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COMAR 10.09.24.03

357 State of Maryland Medical Assistance Manual Revised July 2012 eligibility determinations are finished and the S06 is finalized, suppress all CARES notices on the MAFI screen for the S98 (unless eligible), S99, and S06 cases and send the appropriate attached manual notice. If pending the S06 case would cause it to exceed the 30 day period for making an eligibility determination, determine the S06 case and take the appropriate action when eligibility is determination, determine the S06 case take the appropriate action when eligibility is determined for the original pending case (e.g. closing the S06 case and opening an S99 case). The CARES 9701 application is used by the LDSS for these applicants. The applicant should be tested for eligibility in both S98 and S06. Pend both at the same time. The applicant should have a letter from SSA indicating the QDWI status, but a copy of this letter is not required. The CM must verify that the individual is potentially QDWI eligible per SSA by having a “Current Pay Status” of N33 or N44 on SVES. The disability coding on SVES must also be reviewed to determine whether the person is still considered disabled by SSA. If these individuals have a „Current Pay Status” code N27 on SVES indicating that they are no longer considered disabled by SSA, they are not eligible as a QDWI. The N27 ineligibility code on SVES is changed by the SSA system to a termination code after one year. Persons may apply for QDWI in the same month as their SSA notification that they are no longer entitled to Medicare Part A. Individuals who do not apply for QDWI within 7 months of the SSA notice will have to wait until next Medicare open enrollment period (January 1- March 31) for the federal government to approve their Buy-In coverage, and then the State‟s payments may not begin until July 1. If the delay in applying, they may also be required by SSA to pay a premium surcharge, unless they are covered by an employee group health plan based on their own or their spouse‟s current employment. The QDWI eligible is personally responsible for any surcharge(s) because the State will not pay a premium surcharge The UINC screen must be properly coded with the A/R‟s SSA claim number and BIC, and completed with the unearned income fields, and Application Type, etc. fields at the bottom of the screen. The termination date for previous benefits must be entered to indicate the termination of a prior period of SSA eligibility. The application must be processed within a 30 day period. If there is a delay reason, place the appropriate delay code on the CARES MISC screen. The CARES notice for approval or denial of the application must be suppressed by the Case Manager, and the appropriate approval or denial notice (see attachments) must be completed and issued manually. Any closing notice to a recipient must also be suppressed on CARES, and a QDWI closing notice (see attachment) completed and issued manually.

Coverage