Maryland Children Health Program – Here’s all that you need to know

Introduction and a brief history

The Maryland children’s health program provides full health coverage for children up till the age of 19 and pregnant women irrespective of age that meet the income criteria. The beneficiaries of this program can get care from a range of Managed Care Organizations (MCOs) utilizing the care delivery system through the Maryland Health Choice program. This provides families that qualify, with no-cost or low-cost health coverage.

The Maryland children’s health program is a result of the Balanced Budget Act passed by the US congress in 1997 regarding title XXI the state child health insurance program (SCHIP). The XXI title permitted different states to provide health care facilities and health coverage to a certain segment of the society targeting low-income families. The Federal Government gave states an incentive to provide health care to the low-income sect by matching 65 percent of the expenditure incurred by the states under this program.

Article XXI allowed the states to adopt any of the two simple methods for SCHIP: States could create a separate child health program or expand their existing program, or they could develop an amalgamation of the two ideas which were to be approved by the U.S Department of Health and Human Services.

Maryland decided to implement and expand its already existing program option with effect from July 1, 1998. This coverage was facilitated by state law, Maryland’s Children and Family First Health Care Act of 1998.

Who qualifies for MCHP?

There are two main aspects of eligibility for this program which are both technical and financial.

Technical factors

The technical aspect encompasses factors such as residency in Maryland and citizenship in the United States or qualifying immigration status. Details on citizenship status or alien status can be obtained in the Code of Md. Regulations, to ascertain if you are eligible.

Immigrant pregnant women and children who are qualified otherwise, except for not meeting the 5-year bar can be considered for the MCHP and MCHP premium. However, other non-pregnant adult immigrants are eligible for medical emergency services only.

Children and women who qualify under the Maryland Children’s health program receive a red and white medical identification card and are enrolled in HealthChoice. However, immigrants who are eligible for emergency service coverage are not allowed to be enrolled in HealthChoice and their benefits are paid on payment for service basis.

Financial factors

Financial factors require that the family income has to be within the permissible income standards for the size of the family. These Income standards are based on Federal Poverty Level (FPL) and they change annually.

Uninsured Children who are under the age of 19 years and whose family income is at or below 200 percent of the Federal Poverty level (FPL) are qualified for the MCHP and those with income at or below 300 percent of FPL for MCHP premium. This was around $4,608 per month and $7,032 per month for MCHP and MCHP premium respectively, for a family of four in 2020.

The premium Maryland Children Health Program is subject to a minimal monthly premium per family depending on the family income.

Pregnant women of any age are eligible as long as they are pregnant or in the first or second postnatal month and have a family income at or below 250 percent FPL.

Grandparents can also apply for the MCHP service for their grandchild if the child resides with them and neither of the child’s parents resides in the home. In such a case the grandparent’s income will not be considered while determining the eligibility of the child unless the child is adopted.

What are the benefits of MCHP?

The Maryland Children Health Program provides extensive benefits which include but are not limited to:

  • Visits to the Doctor (Well and sick)
  • Mental health services
  • Dental treatments
  • Hospitalization
  • Lab work and Tests
