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COMAR 10.09.24.04

320 State of Maryland Medical Assistance Manual Revised July 2012

the applicant nor the representative can obtain a specific required verification within 45 days after the date of application, the CM should determine whether an eligibility decision is possible based on the information and verifications provided to date and a written declaration by the applicant or representative of the facts related to the factor of eligibility that has not yet been verified. Au eligibility decision using this declaration for factor of eligibility means that information provided by the applicant or representative may be considerate as having temporarily met verification requirement if the MA case manager determines that the applicant/representative has satisfactorily demonstrated and documented in writing that all of the following conditions exists:

The applicant/representative made a “good faith effort” to obtain the required verification in a timely manner; The required verification cannot be obtained within 45 days for reasons beyond control of the applicant/representative, and there is no other way to verify the specific factor of eligibility;

The A/R has provided information that he/she believes to be accurate; There is no other existing information that leads to MA case manager to believe that the statement of the A/R is inaccurate or incomplete; and The applicant/representative agrees to produce the required verification no later than the next scheduled redetermination

When all of these conditions are met, the worker may base the eligibility determination on the applicant/representative’s written declaration of the facts related to the factor of eligibility.

Example 1:

An application is filed on 1/1/2004 on behalf of Ms. Smith. Ms. Smith daughter, Claudia, is representing her mother in the application process. Ms. Smith is in a nursing home due to a stroke, which has left her unable to communicate. Prior to her stroke, Ms. Smith handled her own affairs and did not appoint a durable P.O.A. Ms. Smith has two bank accounts. Claudia’s name is on one account. Therefore, she is unable to obtain verification of the balance from the bank. The second account was with Shady Saving and Loan that merged 6 months ago with another financial institution, RCG Bank and Trust. Claudia has a 10-month old statement from Shady Savings and Loan showing a $600.00 balance, but has no account number or documentation from the new institution. She has contacted the new institution, but they refuse to releases any information to someone without a P.O.A. or guardianship. On 1/25/04, Claudia presents the following documents to the MA CM:

A copy of her letter to RCG Bank and Trust, requesting the 1/1/04 balance from Shady account #12345 A letter from RCG Bank and Trust, stating that records cannot be researched based on this information, and that the account information may only be released to the account holder P.O.A. or guardian. A letter from an attorney agreeing to represent Claudia in a guardianship case, but advising that this process will take 3 to 6 months to complete. The Shady Savings and Loan bank statement from February 2003 showing a $602 balance.