Issue Date: October 4, 2013
Volume 40 • Issue 20 • Pages 1658—1661
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.37 Family Planning Program Eligibility
Authority: Health-General Article, §§2-104(b) and 15-103(a), Annotated Code of Maryland
Notice of Proposed Action
The Secretary of Health and Mental Hygiene proposes to amend Regulations .02—.04 and .11, repeal existing Regulations .06, .07, and .12, and adopt new Regulations .06, .07, and .12 under COMAR 10.09.37 Family Planning Program Eligibility.
Statement of Purpose
The purpose of this action is to reflect changes in cross-references associated with amendments to COMAR 10.09.24. In addition, new Regulations .06, .07 and .12 are being adopted in order to comply with the Affordable Care Act.
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 W. 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 November 4, 2013. A public hearing has not been scheduled.
A. (text unchanged)
B. Terms Defined.
(1)—(7) (text unchanged)
(8) “Department” means the Department of Health and Mental Hygiene [as defined in COMAR 10.09.36.01, or its authorized agents acting on behalf of the Department], 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.
(9)—(11) (text unchanged)
(12) “Excludable income” means income which is exempt from consideration as countable income.
[(12)] (13)—[(14)] (15) (text unchanged)
(16) “Income tax” means federal, State, or local taxes either paid or withheld from income of a self-employed person not to exceed the tax table amount for the number of known dependents.
[(15)] (17)—[(18)] (20) (text unchanged)
(21) Public Institution.
(a) “Public institution” means an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.
(b)”Public institution” does not mean a medical institution, a skilled nursing facility, or a publicly operated community residence that serves no more than 16 residents.
[(19)] (22)—[(22)] (25) (text unchanged)
.03 Eligibility for Family Planning Progra
A. In order to be determined eligible for benefits under the Family Planning Program, an applicant:
(a) (text unchanged)
(b) Meet the following requirements:
(i) (text unchanged)
(ii) Identity requirements in COMAR [10.09.24.05-1(a)—(e) and (g)] 10.09.24.05-1A—F and H; and
(iii) (text unchanged)
(c) (text unchanged)
(2) May not:
(a)—(d) (text unchanged)
(e) Be an incarcerated inmate in a public institution as defined in COMAR [10.09.24.05-5B] 10.09.24.05-5A.
B. An applicant whose income does not exceed 200 percent of the federal poverty level and is determined eligible for pregnancy or postpartum coverage under COMAR [10.09.11] 10.09.24 shall be:
(1)—(2) (text unchanged)
A. The Department shall:
(1) (text unchanged)
(2) Give oral or written information about the eligibility requirements, coverage, scope and related services of the Family Planning Program, and a woman’s rights and obligations under the Family Planning Program, to any individual requesting this information; [and]
(3) Give a woman requesting Family Planning Program coverage the opportunity to apply [in accordance with the requirements stated in COMAR 10.09.24.04C.]; and
(4) Make the application available to the individual without delay;
B. A resident temporarily absent from the State but intending to return may apply for assistance to the Department or its designee. The individual shall demonstrate continued residency in the State and shall meet all nonfinancial and financial requirements in order to be determined eligible.
[B.] C.—[D.] E. (text unchanged)
[E.] F. Time Limitations.
(1) When an application is filed with the Department, a decision shall be made promptly but not later than 45 days from the date the application is received, unless an extension is granted in accordance with [§F] §G of this regulation.
(2) The time standards specified in [§E(1)] §F(1) of this regulation covers the period from the application date to the date the Department’s notice of decision is mailed to the applicant.
(3) (text unchanged)
(4) When an applicant fails to complete the application form or to provide the required information needed to determine eligibility within the 45 day limit provided under [§F(1)] §G(1) of this regulation, the applicant shall be determined ineligible.
[F.] G. (text unchanged)
[G.] H. Required Information.
(1) The Department shall inform the applicant of the required information and verifications needed to determine eligibility in accordance with the requirements stated in COMAR [10.09.24.04J(3)(a), (b), and (d)] 10.09.24.04I(3)(b), (c), and (e).
