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COMAR 10.09.24.11

1109 State of Maryland Medical Assistance Manual Revised July 2012 Attachment D- Notice to Recipient- Six Month Guarantee DEPARTMENT OF HEALTH AND MENTAL HYGIENE 201 West Preston Street Baltimore, Maryland 21201 - Phone 410-767-5800

ADDRESS Notice to Recipient – Six Month Guarantee Dear Medical Assistance Recipient: Your local Department of Social Services recently requested that we cancel your eligibility for Medical Assistance as of (DATE). You should have received a notice from your local department explaining the reason why you lost your eligibility and the fact that you could appeal the decision to close your case. If you did not receive a notice, contact your case manager at your local department. Your eligibility for Medical Assistance has been extended by us until (DATE). This will give you a full six months of eligibility. This additional eligibility is part of Maryland‟s HealthChoice program and is separate from the eligibility established by your local Department of Social Services. It is called a six month guarantee of Medical Assistance eligibility. Your Medical Assistance eligibility will end on this date unless your local Department determines that you are eligible for an additional period of time. You may reapply for Medical Assistance prior to the expiration of this extended period of eligibility. The six month guarantee applies only to Medical Assistance and not any other benefit for which you are eligible or may have been eligible.