Medical Assistance Program (Medicaid)

Medical Assistance is a Federal and State funded program providing health insurance to persons who meet technical and financial eligibility requirements. There are various categories of Medical Assistance which include:

• Aged, Blind and Disabled (ABD)
• Families and Children (FAC)
• Children up to the age of 19 (MCHP)

In Maryland, the Local Departments of Social Services handle the eligibility determination for (ABD) and (FAC) categories. Pregnant Women or persons wishing to apply for their children under the age of 19 may apply at the Local Department of Social Services or through the Health Department.

Categorically Eligible

Persons who receive Temporary Cash Assistance or SSI benefits are eligible for medical assistance. A separate application does not need to be filed.

Spend-Down

The Spend-Down provision allows medical expenses to be used to help meet eligibility when income exceeds program limits. The amount of overscale income is what the person is responsible to pay towards unpaid medical bills.

Families and Children (FAC)

Medical Assistance provides coverage for families with children under 21 years of age. There is a $90 earned income deduction. The first $50 of child support received is disregarded. 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 between a caretaker relative other than a parent and the child in the household.                           

Income and Assets Standards 

Qualified Medicare Beneficiaries (QMB)

The QMB buy-in programs is an extension of the current Maryland Medical Assistance program. QMB eligibility provides for the state payment of the monthly Medicare premium, co-insurance and deductible for a person or married couple entitled to Medicare Part A (hospital insurance).

• Countable resources must be $4,000 or less for one person or $6,000 for a married couple.
• The countable income standard is $867 for one person and $1,167 for a married couple. The income standard is adjusted yearly, in March, according to the Consumer Price Index.

The general Medical Assistance policy and procedures apply to the eligibility determination for QMB.

• Certification begins the month following the month the person is determined eligible.
• The person or couple must be otherwise ineligible for medical assistance due to excess resources or income.
• The only person eligible is the medicare beneficiary or couple who both have medicare.
• There is no retroactive coverage.
• There is no Spend-Down consideration for excess income.
• A higher income and resources standard applies to QMB.
• The eligible person is mailed a gray and white Medical Assistance card.

Special Low-Income Medicare Beneficiaries (SLMB)

The SLMB buy-in program is an extension of the current qualified medicare beneficiary (QMB) provision which requires Maryland Medical Assistance program to pay the monthly Medicare Part B premium for eligible medicare recipients. 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)

• Resources must be $4,000 or less per individual and $6,000 or less for a married couple.
• SLMB Group I: The countable income limit range is $868 - $1040 individual and $1,041-$1,1170 for married couple.
• SLMB Group II: The countable income limit range is $1,168 - $1,400 individual and $1,401 - $1,575 for married couple. Medicare premium payments for this group may be in full or part according to number of participants and the availability of state funds.

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).
• When a person meets Spend-Down, he/she becomes eligible for Medicare buy-in coverage as a Medicaid recipient.
• 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
• No Medical Assistance card is issued.

Revised April 14, 2009