1. A. The Department or its designee shall determine eligibility for children.

2. B. The Department or its designee shall give oral, written, or electronic information about MCHP Premium such as:

   1. (1) Requirements for eligibility;
   2. (2) Available services;
   3. (3) An individual's rights and responsibilities;
   4. (4) Information in plain English, supported by translation services; and
   5. (5) Information accessible to disabled individuals requesting an application.
3. C. An individual requesting health coverage from an Insurance Affordability Program shall be given an opportunity to apply.
4. D. The Department or its designee shall make the application available to the individual without delay, by telephone, mail, in-person, internet, other available electronic means, and in a manner accessible to disabled individuals requesting an application.

5. E. Applicant Temporarily Absent from the State.

   1. (1) If an applicant is temporarily absent from the State, the applicant or the applicant's representative may apply for assistance by telephone, mail, in person, internet, and other electronic means to the Department or its designee in any jurisdiction.

   2. (2) To establish eligibility for MCHP Premium for an applicant temporarily absent from the State, the applicant or the applicant's representative shall:

      1. (a) Affirm that:

         1. (i) The applicant intends to return to the State; or
         2. (ii) The applicant's parent or guardian intends to return the applicant to the State;
      2. (b) Demonstrate the applicant's continued residency in the State; and
      3. (c) Meet other technical and financial requirements.

6. F. Application Filing and Signature Requirements.

   1. (1) An individual who wishes to apply for health coverage under Insurance Affordability Program shall submit a written, telephonic, or electronic application, signed under penalty of perjury to the Department or its designee in any jurisdiction. An applicant is responsible for completing the application but may be assisted in the completion by an individual of the applicant's choice.
   2. (2) A signed application is required for all applicants who request assistance. If, after the completion of an eligibility determination, assistance is requested for additional family members, a signed application is required for those persons.
   3. (3) The date of application shall be the date on which a written, telephonic, or electronic signed application is received by the Department or its designee. The application may be mailed or submitted electronically to the Department or its designee.

   4. (4) The following individuals shall complete and sign a written or electronic application:

      1. (a) An applicant;
      2. (b) An applicant’s parents living with the child applicant; or
      3. (c) If the applicant does not live with a parent, an authorized representative who is 21 years old or older shall complete and sign the application form.
7. G. An applicant who has filed a written, telephonic, or electronic application may voluntarily withdraw that application, but the application remains the property of the Department or its designee and the withdrawal does not affect the periods under consideration specified under §H of this regulation.
8. H. Period Under Consideration. The Department or its designee shall establish a current period under consideration based on the date of application established under §F(3) of this regulation, for a 12-month period beginning with the month of application.

9. I. Processing Applications — Time Limitations.

   1. (1) When a written, telephonic or electronic application is filed, a decision shall be made promptly, but not later than 60 calendar days from the application date.
   2. (2) The time period specified in §I(1) of this regulation covers the period from the application date to the date the Department or its designee sends a written or electronic notice of its decision to the applicant or the applicant's representative.
   3. (3) The Department or its designee shall inform the applicant by written or electronic notice of the missing information needed to determine eligibility, and the applicable time limit.
   4. (4) When an applicant fails to complete the application or to provide the required information needed to determine eligibility within the 60 calendar day limit provided under §I(1) of this regulation, the applicant shall be determined ineligible.
   5. (5) The Department or its designee shall provide notice of delay for extenuating circumstances within 60 calendar days of the delay, stating the reason for the delay and the anticipated date of decision.
   6. (6) If an applicant is determined ineligible for the current period under consideration due to a nonfinancial factor, the application shall be disposed of and the application date may not be retained. If the applicant reapplies, a new period under consideration shall be established based on the date the new application is filed.

10. J. Information Required.

    1. (1) All information needed to determine eligibility for the MCHP Premium shall be reported. When there is evidence of inconsistency with attested information given by the applicant and reported by the state and federal databases, the applicant shall be required to offer an explanation and appropriate verification to reconcile the inconsistency.
    2. (2) The applicant shall provide the additional information within a reasonable time limit as established by the Department.
    3. (3) If the applicant fails to provide required information within the 60 calendar days, the applicant shall be determined ineligible.

11. K. Social Security Number.

    1. (1) As a condition of eligibility, an applicant shall furnish to the Department or its designee a Social Security number for the applicant. If the applicant cannot furnish a Social Security number, the applicant shall apply for a number. Assistance may not be denied, delayed, or discontinued pending the issuance or verification of the number if the applicant complies with this subsection.

    2. (2) Eligibility may not be established until the applicant:

       1. (a) Furnishes a Social Security number; or
       2. (b) Requests the assignment of the number through the Social Security Administration.
    3. (3) Failure to provide the required Social Security number shall result in ineligibility for the applicant.
    4. (4) If an applicant lacks the resources to meet the requirements of this regulation, the Department or its designee services shall assist the applicant in obtaining the necessary documents, and any costs incurred shall be paid for out of administrative funds.
    5. (5) If the application indicates that a Social Security number was issued previously, the Department or its designee shall request validation of the number by the Social Security Administration.

12. L. Third-Party Liability.

    1. (1) An applicant shall notify the Department or its designee within 10 working days if medical treatment has been provided as a result of a motor vehicle accident or other occurrence in which a third party may be liable for the recipient's medical expenses.
    2. (2) An applicant shall cooperate with the Department or its designee in completing a form designated by the Department to report all pertinent information and in collecting available health insurance benefits and other third-party payments.

    3. (3) In accident situations, a representative shall notify the Department or its designee of the:

       1. (a) Time, date, and location of the accident;
       2. (b) Name and address of the attorney;
       3. (c) Names and addresses of all parties and witnesses to the accident; and
       4. (d) Police report number if an investigation is made.
13. M. Consent Forms. An applicant shall give consent to verify information to establish eligibility to the Department or its designee, by submitting a written, telephonic, or electronic application.

Authority: Health-General Article, §§2-104(b), 15-101(f), 15-103(a)(2), 15-301.1, and 15-302—15-304;
Insurance Article, §§15-1208, 15-1213, 15-1406, and 27-220;
Annotated Code of Maryland; Ch. 202, Acts of 2003

Effective date:

Regulations .01—.19 adopted as an emergency provision effective July 1, 2001 (28:12 Md. R. 1102); adopted permanently effective September 3, 2001 (28:17 Md. R. 1556)

Regulation .02B amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .02B amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251); amended permanently effective September 27, 2004 (31:19 Md. R. 1432)

Regulation .03 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .03 amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251); amended permanently effective September 27, 2004 (31:19 Md. R. 1432)

Regulation .04E amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .05A amended effective November 10, 2003 (30:22 Md. R. 1580); April 19, 2010 (37:8 Md. R. 614)

Regulation .05F, G amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .09 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .09 amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251); amended permanently effective September 27, 2004 (31:19 Md. R. 1432)

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

Regulation .11 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .12 amended as an emergency provision effective July 1, 2002 (29:16 Md. R. 1284); amended permanently effective October 28, 2002 (29:21 Md. R. 1645)

Regulation .12 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .13 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .13A amended as an emergency provision effective July 1, 2004 (31:16 Md. R. 1251); amended permanently effective September 27, 2004 (31:19 Md. R. 1432)

Regulation .14 amended effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .15D amended effective November 10, 2003 (30:22 Md. R. 1580)

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

Regulation .10D adopted effective April 13, 2026 (53:7 Md. R. 328)

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