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COMAR 10.09.24.03

348 State of Maryland Medical Assistance Manual Revised July 2012 Notice Requirement: Use DES 303. The person may file a new application at any time. The application process explained in this release also applies to reapplications.

If the unscheduled redetermination results in ineligibility for any other reason, the local department must take action to cancel the case in accordance with timely with adequate notice requirements. No further action is required. The person may file a new application at any time.

NOTE: A case may be closed no earlier than the month ineligibility was determined.

Improper Program Payment

Follow existing Manual procedures if erroneous payments result from the actions, inactions or delayed actions on the part of either the recipient or the local department.

A QMB Recipient Right to Apply for MA Spend-down

A QMB eligible person or couple whose resources are within the MA requirement, but whose income exceeds schedule MA-1 (income standards) may also qualify for regular MA under spend-down. A recipient in QMB Buy-in only that meets spend-down is considered dual eligible. Excess income for spend-down purposes is based on the amount in excess of the applicable amount in Schedule MA-1. If applicable QMB eligible person is ineligible for MA solely because of excess income, the eligible person may apply for a status change from QMB to MA spend-down by submission of incurred medical expenses not covered by Medicare, others insurance or the QMB Buy-in.

Spend-down Eligibility Procedures

Although Medicare may notify the recipient that these Buy-in services are covered services, the fact of the person‟s Buy-in status is sufficient evidence that these expenses are not obligations of the recipient and, therefore, may not be deducted from excess income.

A Medicare beneficiary is routinely notified of the results of all claims submitted on his/her behalf. The notice is called the Medicare Summary Notice form which is issued by a State‟s Medicare carriers). In Maryland the carrier(s) are as follows:

Novitas Solutions, Inc. Address: PO Box 890385 Camp Hill, PA 17089-0385 Phone: 1-877-235-8073