursing facility services.
If you cannot access these funds and the non-coverage of nursing facility services would cause you to be deprived of medical care, food, clothing, shelter, or other necessities so that your health or life would be endangered, contact the case worker below to find out about requesting an "undue hardship waiver."
This decision is based on COMAR 10.09.24.
.
If you do not agree with this decision, you have the right to request a hearing within 90 days of the date on this notice. The procedures for requesting a hearing are attached. If you have any questions about this letter, please call your Case Manager at the number below.
Case Manager
Department of Social Services
Telephone Number
DHMH 4235B (LTC) Revised 12/08 White–Customer/Authorized Representative Copy Yellow-Long Term Care Facility Copy Pink-Case Record Copy