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Maryland and the ACA’s Medicaid expansion

Enrollment up 81% since 2013; Legislation introduced in 2022 to add adult dental to Maryland Medicaid

ACA’s Medicaid eligibility expansion in Maryland

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Maryland Medicaid expansion was authorized in May 2013 for a Jan. 1, 2014, start date. Medicaid expansion, which makes Medicaid available to low-income, non-elderly adults, is one of the Affordable Care Act’s main tenets to reduce the nation’s uninsured rate. As of early 2022, 38 states and the District of Columbia had adopted the ACA’s Medicaid expansion, while a dozen states had not.

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% reduction in mortality for low-income adults covered by expanded Medicaid. 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.

As has been the case in every state, Medicaid enrollment (including Medicaid expansion enrollment) has surged during the COVID pandemic, pushing total enrollment far higher than it would otherwise have been. As of 2021, there were 366,815 Medicaid expansion enrollees in Maryland.

The higher-than-expected enrollment stems partly from the widespread job losses caused by the pandemic. But the primary driver of the high enrollment is the Families First Coronavirus Response Act, which provides states with additional federal Medicaid funding for the duration of the COVID public health emergency period, but on the condition that the state does not disenroll anyone from Medicaid during the COVID emergency period. So the normal Medicaid eligibility redeterminations have been paused since March 2020, with Medicaid enrollment only trending upward throughout the pandemic.

After the COVID public health emergency period ends, states will once again start to redetermine Medicaid enrollees’ eligibility for coverage, and enrollment is expected to trend sharply downward.

Maryland has accepted federal Medicaid expansion

  • 1,551,687 – Number of Marylanders covered by Medicaid/CHIP as of September 2021
  • 695,390 – Increase in the number of Marylanders covered by Medicaid/CHIP fall 2013 to September 2021
  • 47% – Reduction in the uninsured rate from 2010 to 2019
  • 81% – Increase in total Medicaid/CHIP enrollment in Maryland since Medicaid expansion took effect

Legislation introduced in 2022 to add adult dental coverage to Maryland Medicaid

Since the early 1990s, Maryland has not provided coverage for adult dental care through its Medicaid program (most states provide at least limited or emergency dental coverage for adults enrolled in Medicaid; Maryland is one of just three states that provides no coverage at all). Legislation (HB6 and SB150) has been introduced in 2022 that would add an adult dental benefit to the state’s Medicaid program as of 2023.

Children with Medicaid already have coverage for dental care in Maryland, as is the case nationwide. And Maryland did implement a program in 2019 to provide dental benefits to Maryland residents age 21-64 who are dually enrolled in Medicaid and Medicare (ie, they are disabled and have low incomes and low assets). But the state estimated that fewer than 39,000 people would be eligible for benefits under this program. If HB6/SB150 were to be enacted, a far larger population of low-income residents would gain access to dental care.

The legislative session in Maryland ends April 11, 2022, and the crossover deadline is March 21. Both bills were still in committee in their originating chambers as of early March.

Who is eligible for Medicaid in Maryland?

Maryland’s Medicaid program, which is also called Medical Assistance, has higher income limits than many other states when it comes to Medicaid eligibility for children and people who are pregnant. Individuals with family income up to the following levels are eligible for Medicaid (note that these limits include the build-in 5% income disregard that’s used for MAGI-based Medicaid eligibility):

  • 322% of the federal poverty level (FPL) for children ages 0-18
  • 264% of FPL for someone who is pregnant (note that a pregnant person counts as two people when determining how the household income compares with the federal poverty level)
  • 138% 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.

For ease of reference, the Maryland Connector website shows the monthly income limits in terms of dollar amounts rather than percentage of FPL.

How does Medicaid provide assistance to Medicare beneficiaries in Maryland?

Many people with Medicare receive help through Medicaid with Medicare premium costs, prescription drug expenses, and expenses that Medicare doesn’t cover — such as long-term care.

Our guide to financial resources for Medicare enrollees in Maryland provides an overview of those programs, including Medicare Savings Programs, nursing home benefits, and income guidelines for assistance.

How do I enroll in Medicaid in Maryland?

In general, you can enroll for Maryland Medicaid online or in person. See below for specifics, which vary for different eligible groups.

  • If you are under 65 and don’t have Medicare, apply online through SAIL (Service Access and Information Link) or at
  • Seniors and people who have Medicare can apply for Medicaid using this website.
  • 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)
  • People who are pregnant are encouraged to apply at a local health department. Call 1-800-456-8900 for information.

Maryland Medicaid enrollment

Medicaid enrollment in Maryland has grown significantly in the last few years. From September 2013 to September 2021, total enrollment in Maryland’s Medicaid/CHIP grew by 81%. Total Medicaid/CHIP enrollment was 1,551,687 as of September 2021. As of 2021, there were 366,815 people enrolled in Medicaid expansion in Maryland (Medicaid expansion is called Group VIII).

Maryland has used Medicaid managed care since 1991. As of July 2019, Medicaid Managed Care Organizations (MCOs) covered about 86% of Maryland’s Medicaid population, while the other 11% 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).

There are currently nine health insurance carriers that participate in Maryland’s Medicaid Managed Care program:

  • Aetna Better Health
  • Amerigroup Community Care
  • CareFirst BlueCross Blue Shield Community Health Plan
  • Jai Medical Systems
  • Kaiser Permanente
  • Maryland Physicians Care
  • MedStar Family Choice
  • Priority Partners
  • UnitedHealthcare

Maryland’s leadership and Medicaid expansion

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.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Maryland

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.

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