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COMAR 10.09.24.03

317 State of Maryland Medical Assistance Manual Revised July 2012 Since CARES does not schedule an annual redetermination for an active E01 AU, the MA CM should set a 745 Alert to review the case at least every 12 months or sooner if the child is turning 21 within a year. Then, the MA CM must verify with the IV-E specialist that the IV-E eligibility continues and verify with the OHP service worker that the OHP service case is still open. NOTE: ALL CASE ACTIVITIES MUST BE FULLY NARRATED IN CARES.

Children Discharged from Out-of-Home Placements- Unscheduled Redetermination Eligibility Policies and CARES Procedures

I. Overview Federal and State regulations provide for the prompt redetermination of MA or Medicaid eligibility when there is a change in an individual‟s circumstances (e.g. living arrangements, income, and resources) that may result in the loss of or change in eligibility. Federal and State guidelines also stipulate that MA eligibility must continue until it has been determined that an individual no longer meets the criteria for continued eligibility. This information in this section sets forth policies and procedures, effective upon receipt, which is to be followed to facilitate the transition when a court rescinds a child‟s commitment to the State‟s custody and the child is discharged from an out-of-home placement (OHP). Each LDSS identifies which MA CM is responsible for implementing these policies and procedures. These procedures ensure that these children will continue to receive health care benefits, without a lapse in MA coverage, until they have been given the opportunity to reestablish continued eligibility under MA community or LTC or the Maryland Children‟s Health Program (MCHP). When a child is discharged from the OHP, the service worker at the LDSS is to give the child‟s parent or representative the child‟s Medical Care Program identification card, so the child may access MA services while the child‟s eligibility is being redetermined. If the child is enrolled in HealthChoice, the service worker is to inform the parent/representative of the child‟s MCO and PCP, and give the parent/ representative the child‟s MCO card. The MCO should then be provided with updated contact information about the child‟s head of household or emergency contact. Note: Scheduled redeterminations are required at least every 12 months for coverage groups E02, E03, and E04. Also, continued IV-E certification must be verified with LDSS‟s IV-E specialist at least every 12 months for coverage group E01. For E02, E03, and E 04, CARES automatically sends a redetermination package before the end of the certification period to the child‟s authorized representative before approving MA eligibility for another 12-month certification period. II. Procedures for MA case managers to initiate an Unscheduled Redetermination When a Child is Discharged from Out-of-Home Placement.

A. Medical Assistance eligibility may not be terminated based on a child‟s discharge from