Medicaid, SCHIP, and Federal Authority²

Section 1115 Waiver - Maryland initially received approval for a Health Reform Demonstration in 1996 for its HealthChoice managed care program. There have been several amendments to the original waiver and it was renewed in 2005. As of June 2005, the waiver included expansions in coverage for the Maryland Pharmacy Programs, family planning services, Employed Persons with Disabilities Program, and the Maryland Primary Adult Care program. Under the Maryland Primary Adult Care program, adults up to 116 percent FPL who are ineligible for Medicaid and Medicare will receive primary care, outpatient mental health, and pharmacy services. The Maryland Primary Adult Care program began enrollment in July 2006. The Employed Persons with Disabilities Program provides full Medicaid coverage to disabled individuals with incomes up to 300 percent FPL and began April 2006.

High-Risk Pool  

Since 2003, Maryland has offered a health insurance program, The Maryland Health Insurance Plan (MHIP), to residents who are considered uninsurable either because they are high risk or have a history of medical problems that makes it difficult for them to find affordable insurance coverage in the individual market. In December 2005, MHIP introduced a special premium subsidy program for low income enrollees. Called MHIP+, the program offers discounted premiums and deductibles to individuals with incomes under 225 percent FPL.

MHIP also serves as the "fallback" option under the federal Health Insurance Portability and Accountability Act's (HIPAA) guaranteed portability requirement for those individuals transitioning from group to individual coverage. Maryland 's risk pool is funded by assessments on Maryland hospitals' net patient revenues, a subsidy mechanism that distributes the cost of the risk pool broadly.

As of November 2006, MHIP has more than 9,500 enrollees.

Limited-Benefit Plan  

The Minimum Benefit Legislation ( SB 570 ), enacted in 2004, requires carriers who insure > 10 percent of the covered lives in the small group market to offer a limited-benefit plan. Other carriers may offer if they choose. The actuarial value of the limited plan cannot exceed 70 percent of the actuarial value of the comprehensive standard health benefit plan. The limited-benefit plan is only open to small employers with an average employee wage of less than 75 percent of the state average annual wage and who have not offered health benefits within the last 12 months. Limited-benefit plans became available to qualified small employers beginning July 1, 2005.

Dependent Coverage

Enacted legislation in 2007 (House Bill 1057) allows young adults (including child dependents of domestic partners) to remain eligible for insurance until the age of 25 if the individual resides with the insured policyholder and is unmarried.

Other

Maryland AIDS Drug/Insurance Assistance Program - MADAP is a statewide program which helps low-to-moderate income Maryland residents who are HIV-infected. The MADAP formulary covers a range of medication used to treat HIV infection and to treat, prevent, or relieve certain conditions associated with HIV infection. The income guidelines for MADAP, and MADAP-Plus, are based on 500 percent FPL. The income guidelines for MAIAP (Insurance) are based on 300 percent FPL.

Hospital All-Payor Rate Setting System - Since 1977 Maryland has operated a hospital all-payor system. Under this system the Maryland Health Services Cost Review Commission (HSCRC) sets rates that Maryland 's hospitals may charge. This payment system distributes the cost of hospital uncompensated care among all purchasers including Medicare, Medicaid, commercial carriers, and self-paying patients. Medicare is required to pay these state-established rates for hospital services under a unique federal waiver.

Notes and Sources

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