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COMAR 10.09.24.13

1304 State of Maryland Medical Assistance Manual Revised July 2012 The recipient is admitted to an institution where he is ineligible under the Program for further services.

Note: Such institution include state mental hospitals for anyone under age 65, out of state institutions except when DHMH has authorized the placements, and state-owned and operated residential facilities housing persons under the jurisdiction of the Juvenile Service Administration. Ineligibility is established beginning with the first full month of institutionalization. The recipient’s whereabouts are unknown as evidenced by the return of unfowardable mail directed to him/her; or The recipient is accepted for Medicaid services in another jurisdiction, state, territory, or commonwealth. b. Adequate notice shall be provided by the LDSS upon receipt of acceptable written verification, but no later than the date of action.

4. If a recipient files a request for a hearing within 10 days from the date the notice of action was mailed, the recipient’s benefits shall continue at their previous level until a decision is rendered after the hearing or the request for a hearing or the request for a hearing is dismissed by the hearing officer.

The initial continued coverage period is a one-time-only period of three months. Subsequent one-time-only periods of one month each must be granted until the hearing officer’s written decision is received by the local department.

5. A request for a hearing shall be dismissed if the hearing officer determines that the sole issue appealed is one of federal or State law. The recipient shall be notified in writing that eligibility for assistance is being terminated or benefits are being reduced.

(c) Recovery of Medical Assistance Expenditures Made on Behalf of Ineligible Persons

1. The LDSS shall refer to the Medical Assistance Compliance Administration on a form designated by the Department, all cases in which: a. An otherwise ineligible recipient is granted Medical Assistance coverage pending a hearing decision; and b. The hearing officer subsequently affirms the decision made by the local department of social services.