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10.09.43.00.htm 10.09.43.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 43 Maryland Children's Health Program (MCHP) Premium Authority: Health-General Article, §2-104(b) 15-101(f) 15-103(a)2) 15-301.1, and 15-302―15-304; Insurance Article, §15-1208, 15-1213, 15-1406, and 27-220; Annotated Code of Maryland; Ch. 202, Acts of 2003
10.09.43.01.htm 10.09.43.01. 01 Purpose and Scope.. This chapter governs the determination of eligibility and the conditions of participation for MCHP Premium with an income standard based on the modified adjusted gross income methodology specified in the Affordable Care Act of 2010, effective January 1, 2014.
10.09.43.02.htm 10.09.43.02. 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" means a child or the child's representative who has filed a written, telephonic, or e
10.09.43.03.htm 10.09.43.03. 03 Coverage Groups.. Eligibility may be established for the MCHP Premium Program for children younger than 19 years old whose household income is above 200 percent but at or below 300 percent of the Federal Poverty Level.
10.09.43.04.htm 10.09.43.04. 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 MCHP Premium 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. 5) Information accessible to disabled individuals requesting an application..
10.09.43.05.htm 10.09.43.05. 05 Nonfinancial Eligibility Requirements.. A. Citizenship. In order to be eligible for full benefits under MCHP Premium, an applicant shall be one of the following:1) A citizen of the United States;. 2) A person residing in the United States who is:. a) A qualified alien as defined under Regulation .02B of this chapter;. b) An honorably discharged veteran of the armed forces of the United States;. c) An alien on active duty in the armed forces of the United States; or.
10.09.43.06.htm 10.09.43.06. 06 Consideration of Family Income.. A. The applicant shall report the income of each family member, except for the income of members that do not file a federal tax return and are not claimed as a federal tax dependent.B. Determining Countable Household Income.. 1) In determining an applicant's financial eligibility for MCHP Premium, the applicant's current household income shall be considered.2) For the child applicant who is neither pregnant nor postpartum, househol
10.09.43.07.htm 10.09.43.07. 07 Consideration of Family Income: Earned and Unearned Income ― Repealed..
10.09.43.08.htm 10.09.43.08. 08 Consideration of Family Income: Income Disregards ― Repealed..
10.09.43.09.htm 10.09.43.09. 09 Determining Financial Eligibility.. Current and New Enrollees. An applicant is financially eligible for MCHP Premium if, for the period under consideration, the applicant's countable household income as determined under Regulation .06 of this chapter, is greater than 200 percent but not greater than 300 percent of the federal poverty level for the number of persons in an applicant’s tax-dependent unit equal to the size of the applicant's family.
10.09.43.10.htm 10.09.43.10. 10 Certification Periods.. A. The certification period begins the first day of the month in which the eligible child is enrolled in a MCO.B. Duration of Certification Period.. 1) The initial certification period, or the certification period beginning after a period of ineligibility for MCHP Premium, shall end not later than 1 year from the beginning month of certification for MCHP Premium.2) Notwithstanding §B(1) of this regulation, the certification period may be shortened:.
10.09.43.11.htm 10.09.43.11. 11 Covered Services.. A child enrolled in MCHP Premium is eligible for all health benefits included in the Maryland Medicaid Managed Care Program, as set forth in COMAR 10.09.67, the school-based health centers program as set forth in COMAR 10.09.68, and the rare and expensive case management.
10.09.43.12.htm 10.09.43.12. 12 Program Participation Requirements ― Enrollment.. A. An eligible individual who is enrolled in MCHP Premium shall be covered through a Maryland Medicaid Managed Care MCO.B. Timely Enrollment. The representative shall:. 1) Send to the Department or its designee the first month's family contribution within 30 days of receiving notice of eligibility for MCHP Premium, before enrollment can be completed; and2) Complete and submit to the Department's enrollment broker a MCO selectio
10.09.43.13.htm 10.09.43.13. 13 Program Participation Requirements ― Family Contribution.. A. Family Contribution Required. As a requirement of enrollment and participation in MCHP Premium, the representative of an eligible individual shall agree to pay the following annual family contribution:1) For an eligible individual whose family income is above 200 percent but at or below 250 percent of the FPL, an amount equal to 2 percent of the annual income of a family of two at 200 percent of the FPL; and
10.09.43.14.htm 10.09.43.14. 14 Program Participation Requirements ― Change in Status.. A. The applicant shall report any change in family status or family composition within 10 days of the change.B. Change in family status includes increase or decrease in the number of family members through birth, death, marriage, adoption, separation, divorce, or the voluntary or involuntary removal of a family member from residence with the family.C. The applicant shall complete a written, telephonic, or electronic applic
10.09.43.15.htm 10.09.43.15. 15 Post-Eligibility Requirements.. A. Notice of Eligibility Determination. The Department or its designee shall inform the 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 recipient’s eligibility; and. c) The right to request a hearing; and.
10.09.43.16.htm 10.09.43.16. 16 Hearings.. The requirements relating to hearings under COMAR 10.01.04 apply to this chapter..
10.09.43.17.htm 10.09.43.17. 17 Fraud, Abuse, and Penalty.. A. The requirements relating to fraud and recipient abuse under COMAR 10.09.24.14 apply to this chapter.B. A person convicted of fraud under this chapter is subject to penalties as described in Criminal Law Article, §8-516 and 8-517, Annotated Code of Maryland.
10.09.43.18.htm 10.09.43.18. 18 Adjustments and Recoveries.. In all cases where MCHP Premium benefits have been incorrectly paid, the Department shall seek recovery pursuant to COMAR 10.09.24.15.
10.09.43.19.htm 10.09.43.19. 19 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 for MCHP Premium recipients without regard to the availability of federal financial participation.
10.09.43.9999.htm 10.09.43.9999. Administrative History Effective date:. Regulations .01―19 adopted as an emergency provision effective July 1, 2001 (28:12 Md. R. 1102) adopted permanently effective September 3, 2001 (28:17 Md. R. 1556)Regulation .02B amended effective November 10, 2003 (30:22 Md. R. 1580). Regulation .02B amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251) amended permanently effective September 27, 2004 (31:19 Md. R. 1432)
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