Page 69

COMAR 10.09.24.03

368 State of Maryland Medical Assistance Manual Revised July 2012 You should reapply when your income and/or assets no longer exceed the maximum allowable amount. ⁭ 4. You do not meet the following eligibility requirements:________________________________________________________________________ ____________________________________________________________________________________________________________________________ This decision is based on COMAR 10.09.24 and/or the Social Security Act [1902(a)(10)(E)(ii),1905(p)(3)(A)(I)]. If you do not agree with this decision, you have the right to request a Fair Hearing within ninety (90) days of the date of this notice. If you have any questions about this notice, you may contact your Case Manager at the telephone number below.

Sincerely,

___________________________

Case Manager

___________________________ Telephone

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Page 69

Official source

COMAR 10.09.24.03

368 State of Maryland Medical Assistance Manual Revised July 2012 You should reapply when your income and/or assets no longer exceed the maximum allowable amount. ⁭ 4. You do not meet the following eligibility requirements:________________________________________________________________________ ____________________________________________________________________________________________________________________________ This decision is based on COMAR 10.09.24 and/or the Social Security Act [1902(a)(10)(E)(ii),1905(p)(3)(A)(I)]. If you do not agree with this decision, you have the right to request a Fair Hearing within ninety (90) days of the date of this notice. If you have any questions about this notice, you may contact your Case Manager at the telephone number below.

Sincerely,

___________________________

Case Manager

___________________________ Telephone