<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03-3" citation="COMAR 10.09.24.03-3" title_num="10" subtitle_num="09" chapter_num="24" heading="Medicare Savings Program Coverage.">
  <paragraph num="A.">
    <text>Non-Financial and Resource Eligibility for the Medicare Savings Programs. In order to be eligible for the Medicare savings program under §§E—H of this regulation, an individual:</text>
    <paragraph num="(1)">
      <text>May not be enrolled in Medical Assistance or the Maryland Children's Health Program under this chapter or under COMAR 10.09.11;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Shall be entitled to hospital insurance benefits under Medicare Part A, or medical insurance benefits under Medicare Part B, or both, with or without payment of premiums;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Shall meet the non-financial eligibility requirements for Medical Assistance under this chapter; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Shall be part of an assistance unit whose countable resources do not exceed:</text>
      <paragraph num="(a)">
        <text>For individuals eligible under §§E—G of this regulation, 3 times the maximum amount allowed by the Supplemental Security Income program, as adjusted from time to time by the Social Security Administration, for the number of persons in the assistance unit; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>For individuals eligible under §H of this regulation, 2 times the maximum amount allowed by the Supplemental Security Income program for the number of persons in the assistance unit.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Medicare Savings Program.</text>
    <paragraph num="(1)">
      <text>The Medical Assistance benefits for individuals eligible under §§E—H of this regulation are limited to the Medicare savings program benefits described under those sections of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Current eligibility for Medicare savings program benefits shall continue until the recipient is determined ineligible.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Application and Redetermination Procedures.</text>
    <paragraph num="(1)">
      <text>The requirements under this chapter for applications and redeterminations shall apply for §§E—H of this regulation except as described in §C(2)—(5) of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Applications and re-applications for eligibility under this regulation shall be filed at:</text>
      <paragraph num="(a)">
        <text>The Department or its designee;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Maryland Department of Aging;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>An area agency on aging; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A surrogate organization approved by the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The initial application may be made at a face-to-face interview or by mail with an agency defined under §C(2) of this regulation, as authorized by the Department.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Redeterminations.</text>
      <paragraph num="(a)">
        <text>Applications for redetermination of eligibility shall be mailed by the Department or its designee to the recipient or representative for completion at least once every 12 months.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The recipient or representative shall return the application to the Department or its designee and indicate:</text>
        <paragraph num="(i)">
          <text>Any changes that have occurred since the prior redetermination of eligibility, such as a new address; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>That there is no new information to report, by marking “NO CHANGE” on the front of the application.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Upon notice of a change in circumstances, a redetermination of eligibility under §§E—H of this regulation shall be completed by the Department or its designee.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Eligibility under §§E—H of this regulation shall be initially determined and redetermined by the Department or its designee.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Income and Resource Consideration.</text>
    <paragraph num="(1)">
      <text>Assistance Unit. When financial eligibility is determined for an applicant or recipient under §§E—H of this regulation, the countable income and resources of the following individuals shall be considered and measured against the income and resource standards specified in this regulation for the number of persons in the assistance unit:</text>
      <paragraph num="(a)">
        <text>The applicant or recipient; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The applicant's or recipient's spouse when living in the same household, whether or not the spouse is eligible for the same benefits under this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Determining Countable Income and Resources.</text>
      <paragraph num="(a)">
        <text>Income and resources shall be evaluated for §§E—H of this regulation in accordance with the provisions for aged, blind, or disabled adults residing in the community, as described under this chapter, in addition to the following resource exclusions:</text>
        <paragraph num="(i)">
          <text>The cash value of life insurance; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>An amount up to $1,500 for burial or funeral funds, unless included in the annual resource limit for the full Medicare Part D Low-Income Subsidy (LIS) program.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Cost of Living Disregard. The annual cost of living increase in Social Security income under Title II of the Social Security Act shall be disregarded through the month following the month in which the annual federal poverty level update is published in the Federal Register.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Qualified Medicare Beneficiary (QMB).</text>
    <paragraph num="(1)">
      <text>An individual is eligible for QMB benefits if:</text>
      <paragraph num="(a)">
        <text>All of the requirements of §A of this regulation are satisfied; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The assistance unit's net countable income does not exceed 100 percent of the federal poverty level for the number of persons in the assistance unit.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Current eligibility for QMB benefits shall be effective the first day of the month after the month in which QMB eligibility is determined.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Retroactive coverage before the month of application is not available for QMB benefits.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Medicare savings program benefits for a QMB-eligible person shall include coverage of the following expenses by the Medical Assistance program:</text>
