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Regulation Forms (MDH Employees Only)
May 26, 2017
Volume 44• Issue 11 • Pages 529—531
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.79 Presumptive Eligibility for Correctional Facilities
Authority: Health-General Article, §15-103(b), Annotated Code of Maryland
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to adopt new Regulations
under a new chapter,
COMAR 10.09.79 Presumptive Eligibility for Correctional Facilities
Statement of Purpose
The purpose of this action is to allow State and local correctional centers to conduct Maryland Medicaid presumptive eligibility determinations for justice-involved individuals leaving a correctional facility.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to email@example.com, or fax to 410-767-6483. Comments will be accepted through June 26, 2017. A public hearing has not been scheduled.
.01 Purpose and Scope.
This chapter establishes requirements for qualified State and local corrections facilities to make presumptive eligibility determinations effective July 1, 2017.
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 and Mental Hygiene, 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 a presumptive eligibility worker at a participating qualified correctional facility in accordance with this chapter.
(14) “Presumptive eligibility worker” means an individual who is trained to make presumptive eligibility determinations and includes an employee of a:
(a) Local health department who is physically present at a participating correctional facility at the time of the presumptive eligibility determination; or
(b) Correctional facility.
A. A correctional facility based in Maryland is eligible to participate as a presumptive eligibility entity.
B. To participate as a presumptive eligibility entity, the correctional facility shall enter a memorandum of understanding with the Department.
C. The memorandum of understanding required under §B of this regulation shall require correctional facilities to:
(1) Comply with Departmental policies and procedures supplied by the Department at the time of application and training;
(2) Meet accuracy and timeliness standards established by the Department;
(3) Submit a list to the Department of presumptive eligibility workers who will attend presumptive eligibility training developed by the Department; and
(4) Report the requested information on a form designated by the Department.
D. Before assisting an applicant in filing a presumptive eligibility application, the presumptive 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;
E. If the individual’s full Medical Assistance application is not approved, the presumptive 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:
(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.
F. In order to ensure the applicant has temporary Medical Assistance coverage, the presumptive eligibility worker shall submit the presumptive eligibility application to the Department on the date the application is completed.
G. 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.
H. On finding that a qualified correctional facility has failed to meet the requirements of §§A—G of this regulation, the facility shall take reasonable corrective action measures, as determined by the Department, to address the noncompliance.
.04 Presumptive Eligibility Criteria.
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.
.05 Eligible Populations.
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.
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.
.07 Coverage Span.
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.
.08 Presumptive Eligibility Appeal Rights.
An individual or an organization does not have appeal rights for presumptive eligibility determinations.
DENNIS R. SCHRADER
Secretary of Health and Mental Hygiene
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464
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