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COMAR 10.09.24.03

378 State of Maryland Medical Assistance Manual Revised July 2012 If the child is ineligible for T05 because the child‟s income is over 100% FPL, but the child‟s income does not exceed the cost-of-care and the child‟s resources are within the T02 standard, the CM should Add-A-Program to determine the child‟s eligibility for T02. If the child is ineligible for T05 because the child‟s income is over 100% FPL, but the child‟s income is greater than the cost-of-care and the child‟s resources are within the T02 standard CARES will apply the T02 cost-of-care rules and the AU will go into spend-down (T99). If the child is ineligible for T05 because the child‟s income is over 100% FPL, but the child‟s income is greater than the cost-of-care and the child‟s resources are also over- scale for the T02 standard. CARES denies/closes due to over-scale resource (Code 401). In the denial notice that CARES generates, the CM should also add the reason of “301” for over-scale income.

III. Post-Eligibility Activity

T01 Who Loses TCA Eligibility When T01 recipient ages out of TCA eligibility, the recipient‟s LTC eligibility must be redetermined. If the recipient is unmarried and 21 years old, the Eligibility should be redetermined for T02. Otherwise, the recipient‟s LTC eligibility should be redetermined under the ABD rules for L98. If the F01 AU of a T01 child reports a change in countable resources to exceed the TCA categorically needy limit, both AU‟s will close down (closure reason “401”). CARES will not trickle. Before closing the T01 AU, the CM should Add -A- Program to redetermine eligibility in the T03-T05 coverage group, as appropriate based on the child‟s age. The T03-T05 coverage groups do not have a resource test. If the T01 recipient is an adult whose F01 AU loses TCA eligibility due to over-scale resources, the recipient should be given the opportunity to reduce resources in order to retain MA LTC eligibility in the L98 coverage group. If the resources are not promptly reduced, the T01 case should be closed with proper notice. If the F01 AU of a T01 recipient loses TCA eligibility due to over-scale income or another reason, CARES closes both the F01 and T01 AU‟s. Before closing the T01- T05 coverage group, as appropriate. Also, the T01 recipient should be removed as a non- member of the F-track AU, so the active T-track recipient will not case dual participation for the F-track AU.

T02 Who Becomes Resource- Ineligible