1. A. Non-Financial and Resource Eligibility for the Medicare Savings Programs. In order to be eligible for the Medicare savings program under §§E—H of this regulation, an individual:

   1. (1) May not be enrolled in Medical Assistance or the Maryland Children's Health Program under this chapter or under COMAR 10.09.11;
   2. (2) Shall be entitled to hospital insurance benefits under Medicare Part A, or medical insurance benefits under Medicare Part B, or both, with or without payment of premiums;
   3. (3) Shall meet the non-financial eligibility requirements for Medical Assistance under this chapter; and

   4. (4) Shall be part of an assistance unit whose countable resources do not exceed:

      1. (a) For individuals eligible under §§E—G of this regulation, 3 times the maximum amount allowed by the Supplemental Security Income program, as adjusted from time to time by the Social Security Administration, for the number of persons in the assistance unit; or
      2. (b) For individuals eligible under §H of this regulation, 2 times the maximum amount allowed by the Supplemental Security Income program for the number of persons in the assistance unit.

2. B. Medicare Savings Program.

   1. (1) The Medical Assistance benefits for individuals eligible under §§E—H of this regulation are limited to the Medicare savings program benefits described under those sections of this regulation.
   2. (2) Current eligibility for Medicare savings program benefits shall continue until the recipient is determined ineligible.

3. C. Application and Redetermination Procedures.

   1. (1) The requirements under this chapter for applications and redeterminations shall apply for §§E—H of this regulation except as described in §C(2)—(5) of this regulation.

   2. (2) Applications and re-applications for eligibility under this regulation shall be filed at:

      1. (a) The Department or its designee;
      2. (b) The Maryland Department of Aging;
      3. (c) An area agency on aging; or
      4. (d) A surrogate organization approved by the Department.
   3. (3) The initial application may be made at a face-to-face interview or by mail with an agency defined under §C(2) of this regulation, as authorized by the Department.

   4. (4) Redeterminations.

      1. (a) Applications for redetermination of eligibility shall be mailed by the Department or its designee to the recipient or representative for completion at least once every 12 months.

      2. (b) The recipient or representative shall return the application to the Department or its designee and indicate:

         1. (i) Any changes that have occurred since the prior redetermination of eligibility, such as a new address; or
         2. (ii) That there is no new information to report, by marking “NO CHANGE” on the front of the application.
      3. (c) Upon notice of a change in circumstances, a redetermination of eligibility under §§E—H of this regulation shall be completed by the Department or its designee.
   5. (5) Eligibility under §§E—H of this regulation shall be initially determined and redetermined by the Department or its designee.

4. D. Income and Resource Consideration.

   1. (1) Assistance Unit. When financial eligibility is determined for an applicant or recipient under §§E—H of this regulation, the countable income and resources of the following individuals shall be considered and measured against the income and resource standards specified in this regulation for the number of persons in the assistance unit:

      1. (a) The applicant or recipient; and
      2. (b) The applicant's or recipient's spouse when living in the same household, whether or not the spouse is eligible for the same benefits under this regulation.

   2. (2) Determining Countable Income and Resources.

      1. (a) Income and resources shall be evaluated for §§E—H of this regulation in accordance with the provisions for aged, blind, or disabled adults residing in the community, as described under this chapter, in addition to the following resource exclusions:

         1. (i) The cash value of life insurance; and
         2. (ii) An amount up to $1,500 for burial or funeral funds, unless included in the annual resource limit for the full Medicare Part D Low-Income Subsidy (LIS) program.
      2. (b) Cost of Living Disregard. The annual cost of living increase in Social Security income under Title II of the Social Security Act shall be disregarded through the month following the month in which the annual federal poverty level update is published in the Federal Register.

5. E. Qualified Medicare Beneficiary (QMB).

   1. (1) An individual is eligible for QMB benefits if:

      1. (a) All of the requirements of §A of this regulation are satisfied; and
      2. (b) The assistance unit's net countable income does not exceed 100 percent of the federal poverty level for the number of persons in the assistance unit.
   2. (2) Current eligibility for QMB benefits shall be effective the first day of the month after the month in which QMB eligibility is determined.
   3. (3) Retroactive coverage before the month of application is not available for QMB benefits.

   4. (4) Medicare savings program benefits for a QMB-eligible person shall include coverage of the following expenses by the Medical Assistance program:

      1. (a) Monthly premium for Medicare Part B;
      2. (b) Monthly premium for Medicare Part A, if the individual, due to insufficient working quarters, is not entitled to free coverage by the Social Security Administration; and
      3. (c) Medicare Part A and Part B deductibles and co-insurance for services covered by Medicare, regardless of whether the services are covered under the Medical Assistance State Plan.

