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Maryland Medical Assistance


Maryland Medical Assistance (MMA or Medicaid) provides several different health insurance programs to low-income residents who meet the eligibility requirements. These programs are offered to families, children, pregnant women, refugees, asylees, disabled persons, elderly individuals, and Medicare beneficiaries with a certain income. Under the Affordable Care Act, adults without children are also eligible for Medicaid in Maryland. In the state’s structure of public health programs, each related coverage group is referred to as a track, and there are 11 tracks total.¬† Organized by sharing the same eligibility guidelines, applicants will be placed in one track according to their needs.

Medical Care programs are administered by the Maryland Department of Health and Mental Hygiene, and cover services ranging from doctor’s office visits and preventive care, to maternity coverage and special health needs due to a condition or disability. Exceeding the capacities of traditional health insurance in many cases, these programs ensure the people who need help paying for care can receive it. Whether your health depends on medical care due to age, or because of a condition, MMA will cover many services relevant to your health.

 

Maryland Medical Assistance Eligibility

Requirements for Maryland Medical Care programs varies based on your coverage group, though certain qualities must be met by all applicants. In order to qualify, you must be a resident of Maryland, a U.S. citizen or lawful permanent resident, and have no current source of health insurance. In fact, being uninsured for the past six months consecutively is also a requirement, this includes COBRA, employer-sponsored, or short-term coverage. Each applicant must have income that does not surpass the limit assigned to their coverage group in relation to the Federal Poverty Level.

 

Income and Resource Limits

 

Childless Adults 133% FPL

 

Pregnant Women 250% FPL

Family of 2: $3,000 Asset Limit

Family of 3: $3,100 Asset Limit

Family of 4: $3,200 Asset Limit

Family of 5: $3,300 Asset Limit

 

Infants 185% FPL

Family of 1: $2,500 Asset Limit

Family of 2: $3,000 Asset Limit

Family of 3: $3,100 Asset Limit

Family of 4: $3,200 Asset Limit

 

Children Ages 1-5 133% FPL

Family of 1: $2,500 Asset Limit

Family of 2: $3,000 Asset Limit

Family of 3: $3,100 Asset Limit

Family of 4: $3,200 Asset Limit

 

Children Ages 6-19  100% FPL

Family of 1: $2,500 Asset Limit

Family of 2: $3,000 Asset Limit

Family of 3: $3,100 Asset Limit

Family of 4: $3,200 Asset Limit

 

Parents (employed or unemployed) 133% FPL

Family of 2: $3,000 Asset Limit

Family of 3: $3,100 Asset Limit

Family of 4: $3,200 Asset Limit

Family of 5: $3,300 Asset Limit

 

Single Aged, Blind, or Disabled 75% FPL

$2,500 Asset Limit

 

Couple Aged, Blind, or Disabled 83% FPL

$3,000 Asset Limit

 

Qualified Medicare Beneficiaries (QMB) 100% FPL

Medicaid covers your premiums, coinsurance, and deductibles.

Single: $4,000 Asset Limit

Couple: $6,000 Asset Limit

 

Specified Low-Income Medicare Beneficiaries (SLMB) 135% FPL

Medicaid covers your premiums only.

Single: $4,000 Asset Limit

Couple: $6,000 Asset Limit

 

Covered Benefits

  • Ambulance and wheelchair van services
  • Emergency Medical Transportation
  • Clinic services
  • Ambulatory surgical centers
  • Dental care (for those under 21)
  • Diabetes management
  • Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)
  • Eye glasses (for those under 21)
  • Family Planning
  • Hearing aids (for those under 21)
  • Home and Community-Based Services Waiver
  • Home health care
  • Hospice care
  • Inpatient/outpatient hospital care
  • Kidney dialysis services
  • Lab and X-ray
  • Medical day care services
  • Medical equipment and supplies
  • Mental health care, case management, and rehabilitation
  • Nursing home services
  • Oxygen services and respiratory equipment
  • Personal care
  • Physical therapy
  • Physician services
  • Podiatry
  • Prescriptions
  • Private duty nursing (for those under 21)
  • School-based health-related services (for those under 21)
  • Statewide Evaluation and Planning Services (STEPS)
  • Substance abuse treatment
  • Targeted case management for those with HIV and other diseases
  • Transportation to Medicaid covered services through local health departments
  • Vision exam (every two years)

 

Managed Care

Most Maryland Medical Assistance members can receive health care services through the state’s managed care program, HealthChoice. Beneficiaries of both Medicaid and the Maryland Children’s Health Program will use HealthChoice to choose a Managed Care Organization (MCO) with a primary care doctor and the provider network you will primarily use. Individuals who live in nursing homes or receive Medicare will not have to select an MCO through HealthChoice. MCOs throughout the state include:

 

How to Apply

Maryland Medicaid has not yet streamlined its application system into an electronic format, which means you must fill out an application in person. Go to your Local Department of Social Services with any information on your income, assets, and private health insurance coverage. In the case that your are not healthy enough to come to the office yourself, you may send someone who knows the details of your financial state and other necessary information to complete the application on your behalf. An eligibility worker will decide whether or not you qualify and fall into one of the coverage groups.

 

Resources

Maryland Medical Assistance

Medicaid Expansion

 

Contacts

Find a Local Department of Social Services: 800-332-6347

Department of Health & Mental Hygiene

MA Eligibility Questions: 410-767-1463 or 800-492-5231 ext. 1463

MA Coverage & Recipient Relations: 410-767-5800 or 800-492-5231

 

 

Sources:

 

1. Kaiser State Health Facts. “Medicaid & CHIP – Maryland”. http://www.statehealthfacts.org/profileind.jsp?cat=4&rgn=22.

2. Maryland Department of Health & Mental Hygiene. “MMA”. http://mmcp.dhmh.maryland.gov/SitePages/Home.aspx.

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