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Directory Results for Maryland Medical Assistance Program MANUAL MMIS INSTRUCTIONS FOR SCREEN 4/ SCREEN 8 When a penalty has been calculated using the DES/LTC 811, please complete this document and fax a copy to the Division of Recipient Eligibility Programs to MARYLAND MEDICAL ASSISTANCE PROGRAM NOTICE OF INELIGIBILITY DUE TO EXCESS INCOME Date: Re: Name CID# Dear , , the above named person has been This is to notify you that based on the application filed on to has determined ineligible for - -

Maryland Medical Assistance Program MANUAL MMIS INSTRUCTIONS FOR SCREEN 4/ SCREEN 8 When a penalty has been calculated using the DES/LTC 811, please complete this document and fax a copy to the Division of Recipient Eligibility Programs
MARYLAND MEDICAL ASSISTANCE PROGRAM NOTICE OF INELIGIBILITY DUE TO EXCESS INCOME Date: Re: Name CID# Dear , , the above named person has been This is to notify you that based on the application filed on to has determined ineligible for - -