Maryland Medicaid Pharmacy Program

Maryland Medical Programs

Updated
January 19, 2012

Maryland Medicaid Pharmacy Program

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INFORMATION FOR CONSUMERS


The Maryland Medicaid Pharmacy Program (MPP) Provides services for the following programs:

Medical Assistance

Receive complete pharmacy services.

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

Receive only contraceptives.

Medicare Part D

Fully dual eligible Medicare beneficiaries receive most drugs excluded from Medicare Coverage -- All other drugs are provided by Medicare Prescription Drug Programs (PDPs).

INFORMATION FOR PROVIDERS

Page Last Updated

01/19/2012

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.

What is the cost for services?

The amount of the co-payment depends upon the program. The following table shows the amounts for generic and preferred brand name drugs as well as other brand name drugs.

Fee for Service Co-Payments

Program	Generic and Preferred Brand Name Drugs	Other Brand Name Drugs
Medical Assistance (Fee-for-service recipients)	$1.00	$3.00
HealthChoice (Most Mental Health Drugs and HIV/AIDS drugs Only)	$1.00	$3.00
Primary Adult Care (PAC) (Mental health and HIV/AIDS drugs only)	$2.50	$7.50
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.

How do individuals apply for Medicaid?

People who receive Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA) automatically qualify for Medicaid and do not need to apply. Please see the Medicaid/Medical Assistance Overview page for enrollment information.

If you do not receive SSI or TCA, you must file an application to find out if you are eligible for Medicaid. To do this, you must go to the Local Department of Social Services (LDSS) in the city or county where you live. If you are applying for a child or are pregnant, you may file an application for the Maryland Children’s Health Program (MCHP), which covers the same services as Medicaid. You may apply at your Local Health Department (LHD) for MCHP or to be screened for breast or cervical cancer. If you are elderly and are only applying for assistance with paying your Medicare premiums, co-payments, or deductions, you may apply at your local Area Agency on Aging (AAA).

How to apply for the Maryland Primary Adult Care Program

The Primary Adult Care Program uses a one-page, two-sided, mail-in application. The completed mail in application requires documentation of income, assets and certain other information. To request an application, call toll free, 1-800-226-2142 or for Maryland Relay Service call 1-800-735-2258. A copy of the application and instructions are available to you on-line. (Click HERE) for an application and instructions). Applications will NOT be accepted via email or fax. All applications must be submitted only by mail to:

PAC Eligibility Services
P.O. Box 386
Baltimore, Maryland 21203-0386

The Maryland Medicaid Pharmacy Program Recipient Access Hotline

Recipients with pharmacy related issues may call the toll-free Medicaid Pharmacy Program Recipient Access Hotline at 1-800-492-5231. Local Baltimore Metropolitan area callers may dial 410-767-5800. Do not use these numbers for eligibility or enrollment issues. Calls are accepted from 8:00 a.m. to 5:00 p.m. Monday through Friday. Callers may leave a message before or after hours and on weekends and holidays. Pharmacy staff will return calls on the next business day.