1. A. Financial eligibility for waiver participants is determined according to the provisions of this regulation and applicable sections of COMAR 10.09.24 Medical Assistance Eligibility, as cited in this section.

2. B. Categorically Needy. An individual is eligible for waiver services as categorically needy if the individual is receiving Medical Assistance as:

   1. (1) A recipient of Supplemental Security Income (SSI);
   2. (2) A member of a low income family with children, as described in §1931 of the Social Security Act; or
   3. (3) A recipient eligible in another mandatory or optional categorically needy coverage group with full Medical Assistance benefits, covered in the community under the State Plan.

3. C. Optionally Categorically Needy.

   1. (1) An individual is eligible for waiver services as optionally categorically needy in accordance with 42 CFR §435.217, if the individual's countable income does not exceed 300 percent of the applicable payment rate for SSI, and the individual's countable resources do not exceed the SSI resource standard for one person.
   2. (2) For the purpose of determining financial eligibility for the optionally categorically needy, the individual is treated as an assistance unit of one person.
   3. (3) For the purpose of determining countable income for the optionally categorically needy, income is determined based on the income rules set forth in COMAR 10.09.24, which are applicable to an aged, blind, or disabled individual who is institutionalized, with the exceptions specified in §C(9) of this regulation.
   4. (4) For the purpose of determining countable resources for the optionally categorically needy, resources are determined based on the resource rules set forth in COMAR 10.09.24, which are applicable to an aged, blind, or disabled person who is institutionalized, with the exceptions specified in §C(9) of this regulation.
   5. (5) An individual is not eligible to receive waiver services if a disposal of assets or establishment of a trust or annuity results in a penalty under COMAR 10.09.24, until the penalty time expires.

   6. (6) The spousal impoverishment rules at COMAR 10.09.24.10-1 are applicable, except for the following differences in definitions:

      1. (a) “Community spouse” means an individual who:

         1. (i) Lives in the community outside a medical institution;
         2. (ii) Is not determined to meet the criteria for participation in the Waiver for Individuals with Brain Injury or any other waiver under §1915(c) of Title XIX of the Social Security Act; and
         3. (iii) Is married to an institutionalized spouse.

      2. (b) “Continuous period of institutionalization” means:

         1. (i) At least 30 consecutive days of institutional care in a nursing facility or other medical institution; or
         2. (ii) A determination that a spouse meets the criteria for participation in the waiver for individuals with brain injury or any other waiver under §1915(c) of Title XIX of the Social Security Act.

      3. (c) “Institutionalized spouse” means an individual who is married to a community spouse and who is:

         1. (i) An inpatient in a nursing facility or other medical institution with a length of stay exceeding 30 days; or
         2. (ii) Determined to meet the criteria for participation in the waiver for individuals with brain injury or any other waiver under §1915(c) of the Social Security Act.
   7. (7) Medical Assistance eligibility shall be redetermined at least every 12 months.
   8. (8) As part of the determination and redetermination of Medical Assistance eligibility as optionally categorically needy, the Department of Human Services shall determine whether the applicant or recipient is eligible as a disabled person in accordance with COMAR 10.09.24.05E, unless the applicant or recipient is aged, blind, or has been determined as disabled by the Social Security Administration.

   9. (9) All provisions of COMAR 10.09.24 which are applicable to an aged, blind, or disabled individual who is institutionalized are applicable to waiver applicants and participants who are considered as optionally categorically needy, with the following exceptions in full or in part:

      1. (a) COMAR 10.09.24.04J(1)—(3);
      2. (b) COMAR 10.09.24.04K;
      3. (c) COMAR 10.09.24.06B(2)(a)(ii);
      4. (d) COMAR 10.09.24.08G(1);
      5. (e) COMAR 10.09.24.08H;
      6. (f) COMAR 10.09.24.09;
      7. (g) COMAR 10.09.24.10;
      8. (h) COMAR 10.09.24.10-1; and
      9. (i) COMAR 10.09.24.15A-2(2).

   10. (10) Home Exclusion. The home, as defined in COMAR 10.09.24.08B, is not a countable resource under §C of this regulation if it is occupied by the waiver applicant or participant, the applicant's or participant's spouse, or any one of the following relatives who are medically or financially dependent on the applicant or participant:

       1. (a) Child;
       2. (b) Parent; or
       3. (c) Sibling.
4. D. Posteligibility Determination of Available Income for Optionally Categorically Needy. Participants in the waiver for individuals with brain injury are not required to pay towards their cost of care, and therefore they are not subject to a posteligibility determination of available income.
5. E. Medically Needy. An individual is not eligible for waiver services if the individual is receiving Medical Assistance as a medically needy person in accordance with COMAR 10.09.24.03D.

Authority: Health-General Article, §§2-104(b), 15-103, 15-105, and 15-141.2, Annotated Code of Maryland

Effective date:

Regulations .01—.16 adopted as an emergency provision effective July 1, 2003 (30:14 Md. R. 933); adopted permanently effective December 11, 2003 (30:24 Md. R. 1740)

Regulation .01B amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .01B amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .01B amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .02B amended effective January 25, 2010 (37:2 Md. R. 67)

Regulation .02C, D amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03 amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .03B, E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .03B, F amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .03F amended effective October 14, 2013 (40:20 Md. R. 1652)

Regulation .04 amended effective May 18, 2020 (47:10 Md. R. 516); May 18, 2020 (47:10 Md. R. 516)

Regulation .04A amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .04B amended effective April 9, 2007 (34:7 Md. R. 698); May 1, 2023 (50:8 Md. R. 338)

Regulation .04C amended effective May 1, 2023 (50:8 Md. R. 338)

Regulation .05 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .05 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .05 amended effective January 6, 2014 (40:26 Md. R. 2163); May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .06 amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .06E adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .07C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .07D amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .08E amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .08F amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .09-1 adopted effective April 9, 2007 (34:7 Md. R. 698)

Regulation .09-1 amended effective May 18, 2020 (47:10 Md. R. 516); May 1, 2023 (50:8 Md. R. 338)

Regulation .09-1C amended effective January 6, 2014 (40:26 Md. R. 2163)

Regulation .09-2 adopted as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); adopted permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .10B amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .11C, D amended effective April 9, 2007 (34:7 Md. R. 698)

Regulation .12A amended effective May 18, 2020 (47:10 Md. R. 516)

Regulation .12A, C amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)

Regulation .12C amended effective May 1, 2023 (50:8 Md. R. 338); March 3, 2025 (52:4 Md. R. 218); June 8, 2026 (53:11 Md. R. 485)

Regulation .13 amended as an emergency provision effective July 1, 2008 (35:17 Md. R. 1481); amended permanently effective October 6, 2008 (35:20 Md. R. 1774)