Page 18

COMAR 10.09.24.12

1217 State of Maryland Medical Assistance Manual Revised July 2012

Regulations and policy require prompt redetermination of eligibility for all categories when changes occur which may affect eligibility, i.e., disability, living arrangements, income, resources, etc. Reapplication following the termination of eligibility always began a new period under consideration, and a face-to-face interview was required to complete the process.

To simplify the process, a new procedure is being implemented to allow a “Tardy Redetermination” for recipients who lose Medicaid eligibility due to failure to complete the redetermination. This means the recipient failed to return the redetermination packet, failed to return requested verifications, or failed to notify the CM of difficulty in providing required information. Effective immediately if, under any circumstances, an individual loses MA eligibility for failure to complete the scheduled or unscheduled redeterminations, the CM must process the application without a face-to-face interview if:

o The redetermination packet is returned within four months of the month the MA benefits were terminated,; or o A new application is filed within four months of the month the MA benefits were terminated. If the redetermination packet or a new application is received by the LDSS/LHD within four months of the case closure, eligibility can be determined back to the month in which eligibility was lost, meaning there may be no lapse in coverage. To facilitate this process, take the following steps:

1. The screener should run a clearance to find the most recent MA case closure for the individual and determine if it was processed within the past four months. 2. Rescreen the case, using the first day of the month following the month in which eligibility was lost as the application date (e.g., if case closed on 5/31/01, use 6/01/01 as the effective date). 3. Process each month, since the month of case closure, evaluating the circumstances, i.e. living arrangements, income and assets, etc. For each pending month, review and enter the actual gross income and resources for that month, to ensure that eligibility existed during each month. 4. Certify for months in which eligibility existed. If it is determined that the individual‟s eligibility would have continued uninterrupted if he/she had completed the redeterminations timely, certify the case with no lapse coverage, beginning the first day of the month following the month in which eligibility was terminated. 5. If the individual was ineligible during any months since the month of case closure, certify only for the month(s) for which eligibility is established. If the individual was ineligible during the entire period, send proper notification, including the finding of ineligibility and dates, the reason for the finding, the COMAR supporting the finding, and the right to request a hearing.

These procedures are consistent with existing policy regarding retroactive application.