Medicaid is a health insurance program that provides free or very low-cost medical coverage to people who cannot afford private insurance. In Maryland, if you earn below a certain amount of money, the state will pay for your doctor visits, hospital stays, prescription drugs, and even dental care. There are no monthly bills (called premiums) for most adults who qualify, and you almost never have to pay out of your own pocket when you go to the doctor. Because it is a public program, you do not have to wait for an open enrollment period to sign up; if you qualify, you can apply and get covered on any day of the year.
Health insurance can be confusing, but Medicaid is actually one of the simplest programs to use once you are inside it. To understand how it works, you first need to know who runs it.
Medicaid is a team effort between the federal government in Washington, D.C., and the state government in Maryland. The federal government creates the baseline rules and provides a large part of the money. You can read about the overarching national rules on the official federal website at medicaid.gov. According to federal data, Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 80 million people nationwide.
However, the federal government does not run the program directly. Each state gets to take that federal money and set up its own specific program. Maryland gets to decide exactly how to pay doctors, which extra benefits to offer, and how people apply. In Maryland, the state agency in charge of the program is the Maryland Department of Health. Because rules and processes are handled locally, you should always check the Maryland Department of Health website by name for the most current, state-specific rules and updates.
When you are approved for Medicaid in Maryland, you do not just get a generic state insurance card. Instead, Maryland uses a program called HealthChoice.
Under HealthChoice, the state pays private health insurance companies to manage your health care. These companies are called Managed Care Organizations (MCOs). It works like this:
This means that when you go to the doctor, you show them the card from your MCO, just like someone who buys private insurance.
Not everyone can get Medicaid. The program is designed specifically for people who have limited income or face specific challenges. Under the rules of the Affordable Care Act (often called Obamacare), Maryland expanded its Medicaid program to cover almost any low-income adult.
Here are the main groups of people who qualify:
If you are an adult under the age of 65 and you do not have dependent children, you can still get Medicaid. This was not always true, but today, your approval is based purely on how much money you make.
Children have much easier rules for getting health coverage. Maryland operates the Maryland Children’s Health Program (MCHP). The income limits for children are much higher than they are for adults. This means that a parent might make too much money to get Medicaid for themselves, but their children can still get free or low-cost coverage through MCHP.
Good medical care during pregnancy is vital for both the mother and the baby. Because of this, the income limits for pregnant women are also higher than for regular adults. Furthermore, once a pregnant woman is approved, Maryland guarantees that her coverage will continue during her entire pregnancy and for a full 12 months after the baby is born, no matter what happens to her income during that time.
People who are 65 or older, people who are blind, and people who have recognized disabilities have a different path to Medicaid. For this group, the state looks at both your income and your assets (like money in the bank or extra property). This is called “Non-MAGI” Medicaid, and it often works alongside the Medicare program to cover nursing homes, in-home care, and heavy medical costs.
Young adults who were in the foster care system and had Medicaid on their 18th birthday are allowed to keep their Medicaid coverage until they turn 26 years old. For this specific group, income does not matter at all. The state provides this to ensure young adults starting out on their own have a safety net.
For most adults and children, the only thing the state cares about is your income. To figure out if you make too much money or just the right amount, the government uses a math formula based on the Federal Poverty Level (FPL).
To get approved for standard adult Medicaid in Maryland, you need to meet a few basic requirements before the state even looks at your exact paycheck.
The Federal Poverty Level is a number the federal government sets every year. It represents the absolute minimum amount of money a person needs to survive. Because survival is hard, the Affordable Care Act said states could cover people who make a little bit more than that bare minimum. Specifically, they set the limit at 138% of that poverty line.
This number changes every single year, usually in January or February, to keep up with inflation.
The income limit is not a single flat number for everyone. It changes based on how many people live in your house and are on your taxes.
