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COMAR 10.09.24.12

1202 State of Maryland Medical Assistance Manual Revised July 2012 Failure to comply with the provisions of §B (1)-(4) of this regulation may result in legal action, referral to the MACA for reimbursement, fraud investigation, or both, for illegal use of the Medical Assistance card. Recipients shall cooperate with the State‟s Quality Control review process, including provision and verification of all information pertinent to eligibility determination. Failure to cooperate shall result in the following actions:

o The Quality Control Division shall notify the LDSS of a recipient‟s failure to cooperate; o The LDSS shall immediately attempt to secure the recipient‟s cooperation; o If the recipient still refuses to cooperate, his/her coverage shall be terminated in accordance with this provision, subject to the regulation governing timely and adequate notice.

1200.2 Redetermination Processing

(a)Redetermination Period

For most people who receive Medical Assistance Eligibility must be reviewed at least annually, as required by Federal Regulation. This review is called “Redetermination.” During a redetermination all factors of eligibility must be met, just as they were at the initial application. Some steps required at original application may not be required at redetermination, such as verification of a social security number. The face-to-face interview is no longer required at redetermination. However, the Case Manager (CM) may require a face- to- face interview, at their option. Other steps, such as computation of earned income, are required because this data is likely to have changed since the application was originally filed.

Some individuals do not require determination of eligibility. These persons are automatically eligible for MA based on their receipt of cash benefits:

Individuals receiving Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA) Children in foster care or adoption under title IVE. Residents of Long-Term facilities who are SSI-eligible (coverage group L01) do not require a redetermination. The CM should set a 745 alert at least once a year to review the case for changes. Other individuals may receive eligibility only for a predetermined period of time, such as those who qualify under spend-down, but must be allowed to reapply for continued eligibility.

For those who do not require a redetermination, CARES determines the appropriate date by which the redetermination (“redet”) must be completed and displays this date in the “end date”