Finally, if a patient or their agent fails to apply for MA, a facility providing care may, without requesting the appointment of a guardian, petition the appropriate circuit court for an order requiring the resident or their agent to seek assistance from the MA program or to cooperate in the eligibility determination process. If the authorized representative needs access to financial or other records that must be submitted with the MA application, they may need a court order. Consider a specific transaction (discussed below) if the patient or someone else authorized to access those records does not or cannot furnish them. Md. Code, Health-General Art., § 19-344; COMAR 10.01.04.12 & 10.09.24.04 Representative Payees and U.S. Department of Veterans Affairs (VA) Fiduciaries. These are individuals or organizations appointed to manage income or benefits on behalf of a beneficiary who is unable to due to illness or disability. The Social Security Administration (SSA) and Office of Personnel Management (OPM) have representative payee programs. A representative payee for the Department of Veteran Affairs is called a “VA Fiduciary.” Some private pension companies also have similar programs. A guardian is not needed to manage these types of benefits. Each agency has their own application and program requirements. Achieving Better Life Experience (ABLE) accounts. If a spend down is needed for the patient to qualify for Medicaid or other income-based public benefits (SSI, SNAP, subsidized housing, etc.), an ABLE account may be an option. It is a type of savings account for disability-related expenses. Contributions to an ABLE account will not be counted for purposes of establishing or maintaining a person’s eligibility for income-based benefits. A person is eligible to be a “beneficiary” of an ABLE account if they developed a qualifying disability before the age of 26.5 States have their own ABLE programs with different requirements and contribution limits . In Maryland , a guardian can but is not needed to create or manage an ABLE account. A beneficiary over the age of 18 can establish their own account, or they can select a person to establish one on their behalf. If they are not
If the patient does not have capacity to designate an authorized representative, any of the following people have legal authority to serve as one: • A surrogate decision-maker (discussed above) • A person appointed to make legal or medical decisions on behalf of the patient (e.g., an agent under a financial power of attorney or advance directive • An attorney or paralegal hired by the patient • A personal representative or someone who has applied in good faith to become one • A current guardian or someone who in good faith petitions to become one If none of the above options exist, certain individuals or organizations can serve as authorized representative for an “Applicant Without Representative Who Lacks Capacity to Appoint a Representative” if they declare under oath that: • They are in good faith acting in the best interest of the patient • The patient lacks legal capacity • To the best of their belief, no other individual or organization is willing or able to act on the applicant or recipient’s behalf • The individual, the organization or any director, employee, officer, or employer of the organization does not have a direct financial interest in the disposition of the MA application or discloses whether such an interest exists
˘ The age of eligibility increases to 46 e˝ective January 1, 2026.
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