10.09.60.02

.02 Eligibility, Enrollment, and Disenrollment.

A. To be eligible for enrollment in the Program, an individual shall:

(1) Be a resident of Maryland;

(2) Be a Medicare beneficiary enrolled in the Medicare Part D Voluntary Prescription Drug Benefit Program or a Medicare Advantage Plan that provides Part D coverage;

(3) Have an annual household income, as described in §B of this regulation, at or below 300 percent of the Federal Poverty Guidelines that apply to the individual based on the number of household members of the individual;

(4) Not be enrolled in a health benefit plan, other than a Medicare Part D prescription drug plan or a Medicare Advantage Plan, that provides prescription drug benefits at the time the individual applies for enrollment in the Program; and

(5) Not be eligible for a full federal low-income subsidy under 42 CFR §423.772.

B. Consideration of Annual Household Income.

(1) Annual household income to be considered in determining financial eligibility is both earned and unearned income of the applicant and spouse who reside in the same residence, projected for a 12-month period beginning with the month in which the person submits the application for enrollment in the Program.

(2) Earned income includes:

(a) Wages, commissions, fees, profit from self-employment, salaries, and tips;

(b) The value of nonmonetary compensation received for services rendered; and

(c) Profit from rent received from a roomer, tenant, or boarder.

(3) Unearned income includes:

(a) Payment from unemployment insurance, the Family Investment Program, the Supplemental Security Income Program, Veteran's and Workers' Compensations, private insurance, Black Lung Program, Railroad Retirement, Social Security, pensions, annuities, and other regular benefits received;

(b) Except as provided in §B(4) of this regulation, support from absent relatives, support from legally responsible relatives, and income which is received on a regular basis from relatives and friends who are not legally responsible;

(c) Parental income received by a child as support from his natural or adoptive parents or putative father; and

(d) Income from assets received as either interest, dividends, or other income from savings accounts, certificates, stocks, bonds, insurance policies, mortgages, and from real property that is not included as earned income.

(4) Unearned income does not include support and maintenance furnished in-kind.

C. An eligible individual may apply for enrollment in the Program by submitting a completed application to the Administrator.

D. Maximum Capacity of Program.

(1) The Administrator may not enroll additional individuals at a time when the Program's total enrollment reaches the level authorized by the Department.

(2) The Program shall maintain a waiting list of individuals who meet the eligibility requirements for the Program but who are not served by the Program because of funding limitations.

(3) If, after the Program reaches its maximum capacity as established by the Department, the number of individuals enrolled decreases, the Administrator may recommence enrolling eligible individuals in the Program as specified in this regulation, until the Program's enrollment again reaches the authorized maximum.

(4) The Department may direct the Administrator to limit enrollment based on the amount of money remaining in the Program Fund.

E. Disenrollment.

(1) The Administrator may, after first providing reasonable notice to the enrollee, disenroll from the Program an enrollee for any of the causes specified in §E(2) of this regulation.

(2) An enrollee may be disenrolled from the Program if the enrollee:

(a) Ceases to meet the eligibility criteria set forth in §A of this regulation; or

(b) Is enrolled in:

(i) A Medicare Part D prescription drug plan that does not charge a premium; or

(ii) A Medicare Advantage Plan that does not charge a premium for prescription drug coverage.