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<regulation prefix="Regulation" num=".03-1" citation="COMAR 10.09.37.03-1" title_num="10" subtitle_num="09" chapter_num="37" heading="Family Planning Program Presumptive Eligibility.">
  <paragraph num="A.">
    <text>Definitions.</text>
    <paragraph num="(1)">
      <text>In this regulation, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Terms Defined.</text>
      <paragraph num="(a)">
        <text>“Applicant” means an individual who has applied for presumptive eligibility at a participating family planning clinic.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>“Application” means the presumptive eligibility application.</text>
      </paragraph>
      <paragraph num="(c)">
        <text>“Authorized representative” has the meaning stated in COMAR 10.01.04.01.</text>
      </paragraph>
      <paragraph num="(d)">
        <text>“Determination” means a decision regarding an applicant’s presumptive eligibility.</text>
      </paragraph>
      <paragraph num="(e)">
        <text>“Family planning clinic” means an entity that:</text>
        <paragraph num="(i)">
          <text>Provides family planning services under a written agreement with the Maryland Department of Health, Prevention and Health Promotion Administration; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Is approved to perform family planning presumptive eligibility determinations.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>“Former foster care” means an individual who:</text>
        <paragraph num="(i)">
          <text>Is younger than 26 years old;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Is not eligible and enrolled for coverage under a mandatory Medical Assistance group other than childless adult; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Was formerly in a Maryland out-of-home placement, including categorical Medical Assistance, upon attaining age 18 and leaving out-of-home placement or upon attaining age 19—21 during extended out-of-home placement under COMAR 07.02.11.04B.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>“Income” means property or a service received by an individual in cash or in-kind, which can be applied directly, or by sale or conversion, to meet basic needs for food, shelter, and medical expenses.</text>
      </paragraph>
      <paragraph num="(h)">
        <text>“Maryland Family Planning Program Delegate Service Site” means an entity that provides family planning services under a written agreement with the Department.</text>
      </paragraph>
      <paragraph num="(i)">
        <text>“Medical Assistance” means the program administered by the State under Title XIX of the Social Security Act, which provides comprehensive medical and other health-related care for eligible individuals.</text>
      </paragraph>
      <paragraph num="(j)">
        <text>“Presumptive eligibility” means temporary eligibility for Family Planning Program services as determined by family planning clinics in accordance with this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Requirements.</text>
    <paragraph num="(1)">
      <text>A family planning clinic qualified to make presumptive eligibility decisions shall:</text>
      <paragraph num="(a)">
        <text>Participate as a Medical Assistance Program provider in good standing; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Sign an agreement prepared by the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The agreement under §B(1)(b) of this regulation shall require that the family planning clinic:</text>
      <paragraph num="(a)">
        <text>Comply with Departmental policies and procedures supplied by the Department at the time of application and training;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Meet accuracy and timeliness standards established by the Department;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Submit a list to the Department of family planning clinic employees who will attend presumptive eligibility training developed by the Department;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Prohibit employees who have not attended required trainings from making presumptive eligibility decisions; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Report all requested information on a form designated by the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Before assisting an applicant in filing a presumptive eligibility application, the family planning clinic employee shall:</text>
      <paragraph num="(a)">
        <text>Check the Department’s eligibility verification system to make sure the individual is not actively enrolled in the Medical Assistance Program;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Provide information concerning the full Medical Assistance application process to the individual applying for presumptive eligibility and assist or refer the applicant to an individual who can assist the applicant in completing a full Medical Assistance application; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Determine that the applicant:</text>
        <paragraph num="(i)">
          <text>Has not had a prior family planning presumptive eligibility period within the last 12 months;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Is not pregnant; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Is not actively enrolled in the Medical Assistance Program.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The family planning clinic employee shall fill out the presumptive eligibility application based on information supplied by the applicant.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The family planning clinic employee shall make a presumptive eligibility decision and submit the presumptive eligibility application by applying §D of this regulation and the following information obtained pursuant to §C of this regulation:</text>
      <paragraph num="(a)">
        <text>Residency;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Citizenship;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Family size and composition; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Gross family income.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>The family planning clinic employee shall inform the individual in writing of the family planning clinic’s presumptive eligibility decision, which shall include an explanation of the presumptive eligibility period.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>The family planning clinic shall submit the presumptive eligibility application to the Department on the date of application completion to allow the individual to have temporary Medical Assistance coverage.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>The family planning clinic shall:</text>
      <paragraph num="(a)">
        <text>Keep all written and signed presumptive eligibility applications on file for 6 years; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Make the file available to the Department upon request.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Presumptive Eligibility Criteria.</text>
    <paragraph num="(1)">
      <text>An individual shall apply for presumptive eligibility through a participating family planning clinic.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An individual who applies for presumptive eligibility shall attest to:</text>
      <paragraph num="(a)">
        <text>The citizenship requirements in COMAR 10.09.24.05;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The residency requirements in COMAR 10.09.24.05-3;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The individual’s pregnancy status;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The individual’s family size; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The gross monthly income of the individual’s household.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Presumptive eligibility may be established for individuals who meet the Family Planning Program eligibility requirements in Regulation .03 of this chapter.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Limitations. Presumptive eligibility may not be granted to an individual who:</text>
    <paragraph num="(1)">
      <text>Is pregnant;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Is currently enrolled in the Medical Assistance Program;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Had a prior presumptive eligibility period during the last 12 months;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Does not meet the income requirements stated in Regulation .03 of this chapter ;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Does not meet the residency requirements stated in COMAR 10.09.24.05-3; or</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Does not meet the citizenship requirements stated in COMAR 10.09.24.05.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Coverage Span.</text>
    <paragraph num="(1)">
      <text>Presumptive eligibility begins on the day the presumptive eligibility worker determines the individual is presumptively eligible.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Presumptive eligibility ends on the earlier of:</text>
      <paragraph num="(a)">
        <text>The day the individual is determined eligible for Medical Assistance; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The last day of the month following the month in which the family planning clinic determined presumptive eligibility, if an individual:</text>
        <paragraph num="(i)">
          <text>Is found ineligible for Medical Assistance; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Failed to apply for Medical Assistance.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Presumptive Eligibility Appeal Rights. An individual or an organization does not have appeal rights for presumptive eligibility determinations.</text>
  </paragraph>
</regulation>