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COMAR 10.09.24.04

327 State of Maryland Medical Assistance Manual Revised July 2012

Since the original period has expired, the unpaid medical expenses income during that period which will not be covered by a third party may with the applicant’s written authorization per above, be applied to excess income for the new period.

(b)When verification is not Required

A determination of ineligibility may be made on the basis of unverified facts submitted by the applicant/representative if such facts clearly indicate ineligibility. There are, however, some exceptions to this policy. The following procedures apply to persons who are not in, or planning to enter on Long Term Care (LTC) facility or a general hospital:

1. When the only factor of ineligibility for an applicant is excess income, verification of income is necessary to establish the exact spend-down liability. If the required information is not submitted, a decision of ineligibility must be rendered based on failure to provide the required information. 2. When a recipient reports increased income, verification of the increase is needed if the person wants eligibility to continue for the remainder of the period under consideration. If continued eligibility is not requested, the case may be closed based on the person’s statement of income. (Closed cases may not be preserved for spend-down. Preserved status applies only to application). If the required information is not submitted, a decision of ineligibility must be rendered based on failure to provide the required information. 3. When a determination of ineligibility for an applicant is due to excess resources, every effort should be made to have the applicant provide verification of the exact resource amount. If an applicant fails to provide at required information and or/verifications related to excess resources, it is appropriate to reject the application. However, if the exact amount of the excess is not known, that fact plus any other reasons for ineligibility should be noted in the letter. Refer to Policy Alert 08-1 for a detailed discussion of the treatment of the excess resources of an A/R who is in or entering on LTC facility or an acute hospital.

400.8 Requirements to apply for benefits

Applicants and recipients are required to apply for all income benefits to which may be entitled. Eligibility may not be established until they furnish proof that they have met this requirement. This applies to both members of the assistance unit and the non-assistance unit members whose income and resources are considered.

LDSS/LHD staff must have a general knowledge of various benefit requirements, be able to identify applicant and recipient circumstances which may indicate entitlement to certain benefits, and refer applicants and recipients accordingly. Refer to Chapter .07 for description of types of benefits and how to apply.

Applicants and recipients determined by the LDSS to be unable to perform the required activity because of the applicant’s or recipient’s physical or mental condition and far whom there is no other person to perform the activity are not themselves required to apply for income benefits. Under this circumstance, the LDSS/LHD must obtain from the agency determining entitlement to income benefits, a statement of the requirements for application for income be3enift and work cooperatively