About DHMH - Health Care Financing

Health Care Financing is responsible for the activities and missions of the five Medical Care Programs, which includes: Medical Assistance (Medicaid and HealthChoice), Pharmacy Assistance, Kidney Disease, Family Planning Programs and Maryland Children’s Health Program.  In addition, the Health Services Cost Review Commission and the Maryland Health Care Commission (Healthcare Access and Cost Commission and Maryland Health Resources Planning Commission) are under the Deputy Secretariat for Health Care Financing.

The responsibilities of the Medical Care Programs are covered by three administrations:

The Office of Planning Development and Finance provides support in the areas of budget, administration, and program and policy development and evaluation. It advises the Deputy Secretary on major policy matters, including programmatic changes, budget and fiscal issues, rate-setting, and federal and State legislative issues and proposals.

The Office of Health Services manages the areas of Acute and Primary Care and Long-term Care. Primary responsibilities include development and implementation of regulations, coordination of State Plan amendments, federal waiver agreements, and provider agreements. In addition, it develops legislative proposals and handles compliance activities including pre-authorization, fraud and abuse activities, quality assurance, complaint resolution, and other ongoing program management activities.

The Office of Operations and Eligibility oversees eligibility policy and training, handles claims processing for enrolled health care providers, and assures that eligible recipients receive their entitled health benefits under the five Medical Care Programs (Medical Assistance, Pharmacy Assistance, Kidney Disease, Family Planning Programs and Maryland Children’s Health Program).