Paul Sanchez
Medicaid is a state-administered program in Maryland that provides health care coverage for low-income individuals and families. The program is also known as Medical Assistance (MA) and uses federal and state funds to pay for medical bills. Maryland's Medicaid program is called HealthChoice, and it includes the Maryland Children's Health Program (MCHP), which provides health care coverage for children up to the age of 19 from higher-income families. The enrollment period for Medicaid in Maryland is year-round, and there are several ways to apply, including online, by phone, or in person.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicaid in Maryland? | Low-income individuals, families, and children up to age 19 from higher-income families. Pregnant women with a household income of up to 250% of the FPL, and young adults up to age 26 who aged out of foster care in Maryland are also eligible. |
| What does Medicaid cover? | Doctor visits, pregnancy care, prescription drugs, hospital and emergency services, and more. |
| How to apply for Medicaid in Maryland? | Apply online at the Maryland Health Connection website or via their mobile app. Apply by phone at 1-855-642-8572. Apply in person at your local Social Services office or County Health Department. |
| What is MCHP? | Maryland Children's Health Program (MCHP) is a branch of Medicaid that provides access to health care coverage for children up to age 19. |
| What is SLMB? | Specified Low-Income Medicare Beneficiary, or SLMB, pays for premiums and co-pays for individuals with incomes below 135% of the FPL, or $1,296 monthly for a single person. |
| What is QMB? | Qualified Medicare Beneficiary, or QMB, pays for premiums and co-pays for individuals with incomes below 100% of the FPL, or $1,084 monthly for a single person. |
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What You'll Learn
Medicaid eligibility criteria in Maryland
Medicaid is a federal-state program that provides health coverage to Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. To be eligible for Medicaid in Maryland, individuals must meet specific criteria, including financial, demographic, and medical needs assessments.
Financial Criteria
Medicaid in Maryland assesses an individual's financial situation to determine eligibility. It considers both income and assets. For 2024, the asset limit for an individual is $2,500. If you are 65 or older, the income limit is $350 per month. For those under 65, a household income of less than 138% of the Federal Poverty Level (FPL) may qualify for Medicaid. This equates to less than $3,048 per month for a family of four. These figures tend to increase slightly each year. Retirement income, such as social security, pensions, or other sources, is also factored into the financial assessment. Certain assets, like an individual's primary residence, may be exempt from consideration. Additionally, if you have high medical expenses, you may still qualify for Medicaid even with a higher income.
Demographic Criteria
Demographic criteria for Medicaid eligibility include age, citizenship or immigration status, and residency. For seniors aged 65 or older in Maryland, age is a qualifying factor. Individuals must be residents of Maryland and either U.S. citizens or certain qualified non-citizens, such as lawful permanent residents.
Medical Needs
Maryland evaluates the medical necessity for long-term care when determining Medicaid eligibility. This assessment ensures that those with a genuine medical need for long-term care and services are supported.
Other Criteria
Other criteria that may impact Medicaid eligibility in Maryland include pregnancy, parenting status, and disability. Young adults up to age 26 who aged out of foster care in Maryland qualify for Medicaid regardless of their income. Additionally, individuals receiving Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA) are automatically eligible for Medicaid.
It is important to note that eligibility for Medicaid in Maryland is determined by considering all these factors together. Speaking with a professional can help navigate the complexities of the application process and ensure that all requirements are met.
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Applying for Medicaid in Maryland
Maryland's Medicaid program, also called Medical Assistance (MA), provides health coverage for eligible individuals. The program is designed to assist low-income individuals by paying their medical bills using federal and state funds.
Eligibility Criteria:
To be eligible for Medicaid in Maryland, you must meet specific income and asset guidelines. The eligibility criteria vary based on the specific program and your personal circumstances, such as age, family size, and health status.
For example, the Maryland Children's Health Insurance Program (MCHP) provides health benefits for children under the age of 19 and pregnant women of any age who meet the income guidelines. The income threshold for MCHP is a countable income at or below 200% of the federal poverty level, or up to 300% with a premium.
Application Process:
You can apply for Medicaid in Maryland through the following methods:
- Online: You may apply online at the Maryland Department of Human Services (DHS) website, myDHR (https://mydhrbenefits.dhr.state.md.us). Here, you can find the necessary application forms and instructions.
- In-Person: You can also apply in person by visiting one of the 24 local departments of social services in Maryland. You can locate the nearest office by searching for your county on the DHS website.
- Phone: Additionally, you can apply over the phone by calling 1-855-642-8572. This number can also be used to request a paper application form if you prefer to submit your application by mail.
Required Information:
When applying for Medicaid in Maryland, you will need to provide information about yourself and each member of your household who is enrolling. This includes:
- Policy numbers for any current health insurance.
- Information about employer-sponsored coverage that you or someone in your household is eligible for.
Additional Information:
It is important to note that Maryland also offers the Medicare Buy-In Program, which includes the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs. These programs assist low-income Medicare beneficiaries with their out-of-pocket expenses, including deductibles and co-payments. The eligibility requirements for these programs are based on income and asset levels.
