Medical Assistance Program (Medicaid)
Maryland Medical Assistance (MA), also known as Medicaid, is a federal and state funded program that may help to pay the medical bills of people who have low income, can not afford medical care, and meet other eligibility requirements. All people who receive Temporary Cash Assistance (TCA) or Supplemental Security Income (SSI) benefits automatically receive Medicaid without filing a separate application. Children receiving foster care or subsidized adoption services from the Department of Human Resources are also eligible for Medicaid.
Note: If you only need prescriptions, go to the Primary Adult Care (PAC) Program. PAC also offers primary care physician services as well as mental health services.
I Want to Learn About
Types of Medical Assistance | Services Covered | Eligibility | Income & Asset Standards | Spend-Down | Medicare Buy-In
Types of Medical Assistance
If you have an active Department of Social Service (DSS) case and/or are applying for Food Stamps along with MA, see if you can have all benefits (for all members of your family) start and end at the same time to minimize number of redetermination dates. If you are not eligible for Medical Assistance, learn about some non-DSS Resources.
Families and Children (FAC)
- Provides coverage for families with children under 21 years of age
- Parents and other relatives who are providing care for unmarried children living with them may also qualify in this category
- Parents may choose to exclude children with income or assets from consideration as long as one child remains in the unit
- There must be a blood relationship (or adoption) between a caretaker relative other than a parent and the child in the household for the adult to be considered for coverage
Complete the application, (PDF) required documentation and send to your district office.
Maryland Children’s Health Insurance Plan (MCHP)
For pregnant women and for children under 19 years of age, and whose family income and/or resources do not qualify the family for FAC and only need to apply for medical coverage and are not receiving food or cash assistance through the Department of Social Services apply with the Health Department.
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 the 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.
Complete the application, (PDF) required documentation and send to your district office.
Long Term Care- Medicaid Coverage for Institutionalized Persons
May be granted to individuals who need the level of care provided in a long-term care facility (e.g., nursing home, hospital) and who need financial assistance to cover all or a portion of the cost of care.
The Bureau of LTC Eligibility (BLTCE) determines financial eligibility for Medical Assistance for persons in Skilled Nursing Facilities, Intermediate Care Facilities, or in Hospitals with a discharge plan that requires placement in a Skilled Nursing Facility.
Complete the application (PDF) and required documentation for the relevant jurisdictions and send to:
BLTCE
Bureau of LTC Eligibility
Maryland Department of Human Resources
910 Frederick Road
Catonsville, MD 21228
Fax: 410-744-2432
Contact Angela Tallie, Administrative Assistant, at 410-455-7517 for more information.
Note: The Medicaid Long Term Care (LTC) eligibility process within Maryland was centralized into the BLTCE and incorporates the LTC units for Baltimore City and Baltimore, Anne Arundel and Prince George’s County.
Required Documentation for MA applications
- Proof of Citizenship and Identity is required on all applicants for MA (birth certificate, passport, government issued photo ID)
- General information about family members (such as names and birth dates)
- Social Security numbers of applicants
- Sources and amounts of income
- If pregnant, written proof of pregnancy and expected date of delivery signed by your doctor or nurse
Services Covered by Medical Assistance
Find services covered by MA such as ambulance services, hospice care, lab services and more.
Eligibility
The Maryland Medical Assistance program requires that both technical and financial factors of eligibility be met. Technical eligibility (Baltimore County residency, meeting category requirement for FAC or ABD must be met before financial eligibility is considered.
You must be:
- A Baltimore County resident
- At least 65 years old; or
- Disabled; or
- Blind; or
- Under 21 years old; or
- Caring for a related child in your home; or
- Pregnant; or
- The parents of an unmarried child under 21
Some people meet more than one of the conditions above, if 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.
The Eligibility Worker will review the person’s finances and determine eligibility. Asset balance (savings, checking, certificate of deposit, Keough, money market, mutual fund, IRA, etc...) must be within the program limit before income is considered. If the requirement is not met, then person is not eligible for MA.
If the person does meet the technical and financial criteria, then the illness or injury of the applicant must be determined to be “disabling.” The definition of disabled appears in the Code of Maryland Regulations (COMAR) 10.09.24.02B (19) and reads as follows:
“Disabled” means the inability to perform any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less that 12 months.”