(2) (text unchanged)
[H.] I. (text unchanged)
[I.] J. The Department shall restrict disclosures of information concerning applicants in accordance with the requirements stated in COMAR [10.09.24.04] 10.09.24.04Q.
[J.] K. Eligibility may not be established until the applicant furnishes or applies for a social security number in accordance with the requirements stated in COMAR [10.09.24.04] 10.09.24.04L .
[K.] L. (text unchanged)
.06 Consideration of Family Income: Earned and Unearned Income.
A. This regulation contains the rules for considering earned and unearned income for the current period under consideration.
B. The applicant shall report all income. When there is evidence of regular expenditures which are inconsistent with reported income, the applicant shall be required to offer an explanation and appropriate verification to reconcile the inconsistency.
C. The Department or its designee shall consider all income in accordance with this regulation.
D. Current Eligibility. In considering income for current eligibility, the following rules apply:
(1) When an individual has regular income, the amount to be considered is that which is available or can reasonably be expected to be available for a projected period of 6 months, including the month of application; and
(2) When an individual works for less than 12 months but receives an annual salary, is self-employed, or has irregular or seasonal earnings, the amount to be considered is 1/2 the expected annual income based on the prior year’s gross income.
E. Treatment of Income.
(1) All earned and unearned income which is not designated as excludable income pursuant to §H of this regulation shall be counted to establish countable gross income.
(2) Countable gross income shall be reduced by subtracting appropriate income disregards as specified in Regulation .07 of this chapter to determine countable net income.
F. Earned income includes the following:
(2) Commissions and fees;
(3) Salaries and tips;
(4) The value of in-kind goods and services received as a result of employment;
(5) Profit from self-employment income, as described in Regulation .07 of this chapter;
(6) Remuneration received for work or for activities performed as a participant in a program conducted by a sheltered workshop or activities center;
(7) The Earned Income Tax Credit (EITC) a person receives through the Tax Reduction Act of 1973;
(8) Sick pay which counts as earnings for deduction purposes under Title II of the Social Security Act; or
(9) Work study earnings.
G. Unearned income includes the following:
(1) Benefits and income from:
(a) Social Security;
(b) Veterans Administration;
(c) Workers’ Compensation Program;
(d) Black Lung Program;
(e) Railroad Retirement Board;
(f) Government, private, or company pensions and annuities;
(g) Unemployment benefit plans;
(h) Unemployment supplemental benefit plans;
(i) Payments from oil or mineral rights (leases);
(j) Government payments on land;
(k) Insurance benefits paid directly to a person;
(l) Trust funds;
(m) Individual Retirement Accounts (IRAs);
(n) Keogh Plans; or
(o) Military allotments;
(2) Alimony and court-ordered and voluntary support payments received from an absent spouse, or an absent natural or adoptive parent;
(3) Financial contributions received from persons or public or private agencies;
(4) Interest, dividends, royalties, or other income accrued to stocks, bonds, insurance, and savings certificates if the income is available to the individual on a regular basis;
(5) Interest or dividends accrued to savings accounts;
(6) Mortgage payments;
(7) Lump sum benefits or other amounts of income received on a one-time-only basis including gifts, inheritances, retroactive benefit payments, lottery winnings, damage claims unless specifically excluded by other regulations, or any other lump sums or portions of them that are not excluded under §H of this regulation;
(8) Profit from rental income as described in Regulation .07 of this chapter;
(9) Cash assistance received from nongovernmental social agencies unless excluded under the provisions of §H of this regulation;
(10) Grants, loans, scholarships, and fellowships for educational purposes, with the following exceptions:
(a) Grants or loans to an undergraduate student for educational purposes made or insured under any program administered by the Secretary, U.S. Department of Education; or
(b) Educational expenses as follows:
(i) The portion of educational grants, loans, scholarships, and fellowships that is designated and used solely for undergraduate and graduate educational pursuits such as tuitions, books, mandatory fees, transportation to and from educational institutions, and the cost of child care while in attendance; and
(ii) These expenses may be allowed to the extent that there are insufficient funds from those grants and loans specified under §G(10)(a) to cover these expenses;
(11) Cash assistance, including public assistance grants and SSI benefits, except as specified in COMAR 10.09.24.06B(3)(a)(ii) and C(4)(a)(ii); and
(12) Sick pay which does not count as earnings for deduction purposes under Title II of the Social Security Act.
