<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".11" citation="COMAR 10.09.62.11" title_num="10" subtitle_num="09" chapter_num="62" 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 participants’ eligibility; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The right to request a hearing; or</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>Participant Responsibility.</text>
    <paragraph num="(1)">
      <text>After an individual has been determined to be eligible for the separate CHIP Program and is enrolled in the separate CHIP Program, the participant or the participant’s representative shall:</text>
      <paragraph num="(a)">
        <text>Within 10 days of the occurrence, notify the Department if there is a change in the participant’s, the participant’s parent’s, or the participant’s guardian’s:</text>
        <paragraph num="(i)">
          <text>Income;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Employment;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Address; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Health insurance coverage status;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Limit use of the Medical Assistance card to the individual whose name appears on the card; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>When written or electronic notice of cancellation is received, discontinue use of the Medical Assistance card on the first day of ineligibility and return the card to the Department.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Failure to comply with §B(1) 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="(3)">
      <text>A participant 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="(4)">
      <text>If the participant refuses to cooperate, the participant’s coverage shall be terminated subject to timely and adequate notice under COMAR 10.01.04.03.</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 participant’s eligibility when changes in circumstances or relevant facts are:</text>
        <paragraph num="(i)">
          <text>Reported by someone on the participant’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 participant that redetermination is required to establish continuing eligibility; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Notify the participant 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. Participants 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 participant 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 individuals the Department or its designee shall make a scheduled redetermination of a child participant’s eligibility at least every 12 months.</text>
  </paragraph>
</regulation>