<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".15" citation="COMAR 10.09.43.15" title_num="10" subtitle_num="09" chapter_num="43" heading="Post-Eligibility Requirements.">
  <paragraph num="A.">
    <text>Notice of Eligibility Determination. The Department or its designee shall inform the 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 recipient’s eligibility; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The right to request a hearing; and</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 excluded coverage groups; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The right to request a hearing.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Applicant Responsibility.</text>
    <paragraph num="(1)">
      <text>The applicant shall notify the Department within 10 working days of changes affecting the applicant’s eligibility.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Only an applicant that has been determined eligible by the Department or its designee shall use MCHP Premium benefits.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If written or electronic notice of cancellation is received, the applicant shall discontinue use of MCHP Premium benefits on the first day of ineligibility.</text>
    </paragraph>
    <paragraph num="(4)">
      <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="(5)">
      <text>The applicant shall cooperate with the Department’s quality control review process, including verification of all information pertinent to the determination of eligibility.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>If the applicant refuses to cooperate, the applicant’s coverage shall be terminated.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Unscheduled Redetermination.</text>
    <paragraph num="(1)">
      <text>The Department shall:</text>
      <paragraph num="(a)">
        <text>Promptly make an unscheduled redetermination of a recipient's eligibility if changes in circumstances or relevant facts are:</text>
        <paragraph num="(i)">
          <text>Reported by someone on the applicant’s behalf; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Brought to the attention of the Department from other responsible sources; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Notify the applicant 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 for the remainder of the certification period because of a change in circumstances or failure to establish eligibility following a change in circumstances, 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 for MCHP at any time.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Scheduled Redetermination.</text>
    <paragraph num="(1)">
      <text>Redetermination is required to establish continued eligibility.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Redetermination shall be scheduled annually.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Completion of the application and determination of eligibility for MCHP by the Department or its designee is required for renewal for program eligibility.</text>
    </paragraph>
  </paragraph>
</regulation>