§ 15–103.11
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 15-103.11 (2026)
Title 15. Assistance Programs
Subtitle 1. Medical and Pharmacy Assistance Programs
§ 15–103.11LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Ex parte redetermination” means a process by which the Department determines a Program recipient’s eligibility to continue to receive services using existing data, without requiring the Program recipient to submit additional information.
(3)
“Home– and community–based services” means services authorized under a Medicaid State Plan option or waiver under § 1115 or § 1915(c), (i), or (k) of the federal Social Security Act.
(4)
“Procedural disenrollment” means the termination of a Program recipient’s eligibility to receive services based on reasons related to the renewal process and not on a determination of ineligibility.
(b)
The Department shall comply with the requirements of 42 C.F.R. § 435.912 related to the timely determination and redetermination of Program eligibility, including processing an application:
(1)
If a determination of disability is not required, within 45 days after the receipt of the application; and
(2)
If a determination of disability is required, within 90 days after the receipt of the application.
(c)
The Department shall conduct ex parte redeterminations and use all procedures authorized under 42 C.F.R. § 435.916 to prevent procedural disenrollment of individuals receiving home– and community–based services.
(d)
In accordance with 42 C.F.R. § 435.905 and subject to subsection (e) of this section, the Department shall provide, in electronic and paper formats, and orally as an accommodation, the following information to all applicants and other individuals on request:
(1)
Requirements for Program eligibility;
(2)
Available Program services; and
(3)
The rights and responsibilities of applicants and Program recipients.
(e)
(1)
The Department shall provide the information required under subsection (d) of this section in plain language and in a manner that is timely and accessible to individuals who are:
(i)
Limited English proficient through the provision of language services, including oral interpretation and written translations, at no cost to the individual; or
(ii)
Living with disabilities through the provision of auxiliary aids and services at no cost to the individual in accordance with the federal Americans with Disabilities Act and § 504 of the federal Rehabilitation Act of 1973.
(2)
The Department shall provide taglines in non–English languages to inform individuals of:
(i)
The availability of the accessible information and language services under this section; and
(ii)
How to access the information and services.
(f)
(1)
If a Program recipient is procedurally disenrolled from home– and community–based services due to a failure by the Department to redetermine eligibility in a timely manner after the recipient has timely returned information required under 42 C.F.R. § 435.916(b)(2)(i)(B) and 42 C.F.R. § 435.952(c), the Department shall reinstate the Program recipient’s eligibility and the provision of home– and community–based services and authorize enrollment retroactively to the date of disenrollment pending the Department’s completion of the redetermination process.
(2)
This subsection may not be construed to limit the Department’s authority or diminish the Department’s responsibility to reinstate the eligibility of and the provision of home– and community–based services to a Program recipient who has been disenrolled for a reason other than a failure by the Department to redetermine eligibility in a timely manner.
(g)
Subject to federal approval, the Department shall reserve capacity in home– and community–based services waivers for services needed by Program recipients with developmental disabilities who:
(1)
Were disenrolled from the Maryland Medicaid Home and Community–Based Services waiver program on or after January 1, 2024;
(2)
Have had Program eligibility reinstated; and
(3)
Have requested the reinstatement of waiver services.
(h)
(1)
The Department may not procedurally disenroll an individual from the Program or home– and community–based services solely based on missing documentation, a missing signature, or incomplete information unless the Department has:
(i)
Exhausted all ex parte verification processes required under 42 C.F.R. § 435.916;
(ii)
Provided a clear, specific, and accessible written notice identifying the exact information required; and
(iii)
Provided the Program recipient with a reasonable opportunity to supply the information.
(2)
If the Department violates paragraph (1) of this subsection, a Program recipient’s home– and community–based services shall continue without interruption.
(i)
If the Department disenrolls a Program recipient in violation of this section, the Department shall:
(1)
Automatically reinstate Program and home– and community–based services retroactive to the date of disenrollment; and
(2)
Treat the Program recipient as continuously enrolled.
(j)
(1)
On or before January 1, 2027, and quarterly thereafter, the Department shall:
(i)
Submit to the General Assembly, in accordance with § 2–1257 of the State Government Article, a report regarding Program recipients who receive home– and community–based services; and
(ii)
Post each report submitted under item (i) of this paragraph on the Department’s website.
(2)
The reports required under paragraph (1) of this subsection shall include:
(i)
The total number of Program recipients for whom a redetermination of eligibility was initiated;
(ii)
The total number of Program recipients for whom Program coverage is renewed;
(iii)
Of the Program recipients whose eligibility is renewed, the total number whose coverage was renewed based on an ex parte redetermination;
(iv)
The total number of Program recipients whose eligibility was reinstated in accordance with subsection (f) of this section;
(v)
The total number of Program recipients whose eligibility was terminated;
(vi)
The total number of Program recipients whose eligibility was terminated for procedural reasons;
(vii)
The total number of Program recipients whose eligibility was terminated due to a failure by the Department to redetermine eligibility in a timely manner; and
(viii)
The mean and median processing times for redeterminations of eligibility.