6. F. Specified Low-Income Medicare Beneficiary (SLMB).

   1. (1) An individual is eligible for SLMB benefits if:

      1. (a) All of the requirements of §A of this regulation are satisfied; and
      2. (b) The assistance unit's net countable income is greater than 100 percent but less than 120 percent of the federal poverty level for the number of persons in the assistance unit.
   2. (2) Current eligibility for SLMB benefits shall be effective the first day of the month of application.
   3. (3) An individual may qualify for retroactive SLMB benefits for up to 3 calendar months before the month of application, if the person meets the SLMB eligibility criteria for each of those prior months.
   4. (4) Medicare savings program benefits for a SLMB-eligible person shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part B.

7. G. Qualifying Individual QI.

   1. (1) An individual is eligible for QI benefits if:

      1. (a) All of the requirements of §A of this regulation are satisfied;
      2. (b) The assistance unit's net countable income is at least 120 percent but less than 135 percent of the federal poverty level for the number of persons in the assistance unit; and
      3. (c) The individual is not otherwise eligible for Medical Assistance under this chapter.
   2. (2) Current eligibility for QI benefits shall be effective the first day of the month of application.

   3. (3) An applicant may qualify for up to 3 calendar months before the month of application for retroactive QI benefits if:

      1. (a) The individual meets the QI eligibility criteria for each of those prior months under consideration; and
      2. (b) Each retroactive month is no earlier than January 1 of the calendar year in which the individual applied for QI benefits.
   4. (4) Medicare savings program benefits for a QI eligible individual shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part B.

8. H. Qualified Disabled and Working Individual (QDWI).

   1. (1) An individual is eligible for QDWI benefits if:

      1. (a) The individual:

         1. (i) Meets all of the requirements under §A of this regulation;
         2. (ii) Is younger than 65 years old;
         3. (iii) Was determined disabled by the Social Security Administration (SSA) but lost Social Security benefits solely due to employment;
         4. (iv) Is entitled to enroll in Medicare Part A under §1818A of the Social Security Act; and
         5. (v) Is not otherwise eligible for Medical Assistance under this chapter; and
      2. (b) The assistance unit's net countable income does not exceed 200 percent of the federal poverty level for the number of persons in the assistance unit.

   2. (2) SSA shall establish the effective date of QDWI coverage based on the:

      1. (a) Individual's date of application for QDWI benefits;
      2. (b) Date of potential QDWI eligibility, as specified in a letter from SSA to the individual; and
      3. (c) Dates of the next Medicare open enrollment period.
   3. (3) Medicare savings program benefits for a QDWI-eligible person shall consist of coverage by the Medical Assistance program of the monthly premium for Medicare Part A.
   4. (4) Only the individual who is identified by SSA as potentially eligible may be eligible for QDWI benefits in a QDWI assistance unit.
   5. (5) Retroactive coverage before the month of application is not available for QDWI benefits.
   6. (6) If an individual delays in applying for QDWI benefits after notification of potential QDWI eligibility by SSA, the individual may be required by SSA to pay a premium surcharge for Medicare Part A, unless the individual is covered by an employer-based group health plan.

   7. (7) Eligibility for QDWI benefits shall continue until the earliest of the following dates:

      1. (a) The end of the month after the Department:

         1. (i) Determines that the individual is no longer eligible for QDWI benefits in accordance with this regulation; and
         2. (ii) Sends the recipient a notice of termination at least 10 days before the effective date;

      2. (b) The end of the month before the month that the individual becomes:

         1. (i) Re-entitled to premium-free Medicare Part A; or
         2. (ii) 65 years old;
      3. (c) The date of death; or

      4. (d) The end of the month following the month that the individual:

         1. (i) Is notified by SSA that the individual no longer has a disabling impairment; or
         2. (ii) Files a request for termination of QDWI enrollment.

