Sec. 10.18.05.02. Eligibility

A. Except when an individual is enrolled in Medical Assistance but does not have prescription coverage assistance, an individual who is eligible for Medical Assistance is not eligible for MADAP.

B. To be eligible for benefits, an individual shall meet the following criteria:

(1) Residency;

(2) Medical; and

(3) Financial.

C. Residency Criteria. To meet the residency criteria the individual shall be a resident of Maryland.

D. Medical Criteria. To meet the medical criteria the individual shall be:

(1) Infected with HIV as verified by the individual’s health care practitioner on the medical form provided by the Department; and

(2) Prescribed or will be prescribed, within 3 months from the date the completed application was received by the Department, one or more antiretroviral drugs not excluded from the open formulary.

E. Financial Criteria.

(1) To meet the financial criteria the individual shall have a projected gross household income less than or equal to 500 percent of the Federal Poverty Level Guidelines as updated annually in the Federal Register by the U.S. Department of Health and Human Services under authority of 42 U.S.C. §9902(2).

(2) Projected gross household income shall be determined based on what can reasonably be expected to be received during the 12-month period beginning with the month in which the completed application is filed or verification of eligibility is submitted.

(3) Gross household income includes income derived from:

(a) Wages and salaries, including tips;

(b) Net income from self-employment or business;

(c) Unemployment income;

(d) Social security payments, including disability payments;

(e) Alimony;

(f) Retirement income;

(g) Pension income;

(h) Investment income;

(i) Rental income; and

(j) Other taxable income, such as prizes, awards, and gambling winnings.

(4) Gross household income under this chapter does not include income derived from:

(a) Child support;

(b) Gifts;

(c) Supplemental Social Security Income;

(d) Veterans’ disability payments;

(e) Workers’ compensation; and

(f) Proceeds from loans, such as student loans, home equity loans, or bank loans.