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COMAR 10.09.24.12

1214 State of Maryland Medical Assistance Manual Revised July 2012 Unscheduled redeterminations occur whenever the LDSS becomes aware of changes in the recipient’s situation which necessitates a review of eligibility. This includes a report of a change in circumstances by the recipient, another person, and the local department’s own anticipation of a change in the recipient’s circumstances. When the local department becomes aware that a change is expected to occur, it is the CM’s responsibility to flag the case for review at the time of anticipated change and to initiate contact with the recipient at that time.

Each reported change must be verified and evaluated to determine the scope of the change and its effect on the continued eligibility of the recipient. The LDSS must notify the recipient that verification of the change in circumstances is required and must be received by a given deadline. The deadline should be established on an individual case basis, taking these factors into consideration: the LDSS is expected to determine continued eligibility status within 30 days of the date of change; the recipient must report a change within 10 working days of it’s occurrence; the recipient must be given a timely notice (see Regulation .13B(1) for the standard on timely notice) of termination if the verified change results in ineligibility and the timely notification requirement cannot be waived based on Regulation .13B(3); the extensions of the time limits available to initial applicants do not apply to recipients undergoing unscheduled redeterminations; and failure to supply required verification by the established deadline will result in termination of Medical Assistance coverage after timely notice of termination is given.

A new application is not required on all unscheduled redeterminations. The CM may require completion of a new application if there are multiple or complex changes or when he cannot determine eligibility from the verification alone. A new application is required for all additions of a member to the assistance unit, other than the birth of a previously certified unborn child. Whether or not an application is required, the consideration period remains as established. A face-to-face contact is not required unless the LDSS decides that it cannot make an accurate determination without such contact. The recipient who is determine ineligible based on verified information must have his eligibility terminated at the earliest date consistent with the timely notice requirements. A recipient who was eligible without spend-down may have his/her certification terminated because of increased income which renders him/her potentially eligible only under spend-down. This person’s prior certification period will be preserved for possible spend-down eligibility at any time within the existing consideration period.

(e)Scheduled Redeterminations

The LDSS shall make scheduled redeterminations at least once every 12 months for non-institutionalized and institutionalized persons certified pursuant to Regulation .11C of this chapter. The LDSS shall notify the recipient that redetermination is required to establish continuing eligibility. The notice and application will be sent at least 45 days before expiration of the current certification period. When the signed application is received by the LDSS, a new period under consideration will be set. The new period will be related to the date the application is received but may not include any month in which the person was entitled to coverage under the current certification period.