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MCHP, Maryland's Children's Health Insurance Program
Maryland offers its residents the opportunity to apply for Medicaid, also known as Medical Assistance (MA). This state-administered program is designed to pay the medical bills of low-income individuals using federal and state funds.
Maryland also has a specific program for children's health insurance called the Maryland Children's Health Program (MCHP). This program provides full health benefits for uninsured children under the age of 19 from families whose income is at or below 200% of the federal poverty level. MCHP is managed by the State of Maryland's Department of Health and Mental Hygiene (DHMH) and is available at no cost for eligible households. For families with slightly higher incomes, the MCHP Premium program provides health insurance coverage for a small monthly premium.
To apply for MCHP, you can apply online at www.marylandhealthconnection.gov or by telephone by calling the Maryland Health Connection's Consolidated Service Center at 855-642-8572 (or 855-642-8573 for TTY). You will need to provide proof of income, identity, citizenship, and residence. Additionally, Montgomery County residents can apply through multiple locations, receive assistance with completing the application, and have their applications processed at the County Service Eligibility Units.
MCHP enrollees can obtain care from a variety of Managed Care Organizations (MCOs) through the Maryland HealthChoice Program. These MCOs cover doctor visits, prescription drugs, hospital and emergency services, and more, depending on the specific plan selected.
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SLMB, Specified Low-Income Medicare Beneficiary
The Specified Low-Income Medicare Beneficiary (SLMB) program is one of four Medicaid-administered Medicare Savings Programs (MSPs). The SLMB program is designed to protect low-income Medicare beneficiaries from the costs of Medicare coverage, including out-of-pocket cost-sharing expenses (such as deductibles and co-payments).
The SLMB program pays for the Medicare Part B premium, which is $164.90 per month for most people as of 2023. It is available to those with incomes between 100 and 120 percent of poverty with assets up to $9,090 per individual or $13,630 per couple.
If you meet the income limits for SLMB but also qualify for full Medicaid benefits, you are considered dual-eligible, and qualify for a program called SLMB Plus (SLMB+).* As an SLMB Plus beneficiary, you will receive benefits from both the SLMB program and your state's full Medicaid benefits program.
To find out if you qualify for SLMB, you can contact your State Health Insurance Assistance Program (SHIP) or visit BenefitsCheckUp. You can also call 1-877-839-2675 or visit the SHIP website to find your local program. They can help you determine your eligibility and get started with filing an application.
It is important to note that income limits for SLMB may be slightly higher in some states, such as Alaska and Hawaii. Even if your income or resources are higher than the federal limits listed, you may still qualify for these programs.
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QMB, Qualified Medicare Beneficiary
The Qualified Medicare Beneficiary (QMB) program is one of four Medicare Savings Programs (MSPs) sponsored by Medicaid. The program covers Medicare Part A and Part B premiums, deductibles, copayments, and coinsurance for people with limited income and assets. In 2023, more than 8 million individuals (more than 1 out of 8 Medicare beneficiaries) were in the QMB group.
The QMB program is designed to protect low-income Medicare beneficiaries from the costs of Medicare coverage, including out-of-pocket cost-sharing expenses (deductibles and co-payments). To be enrolled in the QMB program, individuals must qualify for or be enrolled in Medicare Part A at a minimum and meet strict income and asset limits. The income limits for the QMB program may differ from state to state, and some states may set higher income limits or waive the asset guidelines altogether. These limits are based on the Federal Poverty Guidelines (FPG) and change each year. For example, in 2023, the QMB program served individuals with modest assets (up to $9,090 per individual or $13,630 per couple) with combined incomes that did not go over 100% of the federal poverty level.
The biggest advantage of having QMB is saving money on doctor visits, hospital stays, and medical procedures. Since the Medicare Part B premium is normally taken out of a beneficiary's Social Security check, having QMB means more money in their check every month. Additionally, if an individual has QMB, they automatically qualify for the Medicare Part D Low-Income Subsidy (LIS/Extra Help) program, which helps pay for prescription drug costs.
If an individual qualifies for QMB but also meets the requirements for full Medicaid benefits, they are considered dual-eligible—also known as QMB Plus. They will receive benefits from both the QMB program and their state Medicaid program. Having coverage through both programs may allow them to receive services not covered by Medicare, such as vision, hearing, and dental care.
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Frequently asked questions
You can apply for Medicaid online at the Maryland Health Connection website or via their mobile app. You can also apply by phone or in person at your local Social Services office or County Health Department.
Medicaid is designed to help low-income individuals and families get health care coverage. Pregnant women with a household income of up to 250% of the FPL can qualify, as can young adults up to age 26 who aged out of foster care. Individuals with disabilities or blindness may also qualify if their income and resources are very low.
Medicaid covers doctor visits, pregnancy care, prescription drugs, hospital and emergency services, and more, at no cost.
Yes, you can have private health insurance and still be eligible for Medicaid.
