1. A. Definitions. In this regulation, the following terms have the meanings indicated:

   1. (1) “Dependent” means a:

      1. (a) Child of the decedent, or the decedent's descendants;
      2. (b) Sibling, including half or step, of the decedent; or
      3. (c) Parent of the decedent, or the decedent's ancestors.
   2. (2) “Discharge from a long-term care facility and return home” means the release of a person from that facility for the purpose of returning to the home for permanent residence.
   3. (3) “Equity interest in the home” means co-ownership of the home which is not the result of a transfer of the property for less than the fair market value within 2 years before institutionalization.
   4. (4) “Estate” means all real and personal property and other assets included within an individual's estate, as defined for purposes of State probate law.
   5. (5) “Group health plan” means any plan, including a self-insured plan, of or contributed to by an employer to provide health care, directly or otherwise, to the employer's employees, former employees, or their families.
   6. (6) “Incorrect payment of benefits” means payment of benefits to which a recipient is not entitled.
   7. (7) “Lawfully residing in the home” means residing in the home with the permission of the owner or, if under guardianship, the owner's legal guardian.
   8. (8) “Real property” means property which is fixed or immovable, such as land or a building.
   9. (9) “Residing in the home on a continuous basis” means using the home as the principal place of residence.

   10. (10) “Substantial hardship” means the Department's estate claim will result in the sale or transfer of the real property owned by the decedent and that the sale or transfer will result in the removal from the property of a dependent who:

       1. (a) Resided in the property on the date of the decedent's death;
       2. (b) Has resided in the property continuously for a period beginning at least 2 years before the decedent's death; and
       3. (c) Cannot provide an alternate residence.

2. A-1. The Department shall make a claim against income or resources, or both, of a recipient for benefits correctly paid, or to be paid, under the following circumstances:

   1. (1) Under a court order;
   2. (2) In any situation in which a recipient has a cause of action against any person for medical expenses arising from that cause of action; or
   3. (3) As a result of payment by the Department for services for which health care coverage was available to a recipient.

3. A-2. Liens.

   1. (1) Incorrect Payments. Following a court judgment which has determined that benefits were incorrectly paid for a person, the Department shall impose a lien against the person's property, both personal and real, before the person's death, on account of Medical Assistance claims paid or to be paid on the person's behalf.

   2. (2) Correct Payments. Except as provided under §A-2(3) of this regulation, the Department shall impose a lien against the real property of a person, before the person's death, on account of Medical Assistance claims paid or to be paid on that person's behalf under the following circumstances:

      1. (a) The person owns real property, is a patient in a long-term care facility, and is required, as a condition of receiving Medical Assistance services, to spend for costs of medical care all but a minimal amount of his income required for personal needs; and
      2. (b) The Department has determined, after notice and opportunity for a hearing, that there is no reasonable expectation that the person can be discharged from the long-term care facility and return home.

   3. (3) Restrictions on Placing a Lien. The Department may not impose a lien on the home of an institutionalized individual under §A-2(2) of this regulation if any of the following individuals lawfully reside in the home. The institutionalized individual's:

      1. (a) Spouse;
      2. (b) Child as defined in Regulation .02B of this chapter;
      3. (c) Son or daughter who is blind or disabled as defined in Regulation .05D and E of this chapter; or
      4. (d) Sibling, who has an equity interest in the home and who was residing in the home for a period of at least 1 year immediately before the date of the institutionalized person's admission to a long-term care facility.
   4. (4) Termination of a Lien. Any lien imposed on a person's real property under §A-2(2) of this regulation will dissolve if the person is discharged from a long-term care facility and returns to the home.

   5. (5) Delay in the Imposition of a Lien.

      1. (a) When the imposition of a lien against a person's property is delayed because of the person's mental incompetence, eligibility may be granted pending the appointment of a legal representative for the person.
      2. (b) The effective date of the lien shall be the date eligibility was granted.

4. A-3. Adjustments and Recoveries.

   1. (1) The Department shall seek recovery of Medical Assistance benefits correctly paid:

      1. (a) From the estate of any individual who was 55 years old or older when the individual received Medical Assistance benefits; and
      2. (b) From the estate or upon sale of the property on which a lien was imposed and which was owned by an individual described under §A-2(2) of this regulation.

   2. (2) The Department shall seek recovery under §A-3(1) of this regulation of Medical Assistance benefits correctly paid only:

      1. (a) After the death of the person's surviving spouse;
      2. (b) When the individual has no surviving child as defined in Regulation .02B of this chapter;
      3. (c) When the person has no surviving son or daughter who is blind or disabled as defined in Regulation .05D and E of this chapter; and

      4. (d) In the case of liens imposed on a person's home under §A-2(2) of this regulation, when there is no:

         1. (i) Sibling of the person lawfully residing in the home, who has resided there for a period of at least 1 year immediately before the date of the person's admission to a long-term care facility and who has lawfully resided there on a continuous basis since that time, or
         2. (ii) Son or daughter of the person lawfully residing in the home, who has resided there for a period of at least 2 years immediately before the date of the person's admission to a long-term care facility, who has lawfully resided there on a continuous basis since that time, and who can establish to the Department's satisfaction that he or she provided the care that permitted the person to reside in the home rather than in the facility.
   3. (3) The Department may not seek recovery from the estate of a deceased individual under §A-3(1) and (2) of this regulation if, in the Department's judgment, substantial hardship exists.
   4. (4) The Department may not seek recovery from the estate of a deceased individual for Medical Assistance payments of Medicare premiums, copayments, or deductibles.
   5. (5) The Department may not seek recovery from the estate of a deceased individual to the extent of the value of LTC partnership policy benefits furnished to the individual up to the time of death.
5. B. The Department shall accept reimbursement when voluntarily offered by a current or former recipient or someone acting on his behalf.
6. C. Repealed.

