Regulation .01 Eligibility.
Regulation .01 Eligibility.LinkCopy Citation
A.
Criteria. Except as provided in §B of this regulation, a Program participant shall be enrolled in the Maryland Medicaid Managed Care Program, described in this chapter, if the participant is eligible for receipt of Medical Assistance benefits by qualifying:
(1)
As categorically needy or medically needy under COMAR 10.09.24, unless the participant is:
(a)
65 years old or older;
(b)
Newly eligible and 64 1/2 years old or older;
(c)
Eligible to receive Medicare benefits;
(d)
Determined medically needy under a spend down; or
(e)
Otherwise certified for a period of less than 9 months;
(2)
For the Pregnant Women and Children's Program on or after January 1, 1997; or
(3)
For the Maryland Children’s Health Program on or after July 1, 1998; or
(4)
For the Separate CHIP Program and CHIP Health Services Initiative on or after July 1, 2023.
B.
A participant is not eligible for the Maryland Medicaid Managed Care Program if the participant:
(1)
Has been, or is expected to be, continuously institutionalized for more than:
(a)
90 successive days in a long-term care facility; or
(b)
30 successive days in an institution for mental disease (IMD);
(2)
Is institutionalized in an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID);
(3)
Is enrolled in:
(a)
Home Care for Disabled Children under a Model Waiver, pursuant to COMAR 10.09.27;
(b)
The Family Planning Waiver Program pursuant to COMAR 10.09.58; or
(c)
The Employed Individuals with Disabilities Program pursuant to COMAR 10.09.41;
(4)
Is a child receiving adoption subsidy who is covered under the parent's private insurance;
(5)
Is a child under State supervision receiving adoption subsidy who lives outside of the State;
(6)
Is a child in an out-of-State placement; or
(7)
Is an inmate as defined in COMAR 10.67.01.01.