Maryland and the ACA & Medicaid expansion

Key takeaways

Maryland opted to expand Medicaid under the Affordable Care Act; coverage for the expansion population started January 1, 2014.
Maryland’s Medicaid eligibility limits are generous in comparison to those of many other states.
Maryland’s Medicaid enrollment was more than 1.2 million as of June 2020.

Medicaid 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 with dependents, is one of the Affordable Care Act’s main tenets to reduce the nation’s uninsured rate. As of October 1, 2020, 38 states and the District of Columbia have adopted some form of Medicaid expansion.

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.

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.

Who is eligible for Medicaid in Maryland?

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.

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

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.

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.

Maryland Medicaid enrollment

Medicaid enrollment in Maryland has grown significantly in the last few years. From September 2013 to June 2020, total enrollment in Maryland’s Medicaid/CHIP grew by 60 percent. Total Medicaid/CHIP enrollment was 1,230,457 as of June 2020. Based on June 2019 data, the Medicaid expansion total was 310,000.

Maryland has used Medicaid managed care since 1991. As of July 2019, Medicaid Managed Care Organizations (MCOs) covered about 86 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).

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


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