Authority: Estates and Trusts Article, §14.5-1002; Health-General Article, §§2-104(b), 2-105(b), 15-103, 15-105, 15-121, and 15-401—15-407;
Annotated Code of Maryland; Annotated Code of Maryland

Effective date: May 1, 1983 (10:6 Md. R. 558)

Regulations .01, .02, and .06 amended as an emergency provision effective December 1, 1992 (19:25 Md. R. 2198); amended permanently effective June 1, 1993 (20:10 Md. R. 852)

Regulation .02B amended effective May 1, 1986 (13:8 Md. R. 898); August 8, 1988 (15:16 Md. R. 1914); May 1, 1989 (16:8 Md. R. 910); December 1, 1992 (19:23 Md. R. 2041); March 24, 1997 (24:6 Md. R. 485); June 2, 1997 (24:11 Md. R. 793)

Regulations .02B; .03C; .04; .07B, I, J, L; .08G, H; .09B; .10C, E, F; .11D, E; .12B; .14A; and .15D amended as an emergency provision effective May 1, 1983 (10:11 Md. R. 962); adopted permanently effective September 1, 1983 (10:17 Md. R. 1521)

Regulations .02B and .05A amended as an emergency provision effective October 3, 1997 (24:22 Md. R. 1550); amended permanently effective January 12, 1998 (25:1 Md. R. 16)

Regulation .02B amended effective November 24, 2005 (32:23 Md. R. 1826); December 31, 2007 (34:26 Md. R. 2262); October 14, 2013 (40:20 Md. R. 1652)

Regulation .03 amended as an emergency provision effective May 4, 1990 (17:11 Md. R. 1339); amended permanently effective August 13, 1990 (17:15 Md. R. 1858)

Regulation .03-1 adopted effective April 1, 2002 (29:6 Md. R. 567)

Regulation .03-1B amended effective June 9, 2003 (30:11 Md. R. 735)

Regulation .03-2 adopted effective April 1, 2002 (29:6 Md. R. 567)

Regulation .03-2F amended effective January 6, 2003 (29:26 Md. R. 2027)

Regulation .03-3 adopted effective June 7, 2004 (31:11 Md. R. 856)

Regulation .03-3 amended effective December 27, 2010 (37:26 Md. R. 1787)

Regulation .03-4 adopted effective June 7, 2004 (31:11 Md. R. 856)

Regulation .03-4A amended effective December 27, 2010 (37:26 Md. R. 1787)

Regulation .04 amended effective May 1, 1986 (13:8 Md. R. 898); May 1, 1989 (16:8 Md. R. 910); June 30, 2008 (35:13 Md. R. 1179); April 19, 2010 (37:8 Md. R. 615)

Regulation .04J amended as an emergency provision effective October 1, 2001 (28:24 Md. R. 2125); emergency status expired March 29, 2002

Regulations .04J, .07B, G—N, and .08B, G—L amended as an emergency provision effective March 1, 1984 (11:5 Md. R. 449); emergency status extended at 11:14 Md. R. 1247 (July 6, 1984)

Regulations .04J, .07B, G—N, and .08B, G—L amended effective October 15, 1984 (11:20 Md. R. 1742)

Regulation .04J amended effective September 20, 2010 (37:19 Md. R. 1284)

Regulation .05 repealed and new Regulation .05 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulation .05A amended effective April 14, 2003 (30:7 Md. R. 487)

Regulation .05C amended effective April 19, 2010 (37:8 Md. R. 614)

Regulation .05D amended effective March 11, 1985 (12:5 Md. R. 482); April 19, 2010 (37:8 Md. R. 614)

Regulation .05E amended effective March 11, 1985 (12:5 Md. R. 482); March 24, 1997 (24:6 Md. R. 485)

Regulation .05H amended effective June 2, 1997 (24:11 Md. R. 793)

Regulation .05-1 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulation .05-1B amended effective April 19, 2010 (37:8 Md. R. 614)

Regulation .05-2 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulation .05-2 amended effective April 19, 2010 (37:8 Md. R. 614)

Regulation .05-3 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulation .05-3K amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .05-4 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulation .05-5 adopted effective September 24, 2007 (34:20 Md. R. 1737)

Regulations .06, .07M, .08, .10, .11, .12C, and .15 amended effective May 1, 1986 (13:8 Md. R. 898)

Regulation .07 amended effective April 19, 2010 (37:8 Md. R. 615)

Regulation .07D, M amended effective June 30, 2008 (35:13 Md. R. 1179)

Regulation .07J amended effective October 8, 1991 (18:18 Md. R. 2005)

Regulation .07M amended as an emergency provision effective September 30, 1989 (16:21 Md. R. 2258); adopted permanently effective February 1, 1990 (17:1 Md. R. 69)

Regulation .07N amended as an emergency provision effective July 1, 1984 (11:13 Md. R. 1173); amended permanently effective September 10, 1984 (11:18 Md. R. 1584)

