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COMAR 10.09.24.03

325 State of Maryland Medical Assistance Manual Revised July 2012 Ineligible aliens Eligibility is determined based on a professional review of medical records to evaluate if the services received was an emergency service Qualified aliens who do not meet the five year bar don‟t meet the standard requirements for FAC, PW/MCHP The ineligible or undocumented pregnant alien can now file an application with the LDSS and LHD prior to the birth of a child When a determination of eligibility is completed a manual letter will be sent to recipients informing them of their eligibility Medical emergency other than labor and delivery, the CM must submit a DES 401 application (the summary with admission and discharge dates, Emergency Room (ER) admission and ER documentations showing the medical services that were rendered were an emergency nature)

Submit by mail: Delmarva Foundation for Medical Care, Inc Attn MDMA Acute, 6940 Columbia Gateway Drive Suite 420 Columbia, MD 21046-2788

Or submit via fax with a cover page to 1-888-513-1995, cover page should include: Facility Name, Patient Name and Date of Birth, Admission/Discharge Dates, Undocumented Alien Review (or x02) Questions or concerning, providers should call Delmarva‟s provider services number, which is 1- 866-571-3629.

(g) Aged, Blind, or Disable (ABD) (S-Track) or (T-Track) - Children or Adults in Long Term Care

Medicaid coverage for the ABD provides coverage for people who are Disabled or Blind or 65 or older or fatally ill and meet income and asset requirements. The initial certification period is 12 months six-months if eligible for spend-down. (Certification Period of COMAR 10.09.24.11) ABD MN Non-Spend-down (S98) Federally matched MA is provided to ABD whose income and resources (including those of their spouse living with them) are within the MA community MN income and resource standards. ABD Medically Needy Spend-down (S99)