COMAR 10.09.41.03. Nonfinancial Eligibility

A. The Department shall determine whether an applicant or recipient meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation.

B. An applicant or participant meets the nonfinancial eligibility requirements for Medical Assistance benefits under this regulation if the applicant or participant:

(1) Is 16 years old or older, but younger than 65 years old;

(2) Is employed, except when an unemployment grace period described under Regulation .07 of this chapter applies, and verifies employment and compliance with all applicable requirements relating to FICA, income tax reporting, withholding, and payment requirements, including, if self-employed, payment of estimated taxes, by submitting documentation such as:

(a) Pay stubs;

(b) A letter from the employer verifying the applicant's or recipient's employment;

(c) Bank statements showing deposits of earnings;

(d) Income tax returns;

(e) Evidence of payment of estimated taxes; or

(f) Business ledgers;

(3) Except for the consideration of substantial gainful activity, meets the definition of disability in §1614(a)(3) of the Social Security Act, as determined by:

(a) The Department pursuant to a disability determination process for applicants who have not had a disability determination completed by the Social Security Administration within the time period prescribed in §C(2) of this regulation ; or

(b) The Social Security Administration, if the applicant or recipient:

(i) Receives SSDI benefits; or

(ii) Has lost eligibility for SSDI or SSI for any reason other than medical improvement;

(4) As specified in COMAR 10.09.24 :

(a) Meets the eligibility requirements for Medical Assistance as to:

(i) Citizenship; and

(ii) Residency; and

(b) Is not:

(i) An institutionalized person;

(ii) An inmate of a public institution; or

(iii) An inpatient in an institution for mental disease; and

(5) Is not a current recipient of:

(a) Comprehensive Medical Assistance benefits pursuant to COMAR 10.09.24 ; or

pecified in COMAR 10.09.24 :

(a) Meets the eligibility requirements for Medical Assistance as to:

(i) Citizenship; and

(ii) Residency; and

(b) Is not:

(i) An institutionalized person;

(ii) An inmate of a public institution; or

(iii) An inpatient in an institution for mental disease; and

(5) Is not a current recipient of:

(a) Comprehensive Medical Assistance benefits pursuant to COMAR 10.09.24 ; or

(b) Benefits under the Maryland Children's Health Program pursuant to COMAR 10.09.11 or 10.09.43 .

C. Periodic Redetermination of Disability.

(1) The Department shall periodically review a recipient's impairments to determine continuing disability status, consistent with §C(2) of this regulation .

(2) Frequency of Continuing Disability Reviews. The Department may schedule the periodic disability reviews required by §C(1) of this regulation at a frequency that is consistent with the time frames set forth in federal law and regulations as specified in 20 CFR §416.989, as amended, and 20 CFR §416.990, as amended, which are incorporated by reference.

Cross References 10.09.41.06A(1) 10.09.41.06A(2) 10.09.41.08D(2)(a)(i)