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10.09.11.00.htm 10.09.11.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 11 Maryland Children's Health Program Authority: Health-General Article, §2-104(b) 15-101(f) 15-103, 15-105, and 15-301 et seq. Annotated Code of Maryland, Ch. 202, Acts of 2003
10.09.11.01.htm 10.09.11.01. 01 Purpose and Scope.. A. This chapter governs the determination of eligibility for the Maryland Children's Health Program with an income standard based on the modified adjusted gross income methodology specified in the Affordable Care Act of 2010, effective January 1, 2014.B. Eligibility for the Maryland Children's Health Program may be established for children younger than 19 years old whose family income is equal to or less than 200 percent of the federal poverty level.
10.09.11.02.htm 10.09.11.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Affordable Care Act” means the Patient Protection and Affordable Care Act of 2010 (Pub.L.111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Pub.L.111-152) as amended by the Three Percent Withholding Repeal and Job Creation Act (Pub.L.112-56)2) Applicant.. a) "Applicant" means an individual whose written application for the Maryla
10.09.11.03.htm 10.09.11.03. 03 Coverage Groups.. Eligibility may be established for the Maryland Children's Health Program for children younger than 19 years old whose household income is equal to or less than 200 percent of the federal poverty level.
10.09.11.04.htm 10.09.11.04. 04 Application.. A. The Department or its designee shall determine eligibility for children.. B. The Department or its designee shall give oral, written, or electronic information about the Maryland Children’s Health Program such as:1) Requirements for eligibility;. 2) Available services;. 3) An individual's rights and responsibilities;. 4) Information in plain English, supported by translation services; and.
10.09.11.05.htm 10.09.11.05. 05 Application: Additional Requirements.. A. Social Security Number.. 1) As a condition of eligibility, an applicant shall furnish to the Department or its designee a Social Security number for the applicant. If the applicant cannot furnish a Social Security number, the applicant shall apply for a number. Assistance may not be denied, delayed, or discontinued pending the issuance or verification of the number if the applicant complies with this subsection.
10.09.11.06.htm 10.09.11.06. 06 Nonfinancial Eligibility Requirements.. A. Citizenship. In order to be eligible for full benefits under the Maryland Children's Health Program, an individual shall meet the federal requirements for Medical Assistance eligibility as a citizen or qualified alien, as specified at COMAR 10.09.24.05.B. Residency. In order to be eligible for benefits under this chapter, an individual shall be a resident of Maryland, in accordance with the requirements at COMAR 10.09.24.05-3.
10.09.11.07.htm 10.09.11.07. 07 Consideration of Household Income.. A. The applicant shall report the income of any family member, except for the income of a member that does not file a federal tax return and is not claimed as a federal tax dependent.B. Determining Countable Household Income.. 1) In determining an applicant's financial eligibility for the Maryland Children's Health Program, the applicant's current household income is considered.2) For the child applicant who is neither pregnant
10.09.11.08.htm 10.09.11.08. 08 Consideration of Family Income: Earned and Unearned Income ― Repealed..
10.09.11.09.htm 10.09.11.09. 09 Consideration of Family Income: Income Disregards ― Repealed..
10.09.11.10.htm 10.09.11.10. 10 Determining Financial Eligibility.. An applicant is financially eligible for the Maryland Children's Health Program if, for the period under consideration, the applicant's countable household income as determined under Regulation .07 of this chapter does not exceed 200 percent of the federal poverty level for a family size equal to the size of the family for child applicants younger than 19 years old.
10.09.11.11.htm 10.09.11.11. 11 Certification Periods.. A. For a newborn, certification begins on the day the child is born to an eligible woman and ends on the last day of the month of the child's 1st birthday.B. For an eligible child, certification begins on the first day of the month of application, or up to 3 months before the month of application, if medical expenses were incurred during the earlier months, and continues until the day the child is determined ineligible.C. A child who, on the da
10.09.11.12.htm 10.09.11.12. 12 Covered Services.. A. A child certified for the Program is entitled to all health benefits through the Maryland Medicaid Managed Care Program.B. In the case of an alien who is eligible for benefits under COMAR 10.09.24.05D(4)b) covered services are limited to those that are necessary for the treatment of an emergency medical condition, as defined under Regulation .02B of this chapter.
10.09.11.13.htm 10.09.11.13. 13 Post-Eligibility Requirements.. A. Notice of Eligibility Determination. The Department or its designee shall inform an applicant of the applicant's legal rights and obligations and give the applicant written or electronic notification of the following:1) For eligible individuals:. a) The basis and effective date for eligibility;. b) Instructions for reporting changes that may affect the recipients eligibility; and. c) The right to request a hearing;.
10.09.11.14.htm 10.09.11.14. 14 Hearings.. The requirements relating to hearings under COMAR 10.01.04 apply to this chapter..
10.09.11.15.htm 10.09.11.15. 15 Fraud and Abuse.. The requirements relating to fraud and abuse under COMAR 10.09.24.14 apply to this chapter..
10.09.11.16.htm 10.09.11.16. 16 Adjustments and Recoveries.. The requirements relating to adjustments and recoveries under COMAR 10.09.24.15, with the exception of COMAR 10.09.24.15A(1) and (2) apply to this chapter.
10.09.11.17.htm 10.09.11.17. 17 Interpretive Regulation.. State regulations shall be interpreted in conformity with applicable federal statutes and regulations, except if the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services to Program recipients without regard to the availability of federal financial participation.
10.09.11.9999.htm 10.09.11.9999. Administrative History Effective date:. Regulations .01―17 adopted as an emergency provision effective July 1, 1998 (25:15 Md. R. 1182) adopted permanently effective November 30, 1998 (25:24 Md. R. 1773)Regulations .02―07 and .09―13 amended as an emergency provision effective July 1, 2001 (28:14 Md. R. 1319) amended permanently October 29, 2001 (28:21 Md. R. 1856)Regulation .01B amended effective November 10, 2003 (30:22 Md. R. 1580). Regulations .01B amended
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