-
- This summary is
intended to give you basic information about the State of Maryland’s
Medicaid Program. Medicaid is also called Medical
Assistance. Medicaid rules change from to time to time, and
there are many circumstances that affect eligibility. There are too
many rules to present in this document. If you have a question or
want more information about anything you read in this document, call
one of the numbers given on page 9. Don’t use this information to
decide if you or someone else is eligible for Medicaid. If you need
help paying for your own or your family’s medical bills, you should
find out for sure about eligibility by filing an application at your
Local Department of Social Services.
Medicaid is a program that pays the medical bills of
the people who have low income, cannot afford medical care, and meet
other eligibility requirements. It is run by the State and pays the
medical bills with State and federal tax money.
Medicare is an
insurance program that pays medical bills for people who are at least
65 years old, or who are disabled. It is available to people who
receive Social Security benefits regardless of how much money they
have. It pays medical bills with money from the Social Security Trust
Fund, which most people pay into while they work. Retired and
disabled people pay a monthly insurance premium for Medicare Part B.
This is usually taken out of their Social Security check before they
get the check.
3. |
Can I have both
Medicaid and Medicare at the same time? |
Yes. Both programs
can work together. If you receive Medicare and qualify for
Medicaid, the Medicaid
program will pay your monthly Medicare Part B premiums for you (this
is called “Buy-In”). Medicaid will also pay your Medicare co-payments
and deductibles. If you are 65 or over and have not worked long
enough to receive free Medicare Part A (hospital insurance), the
Medicaid program will also pay the Medicare Part A premium. When you
apply for Medicare, it is important to let the Social Security
Administration representative know that you have Medicaid and may be
eligible to have the State pay your Medicare Part A premium.
Whenever you have
both Medicare and Medicaid, you should show both cards to your medical
care provider each time you receive services.
4. |
If I have
private health insurance, can I be eligible for Medicaid? |
Yes. If you have private health insurance
available to you or a member of your family, your eligibility for
Medicaid will not be affected. Any service not covered or only
partially covered by a private health insurance plan and listed as a
Medicaid covered service will be paid by Medicaid. Medicaid will pay
up to the maximum Medicaid is allowed to pay.
5. |
How can I get
Medicaid? |
All people who receive
money through Supplemental Security Income (SSI) or
Temporary Cash Assistance (TCA) automatically receive Medicaid.
If you do not get 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 in
the city or county where you live.
If you are
interested in applying for the Maryland’s Children’s Health Program (MCHP),
you may obtain an application from your Local Health Department. The
completed application can be returned by mail or in person.
6. |
What will I need to do when I apply? |
You will be interviewed by an eligibility worker who will ask for
information about your
income, assets, and private health insurance coverage. You will be
asked to prove what you say is true.
If you are too sick to come to the Local Department of Social Services
office to apply, you may send someone to the interview for you who is
knowledgeable about your money situation and other circumstances.
MCHP does not have an interview requirement.
7. |
How will the eligibility worker decide if I can
get Medicaid? |
First, the eligibility
worker will decide if you belong to one of the groups of people
covered by Medicaid. You will also need to show that you are a
resident of Maryland and a U.S. citizen, or an alien admitted for
permanent residency who has lived in the United States as a qualified
alien for at least 5 years or who otherwise qualifies. You must meet
one of the conditions listed below. Your eligibility will be
determined differently depending on the group you fall into. You must
be…
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At least 65 years old; or |
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Disabled; or |
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Blind; or |
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Under 21 years old; or |
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Caring for a related child in your home; or |
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Pregnant; or |
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The parents of an unmarried child under 21. |
Some people meet more
than one of the conditions above. If that is so, the
person may choose for which eligibility
group to apply. The rules are different for different groups and the
kinds of medical care covered are different for different groups.
8. |
How much money
can I have and be eligible for Medicaid? |
After the eligibility worker determines
that you meet one of these eligibility conditions,
the value of all your assets will be added
up. Assets are cash, money in checking or savings accounts, credit
union accounts, stocks, savings bonds, trusts, annuities, or any other
money that you have saved or invested. Assets also include things
like boats, trailers, real estate, and life insurance policies or
other expensive items you may own.
Medicaid does not count as assets the home
you live in or personal property (e.g., clothing, furnishings, car).
The amount of assets you may have depends on the size of your family
and the
eligibility group for which you are applying. This will be determined
at the time of application.