When you apply, the state asks for your “tax household.” If you are a single person living alone, your limit is based on a household of one. If you are married and have two children, your limit is based on a household of four. As your household size goes up, the amount of money you are allowed to make also goes up.
| Household Size | Who is Counted | How the Limit Works | Coverage Result |
|---|---|---|---|
| 1 Person | Just you (Single Adult) | Lowest income allowance | Full free coverage if under 138% FPL |
| 2 People | You and a spouse, or you and one child | Limit goes up to support two people | Full free coverage if under 138% FPL |
| 4 People | You, a spouse, and two children (example) | Limit is much higher than a single adult | Full free coverage if under 138% FPL |
When Maryland looks at your money, they use a system called Modified Adjusted Gross Income (MAGI). This means they look at your income before taxes are taken out, but they do not count the money you have saved in the bank, the car you drive, or the house you own. For standard adults, assets do not matter; only your monthly paycheck matters.
A common myth is that Medicaid is “bad” insurance that does not cover very much. The truth is exactly the opposite. Because it is designed to protect people who have no extra money to pay for medical bills, Medicaid actually covers more services than many expensive private health plans.
The federal rules say that every state must cover certain “mandatory” services. Then, states can choose to add “optional” services on top. Over the years, Maryland has chosen to add a lot of optional services to make the program robust.
If you need to see a doctor because you are sick, or if you just need a routine yearly check-up, it is covered. You will pick a Primary Care Provider (PCP) who will be your main doctor. This doctor handles your normal health needs and gives you a referral if you need to see a specialist, like a heart doctor or a skin doctor.
If you break your leg, have a heart attack, or need surgery, Medicaid covers the emergency room visit, the ambulance ride, and the entire hospital stay. You do not have to worry about a massive hospital bill destroying your finances.
When your doctor writes you a prescription for medicine, you take it to a standard pharmacy (like CVS, Walgreens, or a local grocery store pharmacy). Medicaid covers the cost of the medicine. In most private insurance plans, you have to pay a portion of the drug cost. In Maryland Medicaid, the medicine is usually completely free, or you might be asked to pay a tiny copay (like one or two dollars).
Mental health is treated the same as physical health. If you need to see a therapist, a counselor, or a psychiatrist, those visits are covered. The program also pays for substance use disorder treatments, including rehab programs and medicines to help fight addiction.
For many years, dental care was only covered for children. Recently, Maryland expanded its rules. Now, adults on Medicaid also have comprehensive dental benefits. This means things like normal teeth cleanings, X-rays, fillings for cavities, and pulling bad teeth are covered.
For vision, the rules are slightly tighter. Children get regular eye exams and free glasses. Adults can get medical care for eye diseases (like glaucoma or cataracts), but Medicaid might not pay for normal adult eyeglasses unless there is a specific medical need.
Children are treated as a top priority in the healthcare system. The state knows that a healthy child does better in school and grows into a healthy adult. Because of this, Maryland created the Maryland Children’s Health Program (MCHP).
MCHP is Maryland’s version of the federal CHIP program. The biggest difference between standard Medicaid and MCHP is the income limit.
For a normal adult, the income limit is 138% of the poverty level. But for a child to get MCHP, the family can make up to roughly 211% of the poverty level. This is a huge difference. It means working-class parents who have decent jobs—but whose jobs do not offer family health insurance—can still get their kids covered.
If a family makes even more money—above 211% of the poverty level but still under about 322%—the children can still get MCHP. However, it shifts into a program called “MCHP Premium.”
In MCHP Premium, the medical coverage is exactly the same, but the family has to pay a small monthly bill to the state. This bill is very low compared to buying a private health plan. Depending on the exact income, the family might pay around $50 to $70 a month to cover all the children in the house.
To truly understand how Medicaid fits into your life, it helps to compare it to the other types of health insurance you might hear about.
The names sound almost identical, but they are completely different programs.
Can you have both? Yes. Millions of seniors have both. This is called being “dual eligible.” When you have both, Medicare acts as your main insurance. It pays the big bills first. Then, Medicaid steps in as your secondary insurance and pays the leftover costs that Medicare did not cover, like the Medicare deductibles and copays.