      <paragraph num="(a)">
        <text>Monthly premium for Medicare Part B;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Monthly premium for Medicare Part A, if the individual, due to insufficient working quarters, is not entitled to free coverage by the Social Security Administration; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Medicare Part A and Part B deductibles and co-insurance for services covered by Medicare, regardless of whether the services are covered under the Medical Assistance State Plan.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Specified Low-Income Medicare Beneficiary (SLMB).</text>
    <paragraph num="(1)">
      <text>An individual is eligible for SLMB benefits if:</text>
      <paragraph num="(a)">
        <text>All of the requirements of §A of this regulation are satisfied; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The assistance unit's net countable income is greater than 100 percent but less than 120 percent of the federal poverty level for the number of persons in the assistance unit.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Current eligibility for SLMB benefits shall be effective the first day of the month of application.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An individual may qualify for retroactive SLMB benefits for up to 3 calendar months before the month of application, if the person meets the SLMB eligibility criteria for each of those prior months.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Medicare savings program benefits for a SLMB-eligible person shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part B.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Qualifying Individual QI.</text>
    <paragraph num="(1)">
      <text>An individual is eligible for QI benefits if:</text>
      <paragraph num="(a)">
        <text>All of the requirements of §A of this regulation are satisfied;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The assistance unit's net countable income is at least 120 percent but less than 135 percent of the federal poverty level for the number of persons in the assistance unit; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The individual is not otherwise eligible for Medical Assistance under this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Current eligibility for QI benefits shall be effective the first day of the month of application.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An applicant may qualify for up to 3 calendar months before the month of application for retroactive QI benefits if:</text>
      <paragraph num="(a)">
        <text>The individual meets the QI eligibility criteria for each of those prior months under consideration; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Each retroactive month is no earlier than January 1 of the calendar year in which the individual applied for QI benefits.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Medicare savings program benefits for a QI eligible individual shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part B.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Qualified Disabled and Working Individual (QDWI).</text>
    <paragraph num="(1)">
      <text>An individual is eligible for QDWI benefits if:</text>
      <paragraph num="(a)">
        <text>The individual:</text>
        <paragraph num="(i)">
          <text>Meets all of the requirements under §A of this regulation;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Is younger than 65 years old;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Was determined disabled by the Social Security Administration (SSA) but lost Social Security benefits solely due to employment;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Is entitled to enroll in Medicare Part A under §1818A of the Social Security Act; and</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Is not otherwise eligible for Medical Assistance under this chapter; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The assistance unit's net countable income does not exceed 200 percent of the federal poverty level for the number of persons in the assistance unit.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>SSA shall establish the effective date of QDWI coverage based on the:</text>
      <paragraph num="(a)">
        <text>Individual's date of application for QDWI benefits;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Date of potential QDWI eligibility, as specified in a letter from SSA to the individual; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Dates of the next Medicare open enrollment period.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Medicare savings program benefits for a QDWI-eligible person shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part A.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Only the individual who is identified by SSA as potentially eligible may be eligible for QDWI benefits in a QDWI assistance unit.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Retroactive coverage before the month of application is not available for QDWI benefits.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>If an individual delays in applying for QDWI benefits after notification of potential QDWI eligibility by SSA, the individual may be required by SSA to pay a premium surcharge for Medicare Part A, unless the individual is covered by an employer-based group health plan.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Eligibility for QDWI benefits shall continue until the earliest of the following dates:</text>
      <paragraph num="(a)">
        <text>The end of the month after the Department:</text>
        <paragraph num="(i)">
          <text>Determines that the individual is no longer eligible for QDWI benefits in accordance with this regulation; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Sends the recipient a notice of termination at least 10 days before the effective date;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The end of the month before the month that the individual becomes:</text>
        <paragraph num="(i)">
          <text>Re-entitled to premium-free Medicare Part A; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>65 years old;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>The date of death; or</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The end of the month following the month that the individual:</text>
        <paragraph num="(i)">
          <text>Is notified by SSA that the individual no longer has a disabling impairment; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Files a request for termination of QDWI enrollment.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>