<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".13" citation="COMAR 10.09.11.13" title_num="10" subtitle_num="09" chapter_num="11" heading="Post-Eligibility Requirements.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>For eligible individuals:</text>
      <paragraph num="(a)">
        <text>The basis and effective date for eligibility;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Instructions for reporting changes that may affect the recipients eligibility; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The right to request a hearing;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For ineligible individuals:</text>
      <paragraph num="(a)">
        <text>A finding of ineligibility, the reason for the finding, and the regulation supporting the finding;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Information regarding application for MAGI Exempt coverage groups; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The right to request a hearing.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Recipient Responsibility. After an individual has been determined to be eligible for MCHP and is enrolled in MCHP:</text>
    <paragraph num="(1)">
      <text>The Department shall periodically redetermine the recipient's eligibility for MCHP as specified under §D; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The recipient or the recipient's representative shall, within 10 days of the occurrence, notify the Department if there is a change in the recipient's, the recipient's parent's, or the recipient's guardian's:</text>
      <paragraph num="(a)">
        <text>Income;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Employment;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Address; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Health insurance coverage status.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A recipient or the recipient's representative shall limit use of the Medical Assistance card to the individual whose name appears on the card.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>When written or electronic notice of cancellation is received, a recipient shall discontinue use of the Medical Assistance card on the first day of ineligibility and return the card to the Department.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Failure to comply with the provisions of §B(1)—(3) of this regulation may result in:</text>
      <paragraph num="(a)">
        <text>The termination of assistance; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Referral to the Department for fraud investigation, or for criminal or civil prosecution.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>A recipient shall cooperate with the Department’s quality control and audit review process, including verification of all information pertinent to the determination of eligibility.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>If the recipient refuses to cooperate, the recipient's coverage shall be terminated subject to the regulation governing timely and adequate notice under COMAR 10.01.04.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Unscheduled Redetermination.</text>
    <paragraph num="(1)">
      <text>The Department or its designee shall:</text>
      <paragraph num="(a)">
        <text>Promptly make an unscheduled redetermination of a child recipient's eligibility when changes in circumstances or relevant facts are:</text>
        <paragraph num="(i)">
          <text>Reported by someone on the recipient's behalf, or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Brought to the attention of the Department or its designee from other responsible sources;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Notify the recipient that redetermination is required to establish continuing eligibility; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Notify the recipient of the required information and verifications needed to determine eligibility and the time standards in acting in the redetermination process.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Eligibility Decisions. Recipients who are determined:</text>
      <paragraph num="(a)">
        <text>Eligible for the remainder of the certification period shall be sent notice in accordance with §A(1) of this regulation; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ineligible because of a change in circumstances or failure to establish eligibility following a change in circumstance shall be sent notice in accordance with §A(2) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>A recipient whose eligibility has been canceled may reapply at any time after the cancellation of eligibility and a new period under consideration shall be established.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Scheduled Redetermination. Except for children eligible as newborns of eligible women, the Department or its designee shall make a scheduled redetermination of a child recipient's eligibility at least every 12 months.</text>
  </paragraph>
</regulation>