If you do not qualify for Medicaid because you make too much money, your next step is the Affordable Care Act (ACA) Marketplace. In Maryland, this is also handled through Maryland Health Connection.
The difference is that Medicaid is a public program that is almost always free. ACA plans are private plans sold by companies. If you buy an ACA plan, the federal government might help you pay the monthly bill through a tax credit, but you will still likely have a monthly premium, a deductible, and copays. Medicaid removes almost all of those costs.
As mentioned earlier, Maryland uses MCOs to deliver your benefits through the HealthChoice program. If you are approved for Medicaid, you will be told to pick an MCO.
This is a very important step. Why? Because doctors do not accept all MCOs. One hospital might accept UnitedHealthcare Community Plan, but not accept Priority Partners. A local pediatrician might take Maryland Physicians Care, but refuse Amerigroup.
When it is time to pick your MCO, you need to check which company your favorite doctors work with. The state provides a tool to search for doctors by MCO. If you do not choose an MCO within a few weeks of being approved, the state will choose one for you automatically. If they pick one your doctor does not take, you will have to find a new doctor.
Once you have your MCO, you will pick a Primary Care Provider (PCP). Your MCO operates very similarly to a Health Maintenance Organization (HMO). This means your main doctor acts as your guide. You cannot just call up a foot surgeon and make an appointment; you must go to your PCP first, and they will give you a referral to see the surgeon.
The application process has been heavily modernized. You do not have to stand in long lines with stacks of paperwork if you do not want to.
Before you start, you need to know exactly who lives in your house and how much money they make. You should gather:
There are three main ways to apply:
Once the screen or the worker tells you that you are approved, your final step is to select your MCO. You can do this on the same website. Once you click the MCO you want, you are done. Your new MCO will mail you a plastic ID card in about two weeks. Keep that card in your wallet—that is what you show to the pharmacist and the doctor.
Medicaid is not a lifetime guarantee. Because it is based on your income, the state has to check regularly to make sure you still qualify. If you get a new job that pays more money, you might lose your Medicaid.
This checking process is called “Redetermination” or simply “Renewal.” It happens once every 12 months.
Here is how to avoid losing your coverage by accident:
When you get your renewal notice, you might not have to do anything. Often, the state’s computers will check your current tax records, see that you are still poor, and automatically renew you for another year. If the computers cannot verify your income, the letter will ask you to upload or mail in a new pay stub to prove you still qualify.
Sometimes things go wrong. You might apply and get a letter saying you were denied. Or, you might go through your yearly renewal and be told your coverage is being canceled.
If you believe the state made a math error—for example, they counted a roommate’s income as your own—you have the right to appeal. The denial letter will have instructions on how to request a “Fair Hearing.” This is a process where a judge looks at your pay stubs and decides if the state made a mistake. You have to ask for an appeal quickly, usually within a few weeks of getting the letter.
If the state did not make a mistake, and you actually do make too much money for Medicaid now, do not panic. Losing Medicaid is considered a “Qualifying Life Event.”
This means you are granted a Special Enrollment Period. You are allowed to immediately transition over to a private health plan through the ACA Marketplace on Maryland Health Connection. Because your income is still likely on the lower end, you will almost certainly qualify for massive tax credits that will pay for most of the cost of your new private insurance plan. You just have to act fast—you usually only have 60 days from the day your Medicaid ends to pick a new private plan.
Medicaid is a powerful, protective system that ensures no resident of Maryland has to go without essential medical care simply because they cannot afford it. The program completely eliminates the burden of deductibles, high copays, and monthly premiums for hundreds of thousands of people across the state.
If you are currently uninsured and struggling financially, you should not wait to get sick to find out if you qualify. Because there is no open enrollment deadline for Medicaid, you can apply right now.
Your best next step is to gather your most recent pay stubs and visit the Maryland Health Connection to start an application. If you need help, look up a local health navigator in your county. The process is completely free, and finding out if you qualify could save you from catastrophic medical debt in the future.