9. |
How much income
can I get and be eligible for Medicaid? |
Income is money that you
get from working, or money that someone gives you, or checks that you
get, like Social Security, unemployment or disability benefits, child
support, retirement benefits, or sick pay. The amount of income you
may have depends on the size of your family and the eligibility group
for which you are applying.
10. |
What if I have too much money? |
If you have too
much in assets, you are not eligible for Medicaid. However, if you
spend your assets on your daily living expenses, medical care, or
bills, you may reapply when your assets are lower.
If you have too much income, you may qualify under a “spend-down,” or
you may decide to apply in a different eligibility group. This
information and your eligibility worker will help you to decide which
group is best for you and your family.
11. |
What is a
Spend-down? |
When a person’s income is more than the amount allowed by Medicaid,
the eligibility worker will figure out exactly how much greater the
income is than the amount allowed. This is called “Excess Income.”
If the person can show that his/her medical bills are equal to or
greater than the excess income, the person can still get Medicaid.
This is called “Spend-down.”
Persons who become
eligible under a spend-down are only eligible for a limited time, and
they will still have to pay some of their own medical bills.
12. |
What are the
different eligibility categories? |
Medicaid is for
people in two broad categories, “Families and Children” or “Aged,
Blind or Disabled”.
Families
and Children (FAC) is for children under 21
years old. Parents and other relatives who are providing care for
unmarried children living with them may also qualify in this
category. The income limits are very low, but families with too much
income may qualify under spend-down. Families with too much assets
cannot qualify until assets are reduced to the amount allowed.
Aged, Blind or Disabled (ABD)
is for people 65 years
old or older, blind, disabled or with an illness that is expected to
result in death. The income limits are the same as for the FAC
category, and people with too much income can qualify under a
spend-down. People with too much assets cannot qualify until the
assets are reduced to the amount allowed.
Family Size
|
ABD and FAC
Medicaid Medically Needy
Maximum Family Income and Assets
|
Countable Monthly Income
|
Countable Assets |
1 |
$ 350 |
$ 2,500 |
2 |
$ 392 |
$ 3,000 |
3 |
$ 434 |
$ 3,100 |
4 |
$ 475 |
$ 3,200 |
5 |
$ 521 |
$ 3,300 |
6 |
$573 |
$3,400 |
Women’s Breast and
Cervical Cancer Health Program (WBCCHP) |
Women’s Breast and
Cervical Cancer Health Program (WBCCHP)
provides full Medicaid
coverage for uninsured women aged 40 to 64 years, who are diagnosed
with breast or cervical cancer through the local health departments’
Breast and Cervical Cancer Program.
Maryland Children's Health Program (MCHP) |
Maryland Children’s Health
Program (MCHP)
is
for pregnant women of any age and children up to age 19 if they have a
family income that is at or below 200% Federal Poverty Level (FPL) for
children and up to 250% FPL for pregnant women and their newborn
children. Click here
to view the current family income limits for the Maryland Children’s
Health Program.
Note: The poverty guidelines are updated
annually in the Federal Register published by the U.S. Department of
Health and Human Services under authority of 42 U.S.C. 9902(2).
Maryland Children's Health Program (MCHP)
Premium |
Maryland Children’s Health Program (MCHP)
Premium
is a program offered to uninsured children up to age 19, who have not
dropped employer-sponsored health insurance within the previous six
months, and who have paid the monthly premium payment per family. The
family income standard for eligibility is more than 200% and at or
below 300% FPL.
For both MCHP and MCHP Premium, assets are not considered in
determining eligibility. In addition, MCHP and MCHP Premium
beneficiaries receive health benefits through
HealthChoice,
Maryland’s Medicaid Managed Care Program. To apply for MCHP or MCHP
Premium, applications may be filed by mail or in person at
Local Health Departments, or in person at Local Departments of Social
Services.
Click here
to view the current family income limits and premium amounts for the
Maryland Children’s Health Program (MCHP) Premium Program.
Qualified Medicare Beneficiaries (QMB)
is for people who
receive Medicare (the medical insurance that comes from Social
Security). The amounts of income and assets allowed for people on QMB
are higher than for ABD. Income may not exceed 100% of the Federal
Poverty Level. Assets may not exceed $4,000 for an individual or
$6,000 for a couple.
Under QMB, Medicaid
pays for your monthly Medicare Part B medical insurance premium, your
Medicare Part A premium in some cases, your Part A hospital deductible
and your annual Part B deductible. Depending on the doctor you see,
Medicaid may also pay your 20% coinsurance for Medicare covered
services.
