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§ 31-204. Determining eligibility of uninsured individual for insurance affordability program

West's Annotated Code of MarylandInsuranceEffective: June 1, 2019

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 31. Maryland Health Benefit Exchange (Refs & Annos)
Subtitle 2. Maryland Easy Enrollment Health Insurance Program (Refs & Annos)
Effective: June 1, 2019
MD Code, Insurance, § 31-204
§ 31-204. Determining eligibility of uninsured individual for insurance affordability program
Currentness
In general
(a) The Exchange or the Department, as applicable, shall determine eligibility for insurance affordability programs as soon as possible after an individual files a State income tax return on which the individual chose a checkoff box described in § 2-115(c)(3) of the Tax--General Article indicating that an uninsured individual may be interested in obtaining minimum essential coverage.
Verification of uninsured individual's eligibility
(b)(1) To the maximum extent practicable, the Exchange or the Department, as applicable, shall verify an uninsured individual's eligibility for an insurance affordability program:
(i) with information on a State income tax return and other data from third-party data sources, including data described in § 1413 of the Affordable Care Act or available under § 2-115(b)(2) of the Tax--General Article; and
(ii) without requesting additional information or attestations from the uninsured individual.
(2) If additional attestations or documentation from the uninsured individual are required to establish eligibility for an insurance affordability program, the Exchange or the Department, as applicable, shall take steps to limit the burden on the uninsured individual, including:
(i) proactively contacting the individual who filed the tax return or the uninsured individual;
(ii) recording, by telephonic or electronic means, attestations and documentation provided by the individual who filed the tax return or the uninsured individual; and
(iii) if the attestations or documentation required to determine eligibility are not obtained using the steps described in items (i) and (ii) of this paragraph, facilitating the selection of an authorized representative for the uninsured individual.
Verification of citizenship status before determining eligibility
(c)(1) Before determining eligibility of an uninsured individual for an insurance affordability program, the Exchange or the Department, as applicable, shall attempt to verify the citizenship status of the uninsured individual and each household member listed on the State income tax return, based on the information available from the return and reliable third-party sources of citizenship data.
(2) If the process described in paragraph (1) of this subsection does not confirm that the uninsured individual and each household member listed on the State income tax return is a United States citizen, the Exchange and the Department may not seek additional verification or take other steps to determine eligibility for or enroll the uninsured individual in an insurance affordability program until the uninsured individual provides affirmative consent using forms and procedures approved by the Exchange.
(3) The affirmative consent required under paragraph (2) of this subsection may be satisfied through the procedures described in 42 U.S.C. § 1320b-7(d).
(4) If citizenship is not verified and affirmative consent is not provided in accordance with paragraph (2) of this subsection, the Exchange and the Department may not take any further steps to determine an uninsured individual's eligibility for or enroll an uninsured individual in an insurance affordability program.

Credits

Added by Acts 2019, c. 423, § 1, eff. June 1, 2019; Acts 2019, c. 424, § 1, eff. June 1, 2019.
MD Code, Insurance, § 31-204, MD INSURANCE § 31-204
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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