What is Medicaid?
Medicaid (also called Medical Assistance) is a program that pays the medical bills of people who have low income and cannot afford medical care. Medicaid provides three types of critical health protection:
- Health insurance for low-income families, children, the elderly, and people with disabilities;
- Long-term care for older Americans and individuals
- ◦Supplemental coverage for low-income Medicare beneficiaries (e.g., payment of Medicare premiums, deductibles, and cost sharing).
Medicaid is a joint federal and state program. Each state establishes its own eligibility standards, benefits package, provider requirements, payment rates, and program administration under broad federal guidelines. The Department of Health and Mental Hygiene (DHMH) runs Maryland’s Medicaid program.
Who is Covered Under Medicaid?
Medicaid covers persons who fall into certain “categories” such as low-income families, children, pregnant women, women with breast or cervical cancer, the elderly, and persons with disabilities. People who receive money through Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA) automatically receive Medicaid. In addition, persons may qualify for Medicaid because of high medical expenses (commonly hospital or nursing home care), if they have low income and assets and are aged, blind, or disabled. For more information on who is covered, see Medical Care Programs Eligibility. To find out if you are eligible for Medicaid, you must file an application with the appropriate local department where you live.
How do Individuals Apply for Medicaid?
People who receive Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA) automatically qualify for Medicaid and do not need to apply.
If you do not receive SSI or TCA, you must file an application to find out if you are eligible for Medicaid. To do this, you must go to the Local Department of Social Services (LDSS) in the city or county where you live. If you are applying for a child or are pregnant, you may file an application for the Maryland Children’s Health Program (MCHP), which covers the same services as Medicaid. You may apply at your Local Health Department (LHD) for MCHP or to be screened for breast or cervical cancer. If you are elderly and are only applying for assistance under the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) Program to pay your Medicare premiums, co-payments, or deductibles, you may apply at your LDSS. QMB/SLMB applications may be filed by mail or in person. To receive an application, call your LDSS or the Area Agency on Aging (AAA).
To apply for the Maryland Pharmacy Assistance Program, you may get a mail-in application by calling 1-800-226-2142.
What Services are Covered Under Medicaid?
Medicaid and MCHP cover a broad range of health care services, including services mandated by the federal government as well as optional services that a state may choose to cover. For a list of covered services, click “Covered Services”.
How do Medicaid Eligibles Receive Services?
Once someone has filed an application and been determined eligible for Medicaid, they will likely receive their medical services through the State’s Medicaid Managed Care Program, HealthChoice. If someone qualifies for HealthChoice, they will choose a Primary Care Provider (PCP) and be enrolled with a Managed Care Organization (MCO) of their choice.
If the person does not qualify for HealthChoice (e.g., because they are also Medicare eligible, eligible for Medicaid through spenddown, or eligible in a long-term care facility), they will still receive Medicaid services, but through “fee-for-service” (FFS). This means that each medical provider who provides services to the Medicaid recipient bills the Medicaid program for payment. Prior to HealthChoice and other managed care programs, all provider claims for Medicaid services were handled this way.
Under HealthChoice managed care, the MCOs contract with DHMH to provide Medicaid covered services through their provider networks in return for monthly payments from DHMH. This set of services is called the “Benefits Package”. The MCOs pay the providers in their networks for these services. Some Medicaid services are not covered by the MCOs, and may be received through Medicaid fee-for-service (such as therapies for children). Specialty mental health services are provided by the State’s public mental health system. All Medicaid eligibles with full coverage receive the same services, whether or not enrolled in an MCO. About 20% of Medicaid eligibles are NOT enrolled in managed care, so their providers are paid fee-for-service by DHMH.
For more information about Medicaid and other Medical Care Programs:
Contact Recipient Relations: (410) 767-5800 - 1 (800) 492-5231
Or Contact Provider Relations: (410) 767-5503 - 1 (800) 445-1159
For more information about Maryland Children’s Health Program (MCHP):
Contact MCHP Hotline 1 (800) 456-8900
For more information about Maryland Children’s Health Program (MCHP) Premium:
Contact Case Management Unit: (410) 767-6883 - 1 (886) 269-5576
Or Contact Policy Division: (410) 767-3641 - (410) 767-6890