Maryland and the ACA’s Medicaid expansion

Enrollment up 53 percent since 2013

Medicaid expansion in Maryland

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Medicaid enrollment in Maryland has grown significantly in the last few years. From September 2013 to December 2017, total enrollment in Maryland’s Medicaid/CHIP grew by 53 percent. Much of that growth is due to the state’s decision to expand Medicaid through the Affordable Care Act (ACA).

Total Medicaid/CHIP enrollment was 1,305,442 as of December 2017. Of that total, more than 315,000 people are enrolled in coverage through expanded Medicaid. And uncompensated care costs in Maryland have dropped significantly: From 7.2 percent of gross patient revenue in fiscal year 2013 to 4.6 percent of gross patient revenue in fiscal year 2016.

Maryland has used Medicaid managed care since 1991. As of July 2017, Medicaid Managed Care Organizations (MCOs) covered more than 89 percent of Maryland’s Medicaid population, while the other 11 percent were covered under the Medicaid Fee for Service program (the Medicaid FFS program includes elderly enrollees who are also eligible for Medicare, and those who are in long-term care facilities).

Everyone who enrolls in Medicaid through the state-run exchange (Maryland Health Connection) is enrolled in an MCO. There are currently nine health insurance carriers that participate in Maryland’s Medicaid Managed Care program.

Who qualifies for Medicaid?

Maryland’s Medicaid program, which is also called Medical Assistance, has higher income limits than most other states. Individuals with family income up to the following levels are eligible for Medicaid:

  • 317 of the federal poverty level (FPL) for children ages 0-18
  • 259 percent of FPL for pregnant women
  • 138 percent of FPL for parents and other adults
  • Aged, blind, and disabled (ABD) individuals may also qualify for Medicaid; see the income and asset guidelines in the FAQs of the Maryland Department of Health and Mental Hygiene website.
  • Maryland helps pay for long-term care for qualifying individuals; see the eligibility criteria and application information.

This table from will help you determine if your income meets the guidelines.

How do you apply for Medicaid?

  • Apply online through SAIL (Service Access and Information Link) or at (the Maryland Health Connection enrollment process does not work for applicants who qualify for Medicaid because they are aged, blind, or disabled, or who are dual-eligible for Medicare and Medicaid).
  • Get an application or apply in person at a local health department or social services office. Call 1-800-456-8900 and have an application mailed to you.
  • For help applying, call 1-855-642-8572 (1-855-642-8573 for individuals who have hearing difficulty)
  • Pregnant women are encouraged to apply at a local health department. Call 1-800-456-8900 for information.

Healthier people, healthier economy with Medicaid expansion

Maryland’s governor authorized Medicaid expansion in May 2013 for a Jan. 1, 2014, start date. Medicaid expansion, which makes Medicaid available to low-income, non-elderly adults with dependents, is one of the Affordable Care Act’s main tenets to reduce the nation’s uninsured rate. To date, 31 states and the District of Columbia have adopted some form of Medicaid expansion, but 19 states have not yet accepted federal funding to expand Medicaid (Maine is supposed to expand Medicaid by July 2018, under the terms of a binding ballot initiative that voters passed in 2017. But Maine’s governor is delaying the process, and it might take longer than expected to implement).

Maryland gathered much information about the impacts of Medicaid expansion before proceeding, and the findings were summarized in a Health Affairs blog by an official with the Maryland Department of Health and Mental Hygiene. Maryland estimated that 190,000 Marylanders would gain Medicaid coverage through the expansion by 2020 and took note of a New England Journal of Medicine research showing a 6.1 percent reduction in mortality for low-income adults covered by expansion. Maryland also learned that Medicaid expansion would have a significant positive effect on the state economy, including an estimated $25 billion in federal Medicaid funding and 27,000 new jobs by 2020.

Expansion of Medicaid exceeded expectation, however. By early 2017, the state reported that 291,000 people had gained coverage in the state as a result of Medicaid expansion.

The outlook for Maryland Medicaid

Republican Larry Hogan took over as Maryland’s governor in January 2015, replacing Democrat Martin O’Malley. O’Malley faced a term limit and was not running for re-election; Lt. Gov. Anthony Brown vied with Hogan.

While Hogan frequently criticized O’Malley and Brown over Maryland’s state-run health insurance exchange, Medicaid expansion was not a campaign issue. In fact, Hogan acknowledged that significant changes to Medicaid were unlikely given Democrats’ dominance in the Maryland General Assembly.

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How to apply in MD

Apply online. Apply in person at a local health department or social services office. Call 1-800-456-8900 and have an application mailed to you. For help applying, call 1-855-642-8572 (1-855-642-8573 for individuals who have hearing difficulty).

Eligibility: Children ages 0-18 with household income up to 317% of FPL. Pregnant women with household income up to 250% of FPL. Adults with household income up to 138% of FPL. Aged, blind, and disabled (ABD) individuals: see income and asset guidelines. See the eligibility criteria for long-term care.

Maryland section