Regulation .07N amended as an emergency provision effective July 1, 1986 (13:14 Md. R. 1628); adopted permanently effective September 8, 1986 (13:18 Md. R. 2020)

Regulation .07N amended effective August 10, 1987 (14:16 Md. R. 1774); July 1, 1988 (15:13 Md. R. 1554)

Regulations .07N and .10E amended as an emergency provision effective July 1, 1985 (12:13 Md. R. 1274); adopted permanently effective November 4, 1985 (12:22 Md. R. 2104)

Regulation .07N amended as an emergency provision effective July 1, 1989 (16:14 Md. R. 1565); amended permanently effective October 30, 1989 (16:21 Md. R. 2261)

Regulation .07N amended as an emergency provision effective July 1, 1990 (17:15 Md. R. 1851); adopted permanently effective November 1, 1990 (17:20 Md. R. 2427)

Regulation .07N amended as an emergency provision effective December 10, 1991 (18:26 Md. R. 2827); amended permanently effective April 1, 1992 (19:5 Md. R. 577)

Regulation .07N amended as an emergency provision effective November 25, 1992 (19:25 Md. R. 2199); amended permanently effective March 29, 1993 (20:4 Md. R. 371)

Regulation .07N amended as an emergency provision effective July 22, 1993 (20:16 Md. R. 1275); amended permanently effective November 1, 1993 (20:21 Md. R. 1654)

Regulation .07N amended as an emergency provision effective August 10, 1994 (21:18 Md. R. 1506); amended permanently effective November 7, 1994 (21:22 Md. R. 1876)

Regulation .08 amended as an emergency provision effective May 15, 1992 (19:11 Md. R. 1012); emergency status extended at 19:19 Md. R. 1702; amended permanently effective September 14, 1992 (19:18 Md. R. 1656)

Regulation .08 amended as an emergency provision effective April 8, 1994 (21:9 Md. R. 744); emergency provision rescinded retroactively to April 8, 1994 (21:14 Md. R. 1226)

Regulation .08 amended effective June 30, 2008 (35:13 Md. R. 1179)

Regulation .08B amended effective September 1, 1993 (20:17 Md. R. 1346); January 12, 1987 (14:1 Md. R. 31); August 22, 1988 (15:17 Md. R. 2049); July 3, 1995 (22:13 Md. R. 967)

Regulation .08G, H amended effective June 2, 1997 (24:11 Md. R. 793)

Regulation .08G, H, and H-1 amended effective January 12, 1987 (14:1 Md. R. 31)

Regulation .08G, H, and I amended effective August 22, 1988 (15:17 Md. R. 2049)

Regulation .08G, H, and K amended effective July 3, 1995 (22:13 Md. R. 967)

Regulation .08G, I amended as an emergency provision effective October 1, 2001 (29:4 Md. R. 413); emergency status extended at 29:8 Md. R. 696; amended permanently effective April 29, 2002 (29:8 Md. R. 700)

Regulation .08J-1 adopted effective September 1, 1993 (20:17 Md. R. 1346)

Regulation .08J-1 amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .08L amended effective June 29, 1987 (14:13 Md. R. 1474); January 25, 1988 (15:2 Md. R. 121)

Regulation .08L amended as an emergency provision effective July 1, 1989 (16:14 Md. R. 1565); amended permanently effective October 30, 1989 (16:21 Md. R. 2261)

Regulation .08M amended effective June 29, 1987 (14:13 Md. R. 1474)

Regulations .08 and .10 amended, and new Regulation .10-1 adopted as an emergency provision effective September 30, 1989 (16:21 Md. R. 2259); adopted permanently effective February 1, 1990 (17:1 Md. R. 69) (Regulation .10-1 originally adopted as Regulation .11)

Regulations .08-1 and .08-2 adopted effective July 3, 1995 (22:13 Md. R. 967)

Regulation .08-2 amended effective April 29, 2002 (29:8 Md. R. 700)

Regulation .08-3 adopted effective November 24, 2005 (32:23 Md. R. 1826)

Regulation .09B, C amended effective September 20, 2010 (37:19 Md. R. 1284)

Regulation .10 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .10C and D amended as an emergency provision effective July 1, 1986 (13:14 Md. R. 1628); adopted permanently effective September 8, 1986 (13:18 Md. R. 2020)

Regulation .10C, D amended effective July 1, 1987 (14:13 Md. R. 1474)

Regulation .10C, D amended as an emergency provision effective March 13, 2009 (36:8 Md. R. 591); emergency status expired July 30, 2009

