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INFORMATION FOR
CONSUMERS
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The Maryland
Medicaid Pharmacy Program (MPP)
Provides services for the following programs:
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Medical Assistance |
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Receive complete
pharmacy services. |
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HealthChoice |
|
Receive most mental
health drugs and
AIDS/HIV drugs
- All other drugs are provided by HealthChoice Managed
Care Organizations (MCOs). |
|
Primary Adult Care (PAC) |
|
Receive most mental
health drugs and AIDS/HIV drugs - All other drugs are provided
by PAC Managed Care Organizations (MCOs). |
|
Family Planning |
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Receive only
contraceptives. |
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Medicare Part D |
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Fully dual eligible
Medicare beneficiaries receive most drugs excluded from Medicare
Coverage -- All other drugs are provided by Medicare
Prescription Drug Programs (PDPs). |
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INFORMATION FOR PROVIDERS
Page Last Updated
08/11/2010
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Do eligibility requirements differ for
various benefit groups? |
Yes, however, all applicants
must be U.S. citizens or qualified aliens.
Medicaid is available to low-income persons
in certain categories. Federal Medicaid laws require that every
state cover certain groups. For example, people
who receive money through Supplemental Security (SSI) or Temporary Cash
Assistance (TCA) automatically receive Medicaid. In addition,
persons may qualify or Medicaid because of high medical expenses
(commonly hospital or nursing home care), if they have low income and
assets and are aged, blind, or disabled. Coverage is also allowed
for certain optional categories. For full eligibility requirements
for the groups covered by Maryland's Medicaid Program, see
Medical Care Programs Eligibility .
The HealthChoice
program is Maryland's Medicaid managed care program. It is a
mandatory program for most of the Medical Assistance population. A
recipient in HealthChoice will receive health care services through a
managed care organization (MCO). Approximately 80 percent of the
Medicaid population participates in HealthChoice.
The Maryland
Primary Adult Care program is for
people aged 19 and over, who are not eligible for Medicare. They
must have incomes (such as earnings and social security)
at or below $1,005
monthly for one person ($1,167
monthly for a couple). Their assets (such as bank accounts,
etc.) must be below $4,000 for one person ($6,000 for a couple).
The Family Planning
program provides medical services related to family planning for women
who lost their Medicaid coverage after they were covered for a pregnancy
under the Maryland Children's Health Program (MCHP). The covered
services include medical office visits, physical examinations,
contraceptives, certain laboratory services, family planning supplies,
reproductive education, counseling and referral, and tubal ligation.
Coverage for family planning services may continues for up to five
years.
Medicare Part D
provides complete pharmacy services to individuals who are eligible for
both Medicare and Medicaid except certain drugs that are excluded from
Medicare. Medicaid provides most of those excluded drugs to dual
eligible recipients. For contact information on each of the Medicare
Part D Prescription Drug Plans
Click Here.
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What
is the cost for services? |
|
Program |
Generic and Preferred
Brand Name Drugs |
Other Brand
Name Drugs |
|
Medical Assistance (Fee-for-service recipients) |
$1.00 |
$3.00 |
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HealthChoice (Most Mental Health Drugs and
HIV/AIDS drugs
Only) |
$1.00 |
$3.00 |
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Primary Adult Care (PAC) (Mental health and HIV/AIDS drugs only) |
$2.50 |
$7.50 |
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Family Planning (Contraceptives only) |
None |
None |
|
Medicare Part D Dual Eligible Recipients (Medicare excluded drugs
only) |
$1.00 |
$3.00 |
Note: For Medical Assistance and HealthChoice recipients, the
copayment for both generic and brand name HIV/AIDS drugs is $1.00.
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How do
individuals apply for Medicaid? |
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How to apply for the Maryland Primary Adult Care
Program |
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The Maryland Medicaid
Pharmacy Program Recipient Access Hotline |
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