Maryland Medical Programs

Updated
July 31, 2001

About Our Programs

Maryland Medicaid Application Process

How Do I Apply For Medicaid?

If you do not get SSI or TCA payments, you must file an application to find out if you are eligible for Medicaid. To do this, you must go to the Department of Social Services in the city or county where you live. You will be asked to complete and sign an application form and will be interviewed by an eligibility worker. You will be asked information about your income and assets and private health insurance coverage, and asked to provide proof that what you say is true. If you are too sick to come to the Social Services office to apply, you may send someone to the interview who knows about your money situation and other circumstances.

How Do I Know If I Am Eligible for Medicaid?

The eligibility worker at DSS will decide if you belong to one of the groups of people covered by Medicaid. You will also need to show that you are a resident of Maryland and a U.S. citizen, or an alien admitted for permanent residency. To be eligible you must meet one of the conditions listed below:

Over 65 years old; or
Disabled; or
Blind: or
Under 21 years old; or
Caring for a related child in your home whose parent is unable to work due to sickness, or is deceased, or who is unemployed, or not living in the home with the child; or
Pregnant.

Some people meet more than one of the conditions above. If that is so, the person may choose which eligibility group to apply in. The rules are different for different groups and the kind of medical care covered may be different for different groups.

What Happens if I Have Other Medical Insurance or Medicare?

After the eligibility worker at DSS determines that you meet one of the eligibility conditions, the value of all your assets and income will be added up to determine if you meet the limits. If you have private health insurance available to you or a member of your family, your eligibility for Medicaid will not be affected. Medicaid will still pay for covered services that are not paid for, or only partly paid for, by a private health insurance plan, up to the amount that Medicaid pays for them

Many people who qualify for Medicaid also have Medicare coverage. Medicare is an insurance program that pays medical bills for people who are over 65 years old, or who are disabled. It is available to people who receive Social Security benefits, regardless of how much money they have. If you receive Medicare and qualify for Medicaid, The Medicaid Program will pay your monthly Medicare Part B premiums for you. Medicaid will also pay your Medicare co-payments and deductibles. If you are 65 or older and do not have enough work credits to receive free Medicare Part A (hospital insurance), the Medicaid program will pay the Medicare Part A premium. Additional Information on Medicare may be found through the Health Care Financing Administration (HCFA).

How do I Receive Services Under Medicaid?

Once you have filled out an application and have been determined to be eligible for Medicaid, you will likely receive services through the State’s Medicaid managed care program (HealthChoice). If you are not institutionalized, do not have Medicare, are not in a spend-down eligibility category, not in a model waiver, and not in a limited-services category, you will choose a Primary Care Provider (PCP) and be enrolled with an Managed Care Organization (MCO) of your choice.

If you are Medicaid-eligible but not eligible for participation in HealthChoice, you will still receive your medically necessary services through the Medicaid Program. You will receive services under “fee-for-service”(FFS). Fee-for-service simply means that the Medicaid Program directly pays each medical provider you see.

If you are eligible for Medicare health insurance coverage, the Medicaid program will pay the portion that Medicare does not pay and pay for any Medicaid-covered service.

If you have other medical insurance coverage, that insurance must pay first for covered services before Medicaid will pay.

If you are enrolled in an eligibility category with only limited benefits, the Medicaid program will pay for only those benefits.

Your benefits will be explained to you when you apply.

Where do I go to apply for Medicaid?

To apply for Medicaid benefits you should call or visit your nearest local Department of Social Services.