Chapter 79. Presumptive Eligibility for Correctional Facilities
Regulation .01 Purpose and Scope.LinkCopy Citation
This chapter establishes requirements for qualified State and local corrections facilities to make presumptive eligibility determinations effective July 1, 2017.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Applicant” means an individual who has applied for presumptive eligibility at a participating qualified correctional facility.
(2)
“Application” means the presumptive eligibility application.
(3)
“Correctional facility” has the meaning stated in Correctional Services Article, §1-101, Annotated Code of Maryland, and includes:
(a)
Correctional facilities under the direction of the Department of Public Safety and Correctional Services; and
(b)
Local correctional facilities within the State’s 24 local jurisdictions.
(4)
“Department” means the Department of Health, which is the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.
(5)
“Determination” means a decision regarding an applicant’s presumptive eligibility.
(6)
“Federal poverty level” means the poverty guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. §9902(2).
(7)
“Former foster care” means an individual who:
(a)
Is younger than 26 years old;
(b)
Is not eligible and enrolled for coverage under a mandatory Medical Assistance group other than childless adult; and
(c)
Was formerly in a Maryland out-of-home placement, including categorical Medical Assistance:
(i)
On attaining age 18 and leaving out-of-home placement; or
(ii)
On attaining age 19—21 during extended out-of-home placement under COMAR 07.02.11.04B.
(8)
“Incarcerated inmate” means an individual who resides in a public institution involuntarily as a result of being accused or found guilty of a criminal offense, including the duration of time in which the individual is involuntarily residing in the public institution in a preadjudication or pretrial status.
(9)
“Income” means property or a service received by an individual in cash or in-kind that can be applied directly, or by sale or conversion, to meet basic needs for food, shelter, and medical expenses.
(10)
“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.
(11)
“Medicare” means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42, §U.S.C. 1395 et seq.
(12)
“Memorandum of understanding” means the agreement by which the correctional facility has contracted with the Department and been deemed a qualified entity eligible to make presumptive eligibility decisions.
(13)
“Presumptive eligibility” means temporary eligibility for Medical Assistance as determined by an eligibility worker at a participating qualified correctional facility in accordance with this chapter.
Regulation .03 Requirements.LinkCopy Citation
A.
A correctional facility based in Maryland is eligible to participate as a presumptive eligibility entity.
B.
The eligibility worker shall:
(1)
Using the Department’s eligibility verification system, verify the individual is not actively enrolled in the Maryland Medical Assistance Program; and
(2)
Complete the full Medical Assistance application process;
C.
Unless the individual is enrolled in the Maryland Medical Assistance Program, the eligibility worker shall:
(1)
Fill out the presumptive eligibility application based on information supplied by the applicant;
(2)
Make a presumptive eligibility determination based on the following information:
(a)
Residency;
(b)
Citizenship;
(c)
Family size and composition; and
(d)
Gross family income;
(3)
Sign the application; and
(4)
Inform the applicant in writing of the presumptive eligibility determination, which includes an explanation of the presumptive eligibility coverage span.
D.
In order to ensure the applicant has temporary Medical Assistance coverage, the eligibility worker shall submit the presumptive eligibility application to the Department on the date the application is completed.
E.
After the application has been submitted, the correctional facility shall:
(1)
Keep all written and signed presumptive eligibility applications on file for 6 years; and
(2)
Make the file available to the Department on request.
F.
On finding that a qualified correctional facility has failed to meet the requirements of §§A—E of this regulation, the facility shall take reasonable corrective action measures, as determined by the Department, to address the noncompliance.
Regulation .04 Presumptive Eligibility Criteria.LinkCopy Citation
A.
An individual shall apply for presumptive eligibility through a participating correctional facility.
B.
An individual who applies for presumptive eligibility shall attest to:
(1)
The citizenship requirements in COMAR 10.09.24.05;
(2)
The residency requirements in COMAR 10.09.24.05-3;
(3)
The individual’s pregnancy status;
(4)
The individual’s family size; and
(5)
The individual’s household’s gross monthly income.
Regulation .05 Eligible Populations.LinkCopy Citation
If an incarcerated inmate in a Maryland-based correctional facility is determined to be eligible for one of the following coverage groups, the individual may qualify for presumptive eligibility for correctional facilities:
A.
Parents and other caretaker relatives whose household income is equal to or less than 133 percent of the federal poverty level;
B.
Pregnant women whose income is equal to or less than 250 percent of the federal poverty level;
C.
Childless adults 19 years old or older and younger than 65 years old whose household income is equal to or less than 133 percent of the federal poverty level; and
D.
Former foster care individuals who are younger than 26 years old.
Regulation .06 Limitations.LinkCopy Citation
Presumptive eligibility may not be granted to an individual who:
A.
Is currently enrolled in the Maryland Medical Assistance Program or Medicare;
B.
With the exception of pregnant women, had a prior presumptive eligibility period during the last 12 months;
C.
Does not meet the residency requirements stated in COMAR 10.09.24.05-3; or
D.
Does not meet the citizenship requirements stated in COMAR 10.09.24.05.
Regulation .07 Coverage Span.LinkCopy Citation
A.
Presumptive eligibility begins on the day the presumptive eligibility worker determines the individual is presumptively eligible.
B.
Presumptive eligibility ends on the earlier of:
(1)
The day the individual is determined eligible for Medical Assistance; or
(2)
The last day of the month following the month in which the correctional facility determined presumptive eligibility, if an individual:
(a)
Is found ineligible for Medical Assistance; or
(b)
Failed to apply for Medical Assistance.
C.
A non-pregnant individual may be determined presumptively eligible once per a 12-month period.
D.
A pregnant individual may be determined presumptively eligible once per pregnancy.
Regulation .08 Presumptive Eligibility Appeal Rights.LinkCopy Citation
An individual or an organization does not have appeal rights for presumptive eligibility determinations.
Chapter annotations
Authority: Health-General Article, §15-103(b), Annotated Code of Maryland
History: Effective date: December 18, 2017 (44:25 Md. R. 1180)
History: Regulation .02B amended effective December 30, 2019 (46:26 Md. R. 1164); March 30, 2026 (53:6 Md. R. 291)
History: Regulation .03 amended effective December 30, 2019 (46:26 Md. R. 1164)