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COMAR 10.09.24.03

375 State of Maryland Medical Assistance Manual Revised July 2012 T04 Child from 1 Year Old Up to 6 Years Old in Long -Term-Care

MA is provided for a child who is at least one year old but less than six years old who resides in a LTCF. The financial and non-financial eligibility rules for P07 are used, as specified in COMAR 10.09.11 and the MCHP Eligibility Manual. The child‟s income must be at or below 133% of the FPL. There is no resource test.

T05 Child Under 19 Years Old in Long-Term-Care

MA is provided for a child under 19 years old who resides in a LTCF. The financial and non- financial eligibility rules for P08 are used, as specified in COMAR 10.09.11 and the MCHP Eligibility Manual. The child‟s income must be at below 100% of the FPL. There is no resource test.

T99 FAC Long- Term- Care- Medically Needy Spend-down

Unmarried children under 21 years old in a LTCF who resources do not exceed the MN resource standards ($2,500), but whose available income exceeds the cost of care in the facility, are eligible for MA if the child‟s total medical expenses are greater than the amount by which the child‟s income exceeds the cost of care. These cases trickle from T02, due to being resource- eligible but income over-scale. Like T 0, the T99 coverage group uses the FAC rules for consideration of income and resources. T99 is similar to L99, which trickles from L98 for the same reasons. MA will not pay for the cost of care in the LTCF because the recipient‟s available income covers the cost. However, MA will cover other medical services for which the recipient is eligible.

II. CARES Procedures Followed by Medical Assistance Case Managers for MA Eligibility Determinations in the T-Track

The MA CM should screen an applicant in the coverage group for which the applicant is most likely to qualify and which best fits the applicant‟s circumstances. For example: If the recipient is 18-20 years old, the recipient should be screened in T02 which goes up

to 21 years old rather than in T05 which goes up to 19 years old. If the applicant has countable resources exceeding the medically needy resource standard of $2,500 for T02, the applicant should be screened in T03-T-05, depending on the applicant‟s age. Resources are not considered for T03-T05. If an A/R is determined ineligible for one T-Track coverage group and either CARES does not trickle or trickles incorrectly, the MA CM should Add-A-Program to screen the A/R in other coverage groups for which the A/R may qualify in the T or L track. The