Specified Low-Income Medicare Beneficiaries (SLMB)
is
for people with more income than allowed under QMB. The asset limit
is the same as for QMB. SLMB pays only for the Medicare Part B
premium that gets deducted from the monthly Social Security check.
If you need help
with your medical expenses, you should go to the Local Department of
Social Services and apply for Medicaid. For MCHP, you may also apply
at your Local Health Department. For QMB or SLMB benefits, you may
also apply at your Area Agency on Aging if you are elderly. People
with very high medical expenses can have incomes over the maximum and
still qualify under spend-down. Children and pregnant women can have
any amount of assets and still qualify if they meet the income test.
The only way you can be sure is to file an application. Even if
you’re not eligible for coverage of all your medical expenses, you
might still be able to get help with some of your expenses
13. |
What Medical
Services are available if I am eligible for Medicaid? |
The Maryland Medicaid Program provides many medical services to keep
you healthy and to treat you when you are sick. Limitations apply to
some of them. The major services are listed on the “Covered Services
List”, and may be changed based on the State’s budget.
SERVICES COVERED BY
MARYLAND MEDICAL ASSISTANCE (MEDICAID)
The following services
are covered by Maryland’s Medicaid Program, if the services are not
covered by Medicare or other insurance and if the Maryland Medicaid
Program's specific requirements are met for the service. If you have
any questions, call the Maryland Medicaid Hotline at 410-767-5800
(Baltimore area) or 1-800-492-5231.
► |
ambulance and
wheelchair van services and emergency medical transportation |
► |
ambulatory surgical center services |
► |
clinic services |
► |
dental services
and dentures (for beneficiaries under 21) |
► |
diabetes care
services (covered under HealthChoice) |
► |
Early and Periodic
Screening, Diagnosis and Treatment (EPSDT) Services (for
beneficiaries under 21) |
► |
eye glasses (for
beneficiaries under 21) |
► |
family planning
services and supplies |
► |
hearing aids (for
beneficiaries under 21) |
► |
home and
community-based services waiver services for targeted populations
of developmentally disabled or mentally retarded individuals,
older adults, physically disabled adults, medically fragile
children, children with autism spectrum disorder, and adults with
traumatic brain injury |
► |
home health agency services |
► |
hospice care |
► |
hospital inpatient and outpatient services (acute, chronic,
psychiatric, rehabilitation, specialty) |
► |
kidney
dialysis services |
► |
laboratory and x-ray services |
► |
medical
day care services |
► |
medical
equipment and supplies |
► |
Medicare premiums, co-payments, and deductibles |
► |
mental
health treatment, case management, and rehabilitation services |
► |
nurse
anesthetist, nurse midwife, and nurse practitioner services |
► |
nursing facility services
(nursing homes) |
► |
oxygen
services and related respiratory equipment services |
► |
personal care services |
► |
pharmacy services (for
beneficiaries not eligible for Medicare Part D) |
► |
physical therapy |
► |
physician services (some
dental surgery may be included) |
► |
podiatry services |
► |
private duty nursing (for
beneficiaries under 21) |
► |
school-based health-related
services (for beneficiaries under 21) |
► |
Statewide Evaluation and
Planning Services (STEPS) through local health departments) |
► |
substance abuse treatment
services |
► |
targeted case management for
HIV-infected individuals and other targeted populations |
► |
transportation services to
Medicaid covered services (through local health departments) |
► |
vision care services (eye
examination every two years) |
January 2006
14. |
How will I
receive my medical care? |
Maryland has a Managed Care
Program called HealthChoice that provides
a
medical home for Medicaid and MCHP recipients. HealthChoice
requires most people in the Medicaid program to join MCOs (managed
care organizations). People on Medicare, living in nursing homes or
other institutions, eligible for Medicaid through spenddown, or aged
65 or older are not enrolled in HealthChoice.
The MCOs provide or arrange to provide almost all of the care for
Medicaid members who join their plans. Medicaid members must receive
their medical care through the MCO they choose.
Persons enrolled in HealthChoice are covered for all Medicaid
services. Some MCOs may choose to offer more benefits. All MCOs pay
special attention to treating little medical problems before they
become big, serious medical problems. Some services received by
HealthChoice enrollees are provided fee-for-service, not by the MCO,
such as personal care, therapies for children, medical day care, and
waiver services.
Medicaid eligibles
who do not qualify for HealthChoice receive their Medicaid
services through “fee-for-service”. This means that each medical
provider who provides services to the Medicaid recipient will bill the
Medicaid program for payment.
