Page 99
COMAR 10.09.24.01-.16 1699 State of Maryland Medical Assistance Manual Revised July 2012
.10 Determining Financial Eligibility for Institutionalized Persons.
A. Scope.
(1) This section applies to persons who are institutionalized throughout a calendar month.
(2) Institutional status is presumed to begin on the first day of the first full calendar month in which the person is institutionalized and ends on the last day of the last full calendar month before discharge.
(3) Institutional status is not interrupted by a transfer from one long-term care facility to another or by a transfer from a long-term-care facility to a hospital.
(4) Presumed institutional status changes on the first day of the month of discharge to the community.
(5) Eligibility for noninstitutionalized persons shall be determined separately under Regulation .09 of this chapter. B. Basis. (1) Financial eligibility shall be determined on the basis of the countable resources and income of members of the assistance unit.
(2) A person is categorically needy if his total income before deductions does not exceed 300 percent of the current SSI payment standard and his countable resources are within the applicable amount in Schedule MA-2A.
(3) A person is medically needy if his total income before deductions exceeds 300 percent of the SSI payment standard or if countable resources exceed the applicable amount in Schedule MA- 2A.
(4) When calculating an institutionalized recipient's available income for the cost-of-care in a long-term care facility, in accordance with Regulations .10 and .10-1 of this chapter, guardianship fees may not be allowed as an income deduction, whether or not the recipient has a community spouse.
C. Retroactive Eligibility.
(1) A retroactive eligibility determination shall be made for services incurred by an institutionalized person within 3 months before the month of application. Eligibility will be considered only for the month, or months, in which the expenses were incurred.
(2) The period under consideration shall be the month, or months, for which coverage is requested.