Understanding Medicaid expansion under health reform

Medicaid will undergo a major expansion under health reform. Charles Milligan, the state's deputy secretary for health care financing, explains who will qualify.

Who in Maryland qualifies for Medicaid under health reform and how do they enroll?


Under health reform, Medicaid will expand to cover more Marylanders than ever before.

On Jan. 1, Medicaid eligibility will expand for adults under the age of 65. A single adult making up to about $15,000 a year will qualify for comprehensive Medicaid benefits, as will an adult in a household of four making up to about $31,000.

Also on Jan. 1, a limited benefit program that Medicaid has offered since 2006 will get better for the adults now enrolled in that program. Several years ago, Medicaid began offering a limited benefit program for low-income adults called the Primary Adult Care (or "PAC") Program. PAC only covers primary care visits, prescription drugs, emergency room bills, and mental health and substance abuse treatment. The PAC program does not cover hospital stays, or most specialty services.

On Jan. 1, the PAC program will convert into a comprehensive Medicaid benefit. About 81,000 Maryland adults now enrolled in PAC will automatically switch to full Medicaid benefits without needing to re-apply.

One more group is included in the Medicaid expansion. Adults who were in Maryland's foster care system when they turned 18 will be covered by Medicaid until they turn 26, regardless of income.

It is important to note that Medicaid's comprehensive benefit package will not change under health reform. For everyone now enrolled, there is no need to re-apply. The newly eligible and former PAC enrollees will receive the same comprehensive benefits as the current eligible people.

The application process will be getting easier. Individuals will be able to apply for Medicaid online through the Maryland Health Connection, at

Individuals already enrolled in Medicaid will be able to use the online system when they need to annually renew their coverage. For more information, people can call 1-855-642-8572 or visit their local health department or department of social services.

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