What Does Medicaid Cover in Maryland?

Medicaid is a cooperative program between federal and state governments, offering health and long-term care coverage to individuals with limited income. In Maryland, this program is known as Medical Assistance. It aims to provide access to necessary healthcare services for various populations, including low-income adults, children, pregnant individuals, elderly adults, and people with disabilities, at no or low cost. Approximately 1.5 million Marylanders, nearly one in four, receive health insurance through Medicaid, with half being children.

Eligibility Requirements

To qualify for Medicaid in Maryland, individuals must reside in the state and meet specific criteria related to income, household size, and citizenship or immigration status. Eligibility is often determined using Modified Adjusted Gross Income (MAGI) for many applicant groups. Adults under 65 may qualify if their household income falls below 138% of the Federal Poverty Level (FPL).

Children can qualify for coverage if their household income is up to 200% of the FPL, and pregnant individuals may be eligible with incomes up to 250% of the FPL. For those aged 65 or over, or individuals who are blind or disabled, eligibility depends on very low income and resource limits, typically below $2,000 in resources. Individuals aging out of foster care in Maryland qualify for Medicaid regardless of their income until age 26.

Applicants must gather documentation to verify their eligibility. This includes proof of income, such as recent pay stubs or W-2 forms, and tax returns from previous years. Applicants need to provide birthdates and Social Security Numbers for all household members seeking coverage, or document numbers for legal immigrants, along with citizenship or immigration status.

Comprehensive Covered Services

Maryland Medicaid provides a wide array of medical services designed to meet diverse healthcare needs, often through Managed Care Organizations (MCOs). These MCOs cover essential benefits, including doctor visits, hospital care, and prescription drugs. Preventive services, such as regular check-ups and immunizations, are also covered.

Emergency services and ambulance transportation are included. Mental health services are extensively covered, encompassing outpatient therapy, psychiatric rehabilitation, case management, and crisis intervention. Substance use disorder treatment is provided, including various levels of diagnosis, treatment, and recovery services, with coverage for medication-assisted treatments like Suboxone.

Dental services are available for all ages, with comprehensive coverage for children through programs like the Maryland Healthy Smiles Dental Program. Adult dental coverage is also provided. Vision care, including eye glasses for beneficiaries under 21, and hearing aids for those under 21, are covered. Laboratory tests, X-rays, and medical equipment and supplies are also included.

Medicaid further covers home health services, nursing facility care, and various home and community-based waiver services for specific populations, such as individuals with developmental disabilities, older adults, and those with traumatic brain injuries. Family planning services and supplies are available, along with coverage for pregnancy care and doula services. Non-emergency medical transportation to appointments is also provided.

Application Process

Once necessary eligibility information and supporting documents are assembled, individuals can submit their Medicaid application in Maryland. The primary method is through Maryland Health Connection, the state’s official health marketplace. Applications can be completed online via their website or using the Enroll MHC mobile application.

Applicants can also apply over the phone by calling the Maryland Health Connection customer service line. For in-person assistance, applications can be submitted at local health departments or departments of social services. A paper application can also be requested by phone.

After an application is submitted, the system provides confirmation. Maryland Health Connection may request additional information or documentation to verify details, and applicants will receive a notice if needed. Straightforward applications are typically processed within 45 days, while more complex cases, such as those involving disability determinations, may take up to 90 days. Coverage generally begins on the first day of the month the application was submitted.

Managing Your Medicaid Coverage

Maintaining Medicaid coverage in Maryland involves several ongoing responsibilities for beneficiaries. The annual renewal process typically occurs every 12 months for most individuals. Recipients receive notification when it is time to renew their coverage, and this can often be completed online via their Maryland Health Connection account or the Enroll MHC mobile app.

Promptly report any changes in income, household size, contact information, or other relevant circumstances. Such changes can impact eligibility and coverage levels. Failure to provide updated information can lead to disenrollment from the program.

Upon approval, beneficiaries receive a red and white medical assistance card in the mail, usually within 14 days of enrollment. This card should be kept safe and presented when accessing medical services. Even if the physical card has not yet arrived, medical services can typically be accessed once eligibility is confirmed.