7. D. Extended Benefits Pending a Hearing Decision.

   1. (1) The Department or its designee shall consider reimbursement in all cases in which:

      1. (a) A recipient received extended benefits pending a hearing and decision by an administrative law judge at the Office of Administration Hearings; and
      2. (b) The administrative law judge affirmed the original decision of the Department or its designee.
   2. (2) The Department or its designee shall institute procedures to recover the cost of any expenditures made on behalf of a recipient in cases identified in §D(1) of this regulation. This provision may not apply to a individual who requested a hearing and extended benefits resulting from a bona fide belief that the Department or its designee has taken an adverse action erroneously.
8. E. The Department shall investigate and take appropriate action in all cases in which eligibility has been incorrectly established as a result of the action or inaction of a recipient, representative, or person acting responsibly for the recipient.

9. F. Assignment of Benefits, Release of Information, and Requirement of Cooperation by Recipient in Recovery Procedures.

   1. (1) A recipient of Medical Assistance is deemed to have created an authorization for the release to the Department of all data, records, and information by insurance companies, nonprofit health service plans, providers of medical care, employers, unions, governmental agencies, and any other agencies, organizations, or individuals necessary for the Department's pursuit of third-party reimbursement. The authorization extends to all information relevant to third-party reimbursement or third-party health care coverage.
   2. (2) The local department of social services shall take reasonable measures to identify and report to the Department on a form designated by the Department all possible third-party benefits available to persons determined eligible for Medical Assistance.
   3. (3) The Department shall collect available benefits from third parties determined liable to pay for services received under Medical Assistance.

   4. (4) An individual who receives medical services that was or will be paid for by Medical Assistance is deemed to have made assignment to the Department of:

      1. (a) His own rights to any medical care support available under an order of a court or an administrative agency, and any third-party payments for medical care; and
      2. (b) The rights of any other individual eligible under the plan, for whom he can legally make an assignment.
   5. (5) Assignment of rights to benefits does not include assignment of rights to Medicare benefits.

   6. (6) An applicant or recipient of Medical Assistance shall cooperate in:

      1. (a) Establishing paternity for a child born out of wedlock for whom he can legally assign rights; and
      2. (b) Obtaining medical care support and payments for himself and any other individual for whom he can legally assign rights.

   7. (7) Waiver.

      1. (a) The Department shall waive the requirements in §G(6) of this regulation if the Department, through the local department of social services, determines that the individual has good cause for refusing to cooperate.

      2. (b) With respect to establishing support paternity of a child born out of wedlock or obtaining medical care and payments for a child for whom the individual can legally assign rights, the Department, through the local department of social services, shall find that cooperation is against the best interests of the child if it is reasonably anticipated that cooperation will result in:

         1. (i) Physical harm to the child for whom support is to be sought;
         2. (ii) Emotional harm to the child for whom support is to be sought;
         3. (iii) Physical harm to the parent or caretaker relative with whom the child is living which reduces the person's capacity to care for the child adequately; or
         4. (iv) Emotional harm to the parent or caretaker relative with whom the child is living, of such nature or degree that it reduces the person's capacity to care for the child adequately.

      3. (c) If at least one of the following circumstances exists, and the Department, through the local department of social services, believes that because of the existence of that circumstance, in the particular case, proceeding to establish paternity or secure support would be detrimental to the child for whom support would be sought, the Department, through the local department of social services, shall find that cooperation is against the best interests of the child:

         1. (i) The child for whom support is sought was conceived as a result of incest or forcible rape;
         2. (ii) Legal proceedings for the adoption of the child are pending before a court of competent jurisdiction; or
         3. (iii) The applicant or recipient is currently being assisted by a public or licensed private social agency to resolve the issue of whether to keep the child or relinquish him for adoption, and the discussions have not gone on for more than 3 months.
      4. (d) If the Department of Human Services has made a finding that good cause for refusal to cooperate does or does not exist, the Department shall adopt that finding as its own for this purpose.
      5. (e) With respect to obtaining medical care support and payments for an individual in any case not covered by §G(7)(b) or (c) of this regulation, the Department, through the local department of social services, shall find that cooperation is against the best interests of the individual or other person to whom Medical Assistance is being furnished, if it is reasonably anticipated that cooperation will result in reprisal against, and cause physical or emotional harm to, the individual or other person.

   8. (8) The Department or its designee shall:

      1. (a) Deny or terminate eligibility for any applicant or recipient who refuses to cooperate as required under §G(6) of this regulation unless cooperation has been waived;

      2. (b) Provide Medical Assistance to any individual who:

         1. (i) Cannot legally assign his own rights, and
         2. (ii) Would otherwise be legally eligible for Medical Assistance but for the refusal by a person legally able to assign his rights or to cooperate as required by this regulation.
   9. (9) The assignment created by this regulation shall be effective as long as the recipient is eligible for Medical Assistance and remains effective for all services paid by the Program during this period of eligibility, and for those services which were erroneously provided to ineligible persons and paid for by the Program.

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)