Sec. 10.09.24.05-3. Nonfinancial Eligibility Requirements — Residency

A. To be eligible for the Maryland Medical Assistance Program, an applicant or recipient shall be a Maryland resident.

B. An individual is a Maryland resident if the individual resides in Maryland with the intent of remaining permanently or for an indefinite period, regardless of whether the individual maintains the residence permanently or at a fixed address.

C. Residency in a state begins on the day that an individual:

(1) Enters the state with the intent to remain permanently or for an indefinite period; or

(2) Decides to remain in the state permanently or for an indefinite period after entering for another purpose.

D. An individual is not a resident of a state if the individual:

(1) Is temporarily residing in or visiting the state without the intent of remaining, except as specified under §I(2)(b)(ii) or §I(3) of this regulation;

(2) Came into the state for a specific, time-limited purpose and does not intend to remain, except as specified under §I(2)(b)(ii) or §I(3) of this regulation; or

(3) Entered the state voluntarily to obtain noninstitutional medical care, such as for acute hospital inpatient services.

E. Residency in a state established on any day in a calendar month shall constitute residency for the full month.

F. Retaining Residency.

(1) Residency is retained until abandoned.

(2) Temporary absence from a state, with the intent to return to the state when the purpose of the absence is accomplished, does not interrupt continuity of residency, unless another state's Medical Assistance program determines that the individual is a resident of the other state.

(3) An individual who is routinely absent from a state for a protracted period of time retains residency in that state if the individual:

(a) Declares the intent to remain a resident of the state;

(b) Has an established residential address in the state; and

(c) Is not certified for Medical Assistance or receiving public assistance in another state.

(4) Residency in a state is not affected by an absence for:

(a) Unanticipated medical care; or

(b) Out-of-state medical treatment preauthorized by the state's Medical Assistance Program.

G. An individual is ineligible for a state's Medical Assistance Program for any month in which the individual is not a resident of the state.

H. State Supplementary Payment for a Recipient of Supplemental Security Income (SSI).

(1) Notwithstanding any other provisions of this regulation, the state of residence for a recipient of a state supplementary SSI payment is the state making the supplementary payment.

(2) An individual receiving a state supplementary payment from another state who moves to Maryland with the intent of remaining in Maryland is not eligible for Maryland Medical Assistance until:

(a) The individual's change of state residence is verified; and

(b) Changes, if any, in the individual's payment amount are made with the Social Security Administration.

I. Additional Residency Criteria for Noninstitutionalized Individuals.

(1) Noninstitutionalized Child.

(a) Except as otherwise specified in this regulation, a noninstitutionalized, unmarried individual younger than 21 years old is considered a resident of the state where the child lives:

(i) With the child's parent or other caretaker relative; or

(ii) In another living arrangement if the child is not living with the child's parent or other caretaker relative, and the child's parent or other caretaker relative is not responsible for the child's day-to-day care and supervision.

(b) For a child receiving federal payments for foster care or adoption assistance under Title IV-E of the Social Security Act, the child's state of residence is the state where the child lives, even if it is not the state making the payments.

(c) If a noninstitutionalized child's Medical Assistance eligibility is determined based on blindness or disability, the child's state of residence is the state where the child lives.

(2) Noninstitutionalized Adult. A noninstitutionalized adult, including an individual younger than 21 years old who is married or otherwise emancipated from the individual's parents, is considered a resident of the state where the individual lives:

(a) Voluntarily with the intent to remain permanently or for an indefinite period; or

(b) At the time of Medical Assistance application, if the individual is:

(i) Determined as incapable of indicating intent, in accordance with §K of this regulation; or

(ii) Not receiving assistance from another state and entered the state with a job commitment or seeking employment, whether or not the individual is currently employed.

(3) The exclusion of Medical Assistance eligibility under §D of this regulation for individuals who temporarily reside in the state without the intent of remaining shall be waived for members of an assistance unit that includes a migrant worker, in MAGI Exempt coverage groups.

(4) Notwithstanding any other provision of this regulation, the state of residence for an individual placed by a state government in another state is the state that arranges or makes the placement for medical or other publicly funded services.

J. Additional Residency Criteria for Institutionalized Individuals.

(1) For an institutionalized adult, including an individual younger than 21 years old who is married or otherwise emancipated from the individual's parents, the state of residence is the state where the individual is institutionalized, if the individual indicates the intent to remain in the long-term care facility indefinitely.

(2) If an institutionalized adult became incapable of indicating intent when the individual was 21 years old or older, the individual's state of residence is the state where the individual is institutionalized.

(3) An institutionalized child younger than 21 years old, or an institutionalized adult who became incapable of indicating intent when younger than 21 years old, is a resident of the state in which the:

(a) Individual's parent or other legal guardian resided at the time of the individual's placement in the long-term care facility;

(b) Individual's parent or other legal guardian currently resides, who applied for Medical Assistance on the individual's behalf; or

(c) Individual is institutionalized if the individual was abandoned by the individual's parents and does not yet have a legal guardian.

(4) Notwithstanding any other provision of this regulation, the state of residence for an individual institutionalized by a state government in an out-of-state facility is the state that arranges or makes the placement.

(5) The Department may not deny Medical Assistance eligibility to an institutionalized individual who satisfies the residency requirements of this regulation, on the grounds that the individual did not establish Maryland residency before entering the long-term care facility.

K. An adult is considered incapable of indicating intent if the individual:

(1) Has an Intelligence Quotient of 49 or less, or a mental age of 7 years old or younger, based on tests acceptable to the Department's Developmental Disabilities Administration;

(2) Is judged legally incompetent; or

(3) Is found incapable of indicating intent based on medical documentation obtained from a physician, psychologist, or other person licensed by the state in the field of intellectual disabilities.