Sec. 10.09.46.02. Medical Assistance Eligibility

A. Financial eligibility for waiver participants is determined according to the provisions of this regulation and applicable sections of COMAR 10.09.24 Medical Assistance Eligibility, as cited in this section.

B. Categorically Needy. An individual is eligible for waiver services as categorically needy if the individual is receiving Medical Assistance as:

(1) A recipient of Supplemental Security Income (SSI);

(2) A member of a low income family with children, as described in §1931 of the Social Security Act; or

(3) A recipient eligible in another mandatory or optional categorically needy coverage group with full Medical Assistance benefits, covered in the community under the State Plan.

C. Optionally Categorically Needy.

(1) An individual is eligible for waiver services as optionally categorically needy in accordance with 42 CFR §435.217, if the individual's countable income does not exceed 300 percent of the applicable payment rate for SSI, and the individual's countable resources do not exceed the SSI resource standard for one person.

(2) For the purpose of determining financial eligibility for the optionally categorically needy, the individual is treated as an assistance unit of one person.

(3) For the purpose of determining countable income for the optionally categorically needy, income is determined based on the income rules set forth in COMAR 10.09.24, which are applicable to an aged, blind, or disabled individual who is institutionalized, with the exceptions specified in §C(9) of this regulation.

(4) For the purpose of determining countable resources for the optionally categorically needy, resources are determined based on the resource rules set forth in COMAR 10.09.24, which are applicable to an aged, blind, or disabled person who is institutionalized, with the exceptions specified in §C(9) of this regulation.

(5) An individual is not eligible to receive waiver services if a disposal of assets or establishment of a trust or annuity results in a penalty under COMAR 10.09.24, until the penalty time expires.

(6) The spousal impoverishment rules at COMAR 10.09.24.10-1 are applicable, except for the following differences in definitions:

(a) "Community spouse" means an individual who:

(i) Lives in the community outside a medical institution;

(ii) Is not determined to meet the criteria for participation in the Waiver for Individuals with Brain Injury or any other waiver under §1915(c) of Title XIX of the Social Security Act; and

(iii) Is married to an institutionalized spouse.

(b) "Continuous period of institutionalization" means:

(i) At least 30 consecutive days of institutional care in a nursing facility or other medical institution; or

(ii) A determination that a spouse meets the criteria for participation in the waiver for individuals with brain injury or any other waiver under §1915(c) of Title XIX of the Social Security Act.

(c) "Institutionalized spouse" means an individual who is married to a community spouse and who is:

(i) An inpatient in a nursing facility or other medical institution with a length of stay exceeding 30 days; or

(ii) Determined to meet the criteria for participation in the waiver for individuals with brain injury or any other waiver under §1915(c) of the Social Security Act.

(7) Medical Assistance eligibility shall be redetermined at least every 12 months.

(8) As part of the determination and redetermination of Medical Assistance eligibility as optionally categorically needy, the Department of Human Services shall determine whether the applicant or recipient is eligible as a disabled person in accordance with COMAR 10.09.24.05E, unless the applicant or recipient is aged, blind, or has been determined as disabled by the Social Security Administration.

(9) All provisions of COMAR 10.09.24 which are applicable to an aged, blind, or disabled individual who is institutionalized are applicable to waiver applicants and participants who are considered as optionally categorically needy, with the following exceptions in full or in part:

(a) COMAR 10.09.24.04J(1)-(3);

(b) COMAR 10.09.24.04K;

(c) COMAR 10.09.24.06B(2)(a)(ii);

(d) COMAR 10.09.24.08G(1);

(e) COMAR 10.09.24.08H;

(f) COMAR 10.09.24.09;

(g) COMAR 10.09.24.10;

(h) COMAR 10.09.24.10-1; and

(i) COMAR 10.09.24.15A-2(2).

(10) Home Exclusion. The home, as defined in COMAR 10.09.24.08B, is not a countable resource under §C of this regulation if it is occupied by the waiver applicant or participant, the applicant's or participant's spouse, or any one of the following relatives who are medically or financially dependent on the applicant or participant:

(a) Child;

(b) Parent; or

(c) Sibling.

D. Posteligibility Determination of Available Income for Optionally Categorically Needy. Participants in the waiver for individuals with brain injury are not required to pay towards their cost of care, and therefore they are not subject to a posteligibility determination of available income.

E. Medically Needy. An individual is not eligible for waiver services if the individual is receiving Medical Assistance as a medically needy person in accordance with COMAR 10.09.24.03D.