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COMAR 10.09.24.15

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State of Maryland Medical Assistance Manual Revised July 2012 o The co-owners are husband and wife (Tenancy by the Entireties lasts only so long as the co owners are married); and o When one co-owner dies, the co owner‟s interest passes automatically to his or her spouse.

If the resource evaluation, based on Regulation .08, revealed that the institutionalized person owns no home property, the lien provision does not apply and no further action is required under this section. Neither does the lien provision apply to home property which is not excluded.

(c)When Home Property May be Subject to a Lien

The circumstances under which a lien may be imposed on the home property of an institutionalized person are as follows:

1. The person is a patient in an Long Term Care Facility( LTCF); 2. The person owns excluded home property; 3. The person has been determined eligible for Medical Assistance, including resources eligibility, with countable and excluded real property within the specified limits; and 4. The Department has determined, after notice and opportunity for a hearing, that there is no reasonable expectation that the person can be discharged from the LTCF and return to live in his home property. (The fact that the person‟s home property has been excluded for eligibility purposes based on his/her expressed intent to return to it does not preclude the imposition of a lien if the requirements of the lien provision are met.)

The LDSS must refer to MACA via DHMH Form 1159C, Lien Worksheet, all cases of persons meeting all of the conditions indicated above. Complete LDSS referral procedures are included in this chapter.

1500.9 Restrictions on the Imposition of a Lien

There are some restrictions on imposing a lien on the excluded home of an institutionalized person. The Department may not impose a lien on the home of an institutionalized person if any of the following relatives reside in the home with the permission of the owner (or, if under guardianship, the permission of the owner‟s legal guardian). For purposes of the lien procedures, these relatives are referred to as “specified relatives”:

The person‟s spouse; The person‟s unmarried child younger than 21 years old; The person‟s son or daughter who is blind or disabled (as determined by the Social Security Administration (SSA), or State Review Team(SRT) as a part of an MA eligibility determination process); or