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COMAR 10.09.24.12

1203 State of Maryland Medical Assistance Manual Revised July 2012 field on the “MAFI” screen. Prior to that date, CARES will mail the appropriate application form to the recipient or representative along with a notice which advises them to complete the form and return it to the CM in order for eligibility to continue. For those who are required to have a redetermination of eligibility, eligibility for MA continues uninterrupted unless the recipient fails to:

Return the redet application The CM fails to initiate the redet or The redet is completed and the recipient no longer meets the eligibility criteria.

In those cases, CARES generates timely and adequate notice of the closure to the recipient and sends a cancel date to MMIS. For cases where the redet application is returned and processed in a timely manner, and all factors of eligibility are met, CARES generates a notice of continued eligibility to the recipient. No information is passed to MMIS, since these individuals have on- going eligibility, i.e. no end date appears on MMIS.

For those who do not require a redetermination, such as recipients of SSI or TCA, or children in the IVE foster care or adoption, eligibility continues on an on-going basis, both in CARES and on MMIS. As long as the individual remains on the cash program or in the IVE placement, no scheduled review of MA eligibility is required. When the individual stops receiving SSI or TCA, or is removed from the IVE placement, eligibility must be redetermined, and the CM must determine if the individual qualifies in any other MA coverage group before termination of eligibility. This usually requires completion of a redetermination form. If the redetermination is not completed by the recipient, eligibility is terminated with timely notice for failure to complete the redetermination process.

If the redetermination is completed and the recipient does not qualify in any other coverage group, eligibility is terminated with timely notice specifying the reason for ineligibility. If the redetermination is completed and the recipient is eligible in another coverage group, CARES will send the appropriate notice to the recipient, a transaction to MMIS to change the coverage group code, and schedule future redeterminations.

(1)Expediting Reapplication

Some recipients have eligibility in a coverage group that is time limited, such as spend-down. For these recipients, an application form will be mailed prior to the end of the current certification period. Eligibility will not continue beyond the end of the current certification, unless the application is returned and on-going eligibility is determined immediately. For most spend-down recipients, eligibility will end because a new spend-down amount must be met. This means that even if eligibility is met, there may be a gap in coverage. The purpose of sending the application form to a current spend-down recipient is to expedite the reapplication and to establish eligibility for the new period.

Note: For spend-down recipients, the application form will be mailed only if the spend-down has been met by the 45th day of the period under consideration and the recipient certified before CARES runs the redetermination processing. If spend-down is met after the 45th day of the