# COMAR Title 10 — Maryland Department of Health

## Subtitle 67 — Maryland Healthchoice Program

### Chapter 02 — Maryland Medicaid Managed Care Program: Eligibility and Enrollment

#### Regulation .01 Eligibility.

*COMAR 10.67.02.01*

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.