Regulation .10C, D amended effective July 27, 2009 (36:15 Md. R. 1165); September 20, 2010 (37:19 Md. R. 1284); October 14, 2013 (40:20 Md. R. 1652)

Regulation .10E amended as an emergency provision effective May 1, 1983 (10:7 Md. R. 632); adopted permanently effective May 9, 1983 (10:9 Md. R. 791)

Regulation .10-1 amended as an emergency provision effective July 1, 1992 (19:15 Md. R. 1382); amended permanently effective November 1, 1992 (19:21 Md. R. 1891)

Regulation .10-1C amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .10-1C, E amended and G adopted effective November 12, 1990 (17:21 Md. R. 2529)

Regulation .10-1D amended effective October 8, 1991 (18:18 Md. R. 2005)

Regulation .11C amended effective September 10, 1994 (11:8 Md. R. 1584) June 2, 1997 (24:11 Md. R. 793)

Regulation .11E amended effective September 10, 1984 (11:18 Md. R. 1584)

Regulation .12B amended effective August 8, 1988 (15:16 Md. R. 1914)

Regulation .12C amended effective September 10, 1984 (11:18 Md. R. 1584)

Regulation .13 repealed and new Regulation .13 adopted effective March 19, 2012 (39:5 Md. R. 382)

Regulation .13C amended effective August 8, 1988 (15:16 Md. R. 1914)

Regulation .14 amended effective August 8, 1988 (15:16 Md. R. 1914)

Regulation .14 amended and recodified to Regulations .14 and .14-1 effective December 1, 1992 (19:23 Md. R. 2041)

Regulation .14B amended as an emergency provision effective May 1, 1984 (11:10 Md. R. 858); emergency status expired August 28, 1984

Regulation .14B amended effective August 29, 1984 (11:17 Md. R. 1492)

Regulation .15 amended effective August 8, 1988 (15:16 Md. R. 1914); July 3, 1995 (22:13 Md. R. 967)

Regulation .15 amended as an emergency provision effective October 13, 1992 (19:22 Md. R. 1979); amended permanently effective February 1, 1993 (20:2 Md. R. 113)

Regulation .15 amended as an emergency provision effective April 8, 1994 (21:9 Md. R. 744); emergency provision rescinded retroactively to April 8, 1994 (21:14 Md. R. 1226)

Regulation .15A-3 amended as an emergency provision effective November 12, 2002 (29:24 Md. R. 1915); amended permanently effective February 17, 2003 (30:3 Md. R. 179)

Regulation .17 adopted effective December 31, 2007 (34:26 Md. R. 2262)

Chapter revised effective January 6, 2014 (40:26 Md. R. 2162)

Regulation .02B amended effective September 11, 2017 (44:18 Md. R. 866); May 20, 2019 (46:10 Md. R. 486); April 4, 2022 (49:7 Md. R. 465); April 13, 2026 (53:7 Md. R. 328)

Regulation .03A amended effective August 5, 2024 (51:15 Md. R. 706)

Regulation .03A, C amended effective May 20, 2019 (46:10 Md. R. 486)

Regulation .03A, F amended effective April 4, 2022 (49:7 Md. R. 465)

Regulation .03F adopted effective May 20, 2019 (46:10 Md. R. 486)

Regulation .03-1 amended effective July 21, 2025 (52:14 Md. R. 712)

Regulation .04F amended effective March 28, 2016 (43:6 Md. R. 406)

Regulation .04-1D amended effective December 31, 2018 (45:26 Md. R. 1243)

Regulation .04-1M adopted effective May 7, 2018 (45:9 Md. R. 461)

Regulation .05-4B amended effective July 4, 2016 (43:13 Md. R. 713)

Regulation .07B, F amended effective April 13, 2026 (53:7 Md. R. 328)

Regulation .08-1B amended effective February 1, 2016 (43:2 Md. R. 127)

Regulation .08-2B, C amended effective April 10, 2017 (44:7 Md. R. 355); May 20, 2019 (46:10 Md. R. 486)

Regulation .08-2C amended effective August 29, 2016 (43:17 Md. R. 954)

Regulation .08-4 adopted effective April 13, 2015 (42:7 Md. R. 568)

Regulation .10C, D amended effective September 11, 2017 (44:18 Md. R. 866)

Regulation .10-2 adopted effective April 13, 2015 (42:7 Md. R. 568)

Regulation .12E adopted effective April 13, 2026 (53:7 Md. R. 328)

Regulation .15A-3 amended effective April 13, 2015 (42:7 Md. R. 568)