How Maryland Medicaid Works
Medicaid is available to individuals and families with limited income and resources, including pregnant women and some immigrants.
Children up to age 19 may qualify for Medicaid coverage through the Maryland Children's Health Program (MCHP), even if their parents don't qualify.
Unlike most health plans, enrollment is available year-round.
If you need help applying for Medicaid or finding the right plan, dial 211 or connect with a Medicaid navigator program.
Who Qualifies for Medicaid?
Medicaid is typically available to those who financially qualify and are:
- An adult 20-64 years old
- A child 0-19 years old
- Pregnant individual
- Parent or primary caretaker
- Former foster care youth
If you receive other types of public assistance, you may automatically be offered Medicaid.
Medicaid costs are income-based and depend on family size. To get an idea of whether you qualify, recent guidelines indicate that coverage is available for a family of four with children at incomes up to $8,855 per month. However, eligibility changes. View the latest guidelines.
Pregnant Women
While pregnant, you may be eligible for Medicaid. You can apply at any time during the pregnancy. Coverage also extends past birth for 12 months, so you have time to access postpartum and other health services.
There are income limits.
Are Immigrants Eligible for Medicaid?
Depending on your immigration status, you may be able to apply for Medicaid. You typically qualify if you've lawfully been in the U.S. for 5 years.
However, children under 21 are not subject to the 5-year rule. Also, pregnant women (regardless of immigration status) are eligible for Medicaid.
You don't need a Social Security Number (SSN) or Taxpayer Identification Number to apply. If you request financial help and file taxes, you will be asked for your SSN.
Federal rules are changing, including the qualifications for financial help with a private plan. You can still apply, but costs may go up.
Read the Maryland Health Connection Frequently Asked Questions (FAQs) about immigration status.
Medicaid for Children
Children may qualify for additional Medicaid health benefits under the Maryland Children's Health Program (MCHP). It's the state's Medicaid program for children up to age 19. Costs may vary, depending on income and family size.
Maryland Children's Health Program
Like Medicaid, care is provided by a Managed Care Organization (MCO).
The MCO provides the following benefits for children:
- Dental care
- Doctor visits, including sick and well-visits
- Hospitalizations
- Lab work and tests
- Mental health support
- Substance use treatment
- Immunizations and flu shots
- Prescription medicine
- Transportation to medical appointments
- Vision
How Medicaid Works
Most people on Medicaid receive care through a Managed Care Organization (MCO).
If you're not enrolled in an MCO, your doctor must submit their fee to Medicaid for payment. These are fee-for-service plans.
What's a Managed Care Organization (MCO)?
MCOs are private insurance companies chosen to provide and manage Medicaid benefits.
The MCO covers your health care.
What's Covered?
Most health care services are covered by Medicaid.
The MCO covers basic health services:
- Doctor visits, including regular checkups and specialists
- Pregnancy care
- Family planning and birth control
- Prescription drugs
- Hospital and emergency services
- Primary mental health services through your doctor
- Xrays and lab work
- Home health services
You'll also get coverage for dental care under Maryland's Healthy Smiles Program.
Finding an MCO
You have options for an MCO. Check which providers serve your area and whether your doctors and pharmacy are part of the MCO.
You can also view the additional services that each provides.
View a list of Managed Care Organizations to find the one for your situation.
How do I get help with enrollment?
If you have questions, free help is available in counties throughout Maryland. Navigators can answer questions in-person and help you find the most savings, and help with enrollment.
The navigator programs are offered through third parties. Find the one nearest you.
Far Western Counties
Where: Garrett, Allegany, Washington
Who: Western Maryland Health Insurance Connector (AHEC West)
Phone: 888-202-0212
Mid Western and Central Counties
Where: Frederick, Carroll, Howard, Baltimore, Baltimore City, Anne Arundel
Who: Health Care Access Maryland (HCAM)
Phone: 855-288-3667 and choose the navigator option.
Capital North
Where: Montgomery
Who: Montgomery County Health Connection
Phone: 240-777-1815
Capital South
Where: Prince George's County
Who: Prince George's Health Connect (PGC Health Connect)
Phone: 301-927-4500
Eastern Shore & Southern
Where: Harford, Cecil, Kent, Queen Anne's, Talbot, Caroline, Dorchester, Wicomico, Somerset, Worcester, Calvert, Charles, St. Mary's
Who: Seedco
Phone: 855-445-5540
Local health departments and departments of social services can also help. You can also call Maryland Health Connection at 1-855-642-8572 or attend a local event.
How Do I Enroll?
Medicaid enrollment is through Maryland Health Connection.
What is Maryland Health Connection?
It's a one-stop enrollment resource for Medicaid and private insurance. You can get an estimate of coverage costs before creating an account and applying for a plan.
When Is Enrollment?
Enrollment is open year-round for MCHP and Medicaid, through Maryland Health Connection.
If you become pregnant, you can also enroll in a health plan or change it within 90 days of learning you're pregnant.
Individuals need to renew their coverage once a year. You will be contacted when it’s time for your renewal.
What is the application process?
There are 3 ways to apply for Maryland Medicaid, and the Maryland Children's Health Program (MHCP):
- Call 1-855-642-8572
- Apply online.
- Download the agency’s mobile app (Enroll MHC) on Apple or Android.
After applying for help, you may need to verify your information, such as your income, citizenship, Social Security number, or other coverage.
You may also need to print, sign, and upload an affidavit to prove your information. Learn more about the types of documents you can use to verify your information and the affidavits you may need to qualify for Medicaid.
During the application, you'll also choose a Managed Care Organization (MCO).
Find a Doctor Who Takes Medicaid
Once you have Medicaid, you can use the Maryland Department of Health's Provider Finder tool to find a doctor or facility that accepts Medicaid.
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