You will receive information in the mail about all of the different
Medicaid MCOs in your area. You may choose any plan. You will
probably want to choose an MCO to which your doctor belongs. You must
sign up within 21 days after you receive the information. If you need
help, call the telephone number found in the information you receive
and you will get help.
16. |
What if I don’t
choose an MCO? |
If you have a doctor, you will be assigned
to the MCO to which your doctor belongs. If you don’t have a doctor,
you will be assigned to an MCO. It’s best if you choose your own MCO.
17. |
If I don’t
qualify for Medicaid, is there any other help for me? |
Yes. The Maryland
Primary Adult Care Program provides primary health services, mental
health services (not including emergency room, specialty or hospital
care) and pharmacy benefits to persons over the age of 19 who do not
qualify for Medicaid or Medicare. This program has income and asset
limits higher than Medicaid. You can apply for the Maryland Primary
Adult Care Program through the mail by calling 1-800-226-2142.
If you are HIV+ or
have AIDS, and have private health insurance either directly through
an insurance company or through a current or former employer, the
Maryland AIDS Insurance Program may pay the cost of your health
insurance premiums. The income and asset limits are higher than for
Medicaid. You may apply through the mail by calling (410) 767-1780.
18. |
What
if I am involved in an accident or am injured before or after I
become eligible for Medicaid? |
When you are involved in an accident or
are injured, and then apply for Medicaid, you should inform the Local
Department of Social Services (or Local Health Department for MCHP).
Your caseworker will obtain information from you concerning the
accident or injury such as the date it occurred, the names of the
persons involved, any doctors you have visited, any attorneys who are
involved, etc. You should also inform your caseworker if you are in
an accident or are injured while you are eligible for Medicaid. You
may also call the Division of Medical Assistance Recoveries to report
this information at (410) 767-1787.
IMPORTANT
TELEPHONE NUMBERS |
Department of Human Resources |
- Which
Local Department of Social Services office to go to:
-
1-800-332-6347
-
Problem with
caseworker or supervisor:
-
1-800-332-6347
|
Department of Health and Mental
Hygiene |
- Question
about Medical Assistance Eligibility Policy:
- (410)
767-1463
-
1-800-492-5231, ext., 1463
|
Questions about services covered by Maryland
Medicaid and other Medicaid questions: |
- (410)
767-5800
-
1-800-492-5231
|
|
Recipient Relations: |
- (410)
767-5800
-
1-800-492-5231
|
|
Medicare Buy-In Program: |
- (410)
767-5376
-
1-800-638-3403
|
|
Provider Relations: |
- (410)
767-5503
-
1-800-445-1159
|
|
Provider Relations (Nursing Homes and Other
Long-Term Care Providers) |
- (410)
767-7812
-
1-800-492-5908
|
|
Maryland Children’s Health Program: |
-
1-800-456-8900
|
-
|
Maryland Pharmacy Assistance Program: |
-
1-800-226-2142
|
-
|
Legal Liabilities-TORT (accident or injury)
Section, Medical Assistance Recoveries: |
- (410)
767-1787
|
-
|
Maryland AIDS Insurance Assistance Program: |
- (410)
767-1780
|
-
|
Maryland
Department of Aging |
- (410)
767-1102
-
1-800-243-3425 or 1-800-AGE-DIAL
|
|
Legal Aid
Bureau |
- (410)
296-6705
-
1-800-999-8904
-
1-800-367-7563 (assistance with nursing home, assisted living
and elderly issues)
|
|
MARYLAND MEDICAL ASSISTANCE PROGRAM
INCOME ELIGIBILITY LIMITS
EFFECTIVE 7/1/94
Family Size |
Monthly |
Annual |
1 |
$350 |
$4,200 |
2 |
$392 |
$4,700 |
3 |
$434 |
$5,200 |
4 |
$475 |
$5,700 |
5 |
$521 |
$6,252 |
6 |
$573 |
$6,876 |
7 |
$645 |
$7,740 |
8 |
$709 |
$8,508 |
9 |
$765 |
$9,192 |
10 |
$826 |
$9,912 |
ASSET ELIGIBILITY
LIMITS
1 |
$2,500 |
2 |
$3,000 |
3 |
$3,100 |
4 |
$3,200 |
5 |
$3,300 |
6 |
$3,400 |
7 |
$3,500 |
8 |
$3,600 |
9 |
$3,700 |
10 |
$3,800 |
|
|
|