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COMAR 10.09.24.04

321 State of Maryland Medical Assistance Manual Revised July 2012

A letter signed by Claudia, explaining her unsuccessful efforts to obtain a current statement, stating that she believes that RCG and Trust account does not exceed $650, and agreeing to submit to verifications of the 1/1/2004 account balance an current balance as soon a she gains guardianship and obtains the from Shady saving and Loan. In this case, the CM considers the $650 as a countable resource, which together with the other assets totals $1, 657. All other factors of eligibility are met. The ease narrated with regard to the outstanding verification, and Ms. Smith eligibility is approved. No later than the first annual redetermination, the MA case manager must obtain verification from Claudia of the account balance for the month of applications, as well as current month. If not received by the first annual redetermination, the case will be closed for failure to submit the required verifications.

Example 2:

Mr. Cheetum is confined to a nursing home and is represented by his (Power of Attorney) P.O.A., Mr. J. Jones, Esq. Mr. Jones provides bank balances as of the month of application, but states his client’s assets prior to the last month are unknown, and that his client is in no condition to assist in the verification process. Since Mr. Jones was retained as P.O.A. prior to his client’s incapacitation, it is reasonable to assume that Mr. Cheetum discussed his financial affairs with his attorney at that time. It is incumbent upon Mr. Jones to review records and request information to establish Mr. Cheetum’s assets over the look-back period (60 months). Although this process may take longer than the timeliness standard, a decision of eligibility cannot be made because Mr. Jones states he cannot provide a written statement concerning his belief as to the value and disposition of his client’s asset during and look-back period. Mr. Jones may request an extension of time limits. If he does not, the application may be denied for failure to submit verifications, and will be reactivated if Mr. Jones provides the verifications before the end of the period under consideration.

Note: Maryland is not changing its eligibility policy to permit presumptive eligibility or declaratory applications. All factors of MA eligibility must still be verified either by the A/R or by the MA case manager. However, the verifications requirement must be reasonable. Allowance must be given for unusual situations when the A/R is making a “good faith effort” but, due to a confirmed impediment outside his/her control, is unable to obtain the required verification within 45 days.

It is not acceptable for an application to remain pending indefinitely without an eligibility decision. The application should be denied if the A/R does not provide the required verifications by the due date, even if all of the conditions specified above are met, and the MA case manager either does not have enough information to determine eligibility, or the information that the MA case manager has received is questionable or contradictory. If the MA CM has enough information to be able to clearly ascertain the facts of the case, eligibility should be determined, even if specific verifications cannot be obtained until later. Eligibility is not guaranteed. If a verification subsequently shows that the recipient is ineligible, the MA case manager should promptly conduct an unscheduled redetermination for this change is information Existing policy relating to the extension of time limits may also be applied. However, such extensions should be utilized routinely and repeatedly to delay eligibility determinations beyond 45 days from the date of application.