The worker will send the medical and social evidence which the applicant has presented to the Department of Human Resources (DHR) State Review Team (SRT). SRT is a unit at DHR that determines disability in consultation with medical professionals appointed by the commissioner. A primary function of the SRT is certifying disability for people who are applying for (or appealing the denial of) Social Security Administration (SSA) disability benefits.
This may take 30 to 60 days. If you receive and eligibility letter stating that you have MA., to help you prepare for the annual redetermination date, write the eligibility date on your calendar.
Income and Assets Standards
Find most current income and asset guidelines at the Department of Health and Mental Hygiene.
What if I make too much money?
- If you have too much in assets, you are not eligible for MA. 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 for “spend-down,” or you may decide to apply in a different eligibility group. This information and your eligibility worker will help you decide which group is best for you and your family.
What if I am denied MA?
If you receive a letter stating that you have been denied MA, review the letter carefully to see the reason for the denial. It may be something as simple as missing information. The letter will go into detail on how to file an appeal.
Spend-Down
When a person's income is more than the amount allowed by MA, the eligibility worker will figure out 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 MA. This is known as a "Spend-down."
Persons who have 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.
Example
When you file an application for MA, your case manager will calculate your monthly income over a six month period of time. Your six month income will be compared to the MA income scale for your household’s size. The difference is your “Spend-down” amount. The following is an example of how we calculate eligibility.
- You and your three children apply for MA on May 1, 2011
- The consideration period is May 1, 2011 thru October 31, 2011
- The case manager determines your income is $3,000 a month
- The Income Scale for a household of four is $2,131 a month
- $3,000 X 6 months = $18,000
- $2,131 X 6 months = -$12,786
- Total $5,214
Meaning you need $5,214 in medical bills to reduce your Spend-down amount to within the program limit. Your case will be placed in a “preserved” status for remainder of the consideration period. This allows you to provide medical bills equal to or greater than the Spend-down amount without having to reapply.
You are hospitalized on June 25, 2011 and submit a bill totaling $15,000. This amount reduces the Spend-down amount to zero and establishes MA eligibility for the period of June 25, 2011 through October 31, 2011. You remain responsible to the hospital for the $5,214 which exceeded the program limit but the remainder of the bill will be covered by MA.
Medicare Buy-in Programs
Also known as Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB), are designed to protect low-income Medicare beneficiaries from the significant and growing costs required to receive Medicare coverage, including out-of-pocket costs and co-payments). When a person meets Spend-Down, he/she becomes eligible for Medicare buy-in coverage as a Medicaid recipient.
Note: Only apply of you are receiving Medicare, not Medical Assistance.
Qualified Medicare Beneficiaries (QMB)
Is for people who receive Medicare (the medical insurance that comes from Social Security). Under QMB, Medicare 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 percent coinsurance for Medicare covered costs. QMB does not supplement your Medicare coverage but instead ensures that you will not be precluded from coverage because you cannot afford to pay the costs associated with Medicare.
QMB is not a program for families. It is specifically for individuals or couples who qualify to receive Medicare and who do not qualify for any other MA program because their income or assets is more than the MA program allows.
Special Low-Income Medicare Beneficiaries (SLMB)
Is for people with more income than allowed under QMB. Pays only for the Medicare Part B premium that gets deducted from the monthly Social Security check. SLMB buy-in provides only the coverage of Part B premiums for a person or married couple who are entitled to receive Medicare Part A (hospital insurance).
Applicants must meet all general requirements for Medical Assistance and Qualified Medicare Beneficiary (QMB) Programs. Medicare deductible and copays are not covered. SLMB is available only to persons who are not eligible for Medical Assistance (ABD/FAC/QMB).
Retroactive coverage of Medicare premiums is available up to three months prior to the application month (but not prior to 1/1/93). Certification begins the month of application and no MA card is issued.
Find most current income and asset guidelines at the Department of Health and Mental Hygiene to see if you qualify for either of the Medicare Buy-in Programs.
If you qualify for either of the above programs, you automatically qualify for extra help paying for the cost of Medicare prescription drug costs.
Apply Online for Medical Assistance
If you want to apply online, go to www.marylandsail.org to file your application.
Revised January 10, 2012
