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COMAR 10.09.24.03

347 State of Maryland Medical Assistance Manual Revised July 2012 The same procedure applies when one of the spouses is not a Medicare beneficiary. The single difference is that the ineligible spouse is not certified for Buy-in. if the ineligible spouse requests assistance; his/her MA eligibility must be tested separately under the existing MA or MASO rules as appropriate. Under this circumstance, the income and resources of the QMB are considered in determining the non-QMB eligible spouse‟s MA eligibility and measured against the MA-I and MA-2 standards for 2 persons.

Certification (Buy-in Only)

Certification for the Buy-on coverage is for a 12-month period and begins the month following the month the person is determined eligible. Certification continues until the person is determined ineligible.

(Retroactive coverage does not apply to a person who is eligible only for the Buy-on.) Do not confuse the month a person becomes eligible with the month the CM.

Completion of the DHMH 2583 (Insurance Reporting Form) is required for eligible Buy-In case. There is a notice requirement for CM to send appropriate notice to client.

Scheduled Redeterminations

Scheduled redeterminations for persons certified for the Buy-in only are conducted once every 12 months. If a recipient is determined ineligible, the local department must take the necessary action to cancel the case in accordance with timely and adequate notice requirements. The cancellation is effective no earlier than the month ineligibility is determined. Notice Requirements: A person may file a new application at any time. The application process explained in this part applies to reapplication.

Unscheduled Redeterminations

Even though QMB cases are certified for 12-month periods and scheduled redeterminations are due once every 12 months, in the event of an unscheduled redetermination, for calculation purposes, it is necessary to split the 12 months into two six-month periods.

Upon notice of a change in circumstances, it is necessary to determine if the recipient continues to be eligible for the remainder of the current certification period. In the case of an increase in income, in order to determine continued eligibility, it is necessary to add the new income to be received and compare the total to be received compare the total to the applicable amount in the QMB income standard. If the total amount, after application of the disregards, is equal to or less than the allowable QMB standard, the recipient remains eligible for the balance of the current period. No notice requirements. No further action needed. 268-8229

If the income exceeds the allowable amount, the recipient is ineligible. The local department must take action to cancel the case in accordance with timely and adequate notice requirements.