Developmental Disabilities Services - Expedited Eligibility Determinations for Recently Relocated Individuals (Ralph's Act)

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0721*

SENATE BILL 721
J1 6lr3060
CF HB 1015
By: Senator Waldstreicher
Introduced and read first time: February 6, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 19, 2026

CHAPTER ______

AN ACT concerning 1

Developmental Disabilities Administration – Services – Expedited Eligibility 2
Determinations for Recently Relocated Individuals 3
(Ralph’s Act) 4

FOR the purpose of requiring that the Maryland Department of Health to provide an 5
expedited Medicaid eligibility determination for developmental disabilities services 6
to certain individuals who were determined to be eligible to receive certain 7
developmental disabilities services in another state be eligible to continue to receive 8
those services received certain services in another state and relocated in the State; 9
requiring the Department to establish an expedited review process for cert ain 10
individuals relocating to the State; authorizing requiring the Department to begin 11
the determination process before an individual establishes residency in the State 12
under certain circumstances; and generally relating to eligibility determinations for 13
developmental disabilities services in the State. 14

BY repealing and reenacting, without amendments, 15
Article – Health – General 16
Section 7–101(a) and (g) 17
Annotated Code of Maryland 18
(2023 Replacement Volume and 2025 Supplement) 19

BY adding to 20
Article – Health – General 21
Section 7–404.2 22
Annotated Code of Maryland 23
2 SENATE BILL 721

(2023 Replacement Volume and 2025 Supplement) 1

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 2
That the Laws of Maryland read as follows: 3

Article – Health – General 4

7–101. 5

(a) In this title the following words have the meanings indicated. 6

(g) “Developmental disability” means a severe chronic disability of an individual 7
that: 8

(1) Is attributable to a physical or mental impairment, other than the sole 9
diagnosis of mental illness, or to a combination of mental and physical impairments; 10

(2) Is manifested before the individual attains the age of 22; 11

(3) Is likely to continue indefinitely; 12

(4) Results in an inability to live independently without external support 13
or continuing and regular assistance; and 14

(5) Reflects the need for a combination and sequence of special, 15
interdisciplinary, or generic care, treatment, or other services that are individually planned 16
and coordinated for the individual. 17

7–404.2. 18

(A) AN INDIVIDUAL SHALL BE ELIGIBLE TO RECEIVE SERVICES FROM THE 19
DEPARTMENT UNDER THIS TITLE IF: 20

(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 21
INDICATED. 22

(2) “DEPENDENT” MEANS AN INDIVIDUAL WITH DISABILITIES WHO: 23

(I) RELIES ON SUPPORT FROM AN IMMEDIATE FA MILY 24
MEMBER WHO IS A RESIDENT OF THE STATE; OR 25

(II) HAS AN IMMEDIATE FAMI LY MEMBER WHO IS A R ESIDENT 26
OF THE STATE AND ACTS AS THE INDIVIDUAL’S LEGAL GUARDIAN. 27

SENATE BILL 721 3

(3) “IMMEDIATE FAMILY MEMBER” MEANS A SPOUSE, A PARENT, AN 1
ADOPTIVE PARENT, A STEP –PARENT, A GRANDPARENT, A STEP–GRANDPARENT, A 2
SIBLING, A STEP–SIBLING, A CHILD, OR A STEP–CHILD. 3

(B) THE DEPARTMENT SHALL PROV IDE AN EXPEDITED MEDICAID 4
ELIGIBILITY DETERMINATION FOR DEVELOPMEN TAL DISABILITIES SER VICES FOR 5
PURPOSES OF ENROLL MENT IN THE COMMUNITY PATHWAYS WAIVER TO AN 6
INDIVIDUAL IF: 7

(1) THE INDIVIDUAL: 8

(I) IS A DEPENDENT OF AN IMMEDIATE FAMILY MEMBER; 9

(II) RECEIVED HOME – AND COMMUNITY –BASED WAIVER 10
SERVICES OR SIMILAR SERVICES UNDER A SIM ILAR ASSISTANCE PROG RAM IN 11
ANOTHER STATE FOR THE IMMEDIATELY PRECEDING 10 YEARS; AND 12

(III) MOVED TO THE STATE TO LIVE WITH TH E IMMEDIATE 13
FAMILY MEMBER ON THE DEATH OR INCAPACITAT ION OF THE INDIVIDUA L’S 14
CARETAKER IN THE OTHER STATE; AND 15