H. Excludable Income. Income from the following sources shall be excluded in determining countable gross income:
(1) The value of the coupon allotment under the Supplemental Nutrition Assistance Program (SNAP);
(2) Payment received under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, 42 U.S.C. §4601 et seq., excluding compensation received for the fair market value of the acquired real property;
(3) Grants or loans to an undergraduate student for educational purposes made or insured under any program administered by the Secretary, U.S. Department of Education;
(4) Work-study earnings, work-study stipends, and reimbursement for out-of-pocket expenses of a student;
(5) Benefits received under Title III C Nutrition Program for the Elderly of the Older Americans Act of 1965, as amended;
(6) Stipends, compensation, or expenses received by volunteers from a program existing or to be set up under the “Domestic Volunteer Service Act of 1973” sponsored by ACTION, such as but not limited to:
(a) PLS (Demonstration Project Program for Local Services);
(b) VISTA (Volunteers in Service to America);
(c) UYA (University Year for Action);
(d) RSVP (Retired Senior Volunteer Program);
(e) Foster Grandparents;
(f) Older American Community Service Program;
(g) SCORE (Service Corps of Retired Executives); and
(h) ACE (Action Corps of Executives);
(7) The value of supplemental food assistance received under the Child Nutrition Act of 1966, as amended, and the special food service program for children under the National School Lunch Act, as amended;
(8) The value of livestock and home produce used for own consumption;
(9) Educational expenses as follows:
(a) The portion of educational grants, loans, scholarships, and fellowships that is designated and used solely for undergraduate and graduate educational pursuits such as tuitions, books, mandatory fees, transportation to and from educational institutions, and the cost of child care while in attendance; and
(b) These expenses may be allowed to the extent that there are insufficient funds from those grants and loans specified under §H(3) and (4) of this regulation to cover these expenses;
(10) Payments received from providing foster care or subsidized adoption services to a child placed in the home by a public or private nonprofit child placement or child care agency;
(11) Assistance provided in cash or in-kind under the Emergency Energy Conservation Services Program, including plans for crisis intervention to prevent fuel cut-offs, and assistance provided under the Low-Income Home Energy Assistance Act;
(12) The value of rent subsidies or other assistance received by a person for his dwelling unit under:
(a) The U.S. Housing Act of 1937, 42 U.S.C. §§1400 et seq.;
(b) The National Housing Act, 12 U.S.C. §§1701 et seq.;
(c) Section 101 of the Housing and Urban Development Act of 1965, 42 U.S.C. §§1400 et seq.; or
(d) Title V of the Housing Act of 1949, 12 U.S.C. §§1601 et seq. and 42 U.S.C. §§1400 et seq.;
(13) Earnings of a person younger than 21 years old as follows:
(a) The earned income of each person younger than 18 years old;
(b) The earned income of each person younger than 21 years old shall be disregarded if the person is a full-time student or a part-time student who is not employed full-time; and
(c) A student is one who is attending a school, college, or university or a course of vocational or technical training designed to fit him or her for gainful employment and includes a participant in the Job Corps program and other training programs under Job Training Partnership Act (JTPA);
(14) The value of earned and unearned in-kind income;
(15) Infrequent or irregular earned income if:
(a) The total gross amount does not exceed $30 per quarter; and
(b) It is received less frequently than twice per quarter or cannot be reasonably anticipated;
(16) Infrequent or irregular unearned income if:
(a) The total amount does not exceed $200 per 6 months; and
(b) It is received less frequently than twice per quarter or cannot be reasonably anticipated;
(17) Third-party payments for food, clothing, shelter, or other goods and services made on behalf of a household member or other persons whose income and resources are considered in determining eligibility, provided the payment is not reimbursement for services rendered by a member of the household or other persons whose income and resources are considered;
(18) The Earned Income Tax Credit (EITC) an individual receives through the Tax Reduction Act of 1973;
(19) Assistance, including any interest earned on the assistance, received under the Disaster Relief Act of 1974 (PL 93-288) or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States;
(20) Support and maintenance (in-kind income) provided as replacement for an excluded home because of a casualty loss or a presidentially declared major disaster, such as:
(a) If an excluded home is damaged or destroyed, and temporary housing is furnished to a person who owned an excluded home, the temporary housing is in-kind support and maintenance intended to replace the home pending repair or replacement of the excluded home; or
(b) If an excluded home is damaged or destroyed as a result of a Presidentially declared major disaster, the value of support and maintenance (in cash or in-kind) received by a person, or couple if:
(i) The individual or couple was residing in the household as a home when a catastrophe occurred in the area in which the home was located;
(ii) The catastrophe was declared by the President to be a major disaster for purposes of the Disaster Relief Act of 1974;
(iii) The individual or couple stopped living in the home because of the catastrophe and, within 30 days after the catastrophe, began to receive the support and maintenance; and
(iv) The individual or couple received the support and maintenance while living in a residential facility, including a private home, maintained by another person;
(21) Income from the sale of a household member’s blood or plasma;
(22) Cash, including interest earned on the cash, or in-kind replacement received from any source for purposes of repairing or replacing an excluded resource that is lost, damaged, or stolen;
(23) Reparation payments made by the Federal Republic of Germany;
(24) Cash donations based on need from one or more charitable organizations;
(25) Interest income accrued to a:
(a) Bank account during the period under consideration, such as a checking, savings, or money market account;
(b) Dedicated bank or other financial institution account that is considered an excludable resource because it is unavailable, such as an escrow account for a security deposit; or
(c) Keogh account, individual retirement account (IRA), or other private retirement account that is countable as a resource;
(26) Refund of taxes on income, property, food, or other items already paid;
(27) Proceeds of a loan received by an individual as the borrower;
(28) Payments received from a trust, if the trust is countable as a resource;
(29) Interest payments received for a mortgage, promissory note, or other loan; and
(30) All income excluded by federal statute for medical assistance programs.
.07 Consideration of Family Income: Income Disregards.
A. Income Disregards. The following disregards shall be deducted, in the following order, from the countable gross income:
(1) $90 monthly for each employed member of the unit whether working full-time or part-time;
(2) A disregard of 1/2 of the gross income amount for the following types of income:
(a) Profit from self-employment income, unless an applicant or recipient can document a cost to produce in excess of the disregard of 1/2 of gross income; and
(b) Profit from rental property income and other income-producing property;
(3) A refund or advance payment of earned income tax credit; and
(4) The actual amount of child care expenses not to exceed $200 monthly per child if employed at least 100 hours per month or $100 monthly per child if employed less than 100 hours per month and paid to a person who is not a:
(a) Member of the household; and
(b) Legally responsible relative whose income and resources shall be considered;
B. Disregard of Child Support and Alimony Paid to Dependents Not Living with the Family. The actual amount of child support and alimony paid to dependents not living in the household shall be deducted from the household countable net income.
.11 Post–Eligibility Requirements.
A. (text unchanged)
B. Recipient Responsibility.
(1)—(5) (text unchanged)
(6) If the recipient refuses to cooperate, the recipient’s coverage shall end subject to the regulation governing timely and adequate notice under COMAR [10.09.24.13B] 10.01.04.
C.—D. (text unchanged)
The procedures for the Program granting a hearing to an applicant or a recipient and the status of benefits pending a hearing are set forth in COMAR 10.01.04.
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene