<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".01" citation="COMAR 10.67.02.01" title_num="10" subtitle_num="67" chapter_num="02" heading="Eligibility.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>As categorically needy or medically needy under COMAR 10.09.24, unless the participant is:</text>
      <paragraph num="(a)">
        <text>65 years old or older;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Newly eligible and 64 1/2 years old or older;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Eligible to receive Medicare benefits;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Determined medically needy under a spend down; or</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Otherwise certified for a period of less than 9 months;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>For the Pregnant Women and Children's Program on or after January 1, 1997; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>For the Maryland Children’s Health Program on or after July 1, 1998; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For the Separate CHIP Program and CHIP Health Services Initiative on or after July 1, 2023.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A participant is not eligible for the Maryland Medicaid Managed Care Program if the participant:</text>
    <paragraph num="(1)">
      <text>Has been, or is expected to be, continuously institutionalized for more than:</text>
      <paragraph num="(a)">
        <text>90 successive days in a long-term care facility; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>30 successive days in an institution for mental disease (IMD);</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Is institutionalized in an intermediate care facility for individuals with intellectual disabilities or persons with related conditions (ICF/IID);</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Is enrolled in:</text>
      <paragraph num="(a)">
        <text>Home Care for Disabled Children under a Model Waiver, pursuant to COMAR 10.09.27;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Family Planning Waiver Program pursuant to COMAR 10.09.58; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The Employed Individuals with Disabilities Program pursuant to COMAR 10.09.41;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Is a child receiving adoption subsidy who is covered under the parent's private insurance;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Is a child under State supervision receiving adoption subsidy who lives outside of the State;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Is a child in an out-of-State placement; or</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Is an inmate as defined in COMAR 10.67.01.01.</text>
    </paragraph>
  </paragraph>
</regulation>