(2) THE IMMEDIATE FAMILY MEMBER ON WHOM TH E INDIVIDUAL IS 16
DEPENDENT HAS RESIDED IN THE STATE FOR THE IMMEDIA TELY PRECEDING 2 17
YEARS. 18

(B) (1) THE DEPARTMENT SHALL ESTABLISH AN EXPEDITED PROCESS TO 19
DETERMINE WHETHER AN INDIVIDUAL MEETS THE CRITERIA UNDER SUBSE CTION 20
(A) OF THIS SECTION AND IS ELIGIBLE TO RECEIVE SERVICES UNDER THIS TITLE. 21

(2) THE PROCESS ESTABLISH ED UNDER THIS SUBSEC TION SHALL 22
REQUIRE THAT A DETERMINATION BE COMPLETED WITHIN 30 DAYS. 23

(C) (1) IN PROVIDING EXPEDITED ELIGIBILITY DETERMINATIONS UNDER 24
SUBSECTION (B) OF THIS SECTION, THE DEPARTMENT SHALL: 25

(I) PRIORITIZE COMPLETED APPLICATIONS FOR REV IEW ON 26
RECEIPT; 27

(II) TO THE EXTENT AUTHORI ZED BY LAW , RELY ON 28
DOCUMENTATION, DIAGNOSTIC EVALUATIO NS, ELIGIBILITY DETERMIN ATIONS 29
FROM THE INDIVIDUAL ’S PREVIOUS STATE OF RESIDENCE, AND ANY OTHER 30
DOCUMENTATION THAT T HE DEPARTMENT RELIES ON WHEN MAKING OTHER 31
DETERMINATIONS UNDER THIS TITLE; AND 32

4 SENATE BILL 721

(III) COMPLETE EACH EXPEDITED ELIGIBILITY DETERMINATION 1
WITHIN 60 BUSINESS DAYS AFTER THE RECEIPT OF A COMPLETE APPLICATION. 2

(2) IN PROVID ING AN EXPEDITED ELI GIBILITY DETERMINATI ON 3
UNDER SUBSECTION (B) OF THIS SECTION , THE DEPARTMENT MAY NOT WA IVE 4
SUBSTANTIVE ELIGIBIL ITY REQUIREMENTS EST ABLISHED UNDER THIS TITLE OR 5
REQUIREMENTS ESTABLI SHED BY REGULATION F OR THE ASSIGNMENT OF A 6
SERVICE PRIORITY CATEGORY. 7

(C) (D) IF AN INDIVIDUAL HAS BEEN DETERMINED UNDER THIS SECTION 8
TO BE ELIGIBLE TO RECEIVE SERVICES, THE INDIVIDUAL SHALL BE: 9

(1) PLACED IN THE CRISIS RESOLUTION CATEGORY; AND 10

(2) GIVEN ACCESS TO WAIVE R SERVICES THROUGH T HE MOST 11
APPROPRIATE RESERVE CATEGORY AS DETERMINED BASED ON THE SERVICES THE 12
INDIVIDUAL RECEIVED IN THE INDIVIDUAL’S PREVIOUS STATE OF RESIDENCE. 13

(E) IF THE DEPARTMENT DETERMINES THAT AN INDIVIDUAL WHO HAS NOT 14
YET ESTABLISHED RESI DENCY IN THE STATE MEETS THE CRI TERIA ESTABLISHED 15
UNDER SUBSECTION (B)(1)(I) AND (II) AND (2) OF THIS SECTION, THE DEPARTMENT 16
SHALL DETERMINE WHETHER THE INDIVIDUAL HAS A DEVELOPMENTAL DISABILITY 17
AS DEFINED UNDER § 7–101(G) OF THIS TITLE. 18

(D) THE DEPARTMENT MAY DETERM INE, BEFORE AN IND IVIDUAL 19
ESTABLISHES RESIDENCY IN THE STATE: 20

(1) WHETHER AN INDIVIDUAL IS ELIGIBLE TO RECEIVE SERVICES; 21

(2) THE APPROPRIATE SERVICE PRIORITY CATEGORY; AND 22

(3) WHETHER THE INDIVIDUAL IS ELIGIBLE FOR CRISIS RESOLUTION 23
SERVICES. 24

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 25
October 1, 2026 July 1, 2027. 26