Topics on this page
- What is Medical Assistance (Medicaid)?
- Eligibility
- Income Eligibility
- Asset Eligibility
- Applying
- Appeals
- Sources of Law
What is Medical Assistance (Medicaid)?
Medical Assistance (also called Medicaid) is a program that pays the medical bills of people who have low income and cannot afford medical care. If you qualify, Medical Assistance pays for medical care such as doctors, hospitals, and prescriptions, mental health treatment, substance abuse treatment, and more.
Eligibility
Generally, to be eligible for Medicaid in Maryland, you must:
- be a Maryland resident;
- be a U.S. citizen or a non-citizen who meets certain immigration status requirements;
- meet income limits; and
- meet asset limits.
To receive Medical Assistance in the “Aged, Blind and Disabled” category, (MA-ABD), you must be either:
- Age 65 or older;
- Blind; or
- Disabled.
To qualify for benefits as disabled, you must meet all of the following:
- You have a significant physical or mental medical impairment;
- Your condition has lasted (or will last) for at least twelve months or it is expected to result in death; and
- You are unable to perform "substantial gainful activity"- that is, you cannot work.
Medical Assistance uses the same disability requirements as the Social Security Administration.
Income Eligibility
To be eligible for MA-ABD, your income must be very low. For an individual, your monthly income must be under $350 (which is called the “medically needy income level”), See the chart below for more details.
You can also “spend down” to qualify for MA-ABD. For an individual, if you incur medical expenses that are greater than $350, you can use those expenses to “spend down” your income, and qualify for MA_ABD.
Monthly spend down amount = Amount of Income – medically needy income level
Spend down is conducted on every six months – so you must have medical expenses equal to six times your monthly spend down amount to qualify.
Medically Needy Monthly Income Level - Eligibility limit by household size
Persons dependent Amount
on income
1 $350
2 $392
3 $434
4 $475
5 $521
6 $573
7 $645
8 $709
The medically needy resource standards of the Medical Assistance - Aged, Blind and Disabled (MA-ABD) program have been effective since July 1, 1989. Revisions to existing standards can be found in the Code of Maryland Regulations (COMAR) 10.09.24.07.
You can also qualify for MA-ABD because you receive Supplemental Security Income (SSI).
Asset Eligibility
MA-ABD has an asset requirement. After excluded assets (such as the home), the asset limit by household size is:
- Individual: $2,500
- Couple: $3,000
- Each additional person Add $100
Regulations (COMAR) 10.09.24.08
Applying
You can apply online, in-person, or over the phone. The Maryland Department of Health's website has a page that lists the available options for the different Medicaid programs.
Appeals
You can appeal any denial, termination, or reduction of benefits
- Appeals must be filed in writing at the DSS office. It is best to file it in person and to get a receipt showing that you filed the appeal.
- Appeals must be filed within 90 days of the action, or you cannot appeal.
- If you file within 10 days of notice that benefits are being terminated or reduced, they will continue until the decision. If you do not appeal within 10 days, the termination or reduction will happen.
Appeal rights and hearings in the Medical Assistance Program are controlled by the regulation at COMAR 10.01.04.
Sources of Law
State Regulations: In the Medical Assistance Program, the Maryland Regulations are by far the most important source of law. The federal regulations, the state statute, and the federal statute are rarely useful in understanding the governing law.
- Eligibility: COMAR 10.09.24.00 to 10.09.24.9999 - Covering financial and non-financial eligibility conditions. (Scroll down to 10.09.24 Medical Assistance Eligibility)
- Coverage: The kinds of medical conditions and medical treatments that are covered by Medical Assistance is very long and very detailed. Generally, the regulations about what is and what is not covered are in COMAR 10.09.01.00 to 10.09.74.9999
- Appeals: COMAR 10.01.04.00 to 10.01.04.9999.
State Law: Md. Ann Code Health General §15-101 to §15-135