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COMAR 10.09.24.04
332 State of Maryland Medical Assistance Manual Revised July 2012
400.15 Filing an Application for Medicare Part A
An applicant who is 65 years old or older, or blind or disabled, is not eligible until he/she furnishes proof that he/she has applied for or is receiving Medicare, Part “A”. Once the application is filed and that fact is verified, determination of eligibility may not be delayed pending the results of the application. Periodic reviews of eligibility are necessary for those blind or disabled persons initially determined ineligible for Medicare because of the required waiting period.
An applicant must present proof from the Social Security Administration that an application has been filed. Although the applicant is required to apply for Medicare, Part “A” there is no requirement to purchase this benefit. Persons who have not earned sufficient quarters of coverage under Social Security are not eligible for free Part A coverage. Nevertheless, the applicant must apply for, but may reject this coverage if payment of a premium is required.
The above requirement also applies to a recipient who attains age 65 or becomes blind or disabled if he/she is not already covered as a disabled person. The LDSS/LHD will need to monitor birthdates at each redetermination and refer a potentially eligible person to the Social Security Administration for application.
400.16 Application Procedures Specific to Institutionalized Persons
The general application requirement and procedures of this chapter to both non-institutionalized and institutionalized persons at the time of application and redetermination. However, because of the physical and mental impairments of many institutionalized persons, it is sometimes necessary to qualify the general requirements. The following qualifications are worthy of note.
(a) Person/s who can complete the application
As with non-institutionalized persons, there is no specific rule as to who may or may not complete the application. However, since there is usually no face-to-face interview with institutionalized persons, it becomes important that the application form be completed by the person who is the most knowledgeable about the applicant’s situation, and that same person, except in rare situations, must be the person with whom the face-to-face interview is conducted. The rare exception might be the situation in which the most knowledgeable person lives in another state and cannot visit this state at each redetermination. However, there must be same contact with the person who completes the application and provides the information.
(b) Person/s able to be representative
The representative should be the individual who normally handles the affairs of the institutionalized person. In most instances, that individual will be relative or legal guardian. However, if neither of these individuals exist, then a friend, hospital social worker, nursing home administrator, or other interested party may act on behalf of the person is considered the representative. This means that the same person who completes and signs the application and who appears for the face-to-face interview is also the person who has the responsibility of doing whatever is necessary to establish the person’s eligibility. This includes, but is not limited to making home visits or other contacts necessary to