<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".22" citation="COMAR 14.35.07.22" title_num="14" subtitle_num="35" chapter_num="07" heading="Medicaid to Private Plan Enrollment Program.">
  <paragraph num="A.">
    <text>To the extent permissible by federal law, the Exchange shall enroll an individual into a QHP if the individual was enrolled in Medicaid or MCHP through the Exchange and loses Medicaid or MCHP eligibility after:</text>
    <paragraph num="(1)">
      <text>A redetermination based on a change in circumstances reported after April 15, 2023, pursuant to which the individual is determined eligible for a QHP but does not enroll in a QHP following receipt of the QHP eligibility determination; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A renewal conducted between April 15, 2023, and April 30, 2024, provided the Exchange verifies that the individual’s most recent attested income exceeds the Medicaid-eligible amount as described in Health-General Article, §15-103(a)(2), Annotated Code of Maryland, and the individual meets eligibility requirements under this chapter to enroll in a QHP.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Exchange shall select a plan for an individual described in §A(1) of this regulation on a date no earlier than the seventh day after the date of the QHP eligibility determination.</text>
  </paragraph>
  <paragraph num="C.">
    <text>To the extent permissible by federal law, the Exchange shall select a plan for an individual described in §A(2) of this regulation on a date no earlier than the day immediately following the day that the individual’s Medicaid coverage terminates.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The QHP into which the Exchange enrolls an individual shall be determined by the Exchange using the following guidance:</text>
    <paragraph num="(1)">
      <text>For an individual who has tax household members who are already enrolled in a QHP, the Exchange shall enroll the individual into the household QHP.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For an individual who is eligible for a CSR plan for up to 150 percent FPL or a CSR plan for 151—200 percent FPL and does not have tax household members already enrolled in a QHP, the Exchange shall enroll the individual in:</text>
      <paragraph num="(a)">
        <text>The lowest-cost Silver plan in the individual's region, if the individual’s former managed care organization does not have an affiliate offering QHPs in that region; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The lowest-cost Silver plan offered by an affiliate of the individual’s former managed care organization, if an affiliate offers a QHP in the individual’s region.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>For an individual who is not eligible for a CSR plan for up to 150 percent FPL or a CSR plan for 151—200 percent FPL and does not have tax household members already enrolled in a QHP, the Exchange shall enroll the individual in a plan based on the following guidance:</text>
      <paragraph num="(a)">
        <text>If an affiliate of the individual’s former managed care organization offers QHPs in the individual’s region, the Exchange shall enroll the individual in the lower-cost option of either:</text>
        <paragraph num="(i)">
          <text>The lowest-cost Gold plan offered by the managed care organization affiliate; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The lowest-cost Silver plan offered by the managed care organization affiliate.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>If an affiliate of the individual’s former managed care organization does not offer QHPs in the individual’s region, the Exchange shall enroll the individual in the lower-cost option of either:</text>
        <paragraph num="(i)">
          <text>The lowest-cost Gold plan in the region; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The lowest-cost Silver plan in the region.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>For plans selected for an individual under §A(1) of this regulation, enrollment shall be effective on:</text>
    <paragraph num="(1)">
      <text>The first day of the month following the date of QHP selection pursuant to §B of this regulation, if the selected plan has a premium greater than zero dollars; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The first day of the month following the individual’s confirmation of enrollment, if the selected plan has a premium of zero dollars.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>To the extent permissible by federal law, for plans selected for an individual under §A(2) of this regulation, enrollment shall be effective on:</text>
    <paragraph num="(1)">
      <text>The first day of the month following the date of QHP selection pursuant to §C of this regulation, if the selected plan has a premium greater than zero dollars; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The first day of the month following the individual’s confirmation of enrollment, if the selected plan has a premium of zero dollars.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>References to “cost” under this regulation mean premium cost to the consumer after APTCs and State-based subsidies are applied.</text>
  </paragraph>
</regulation>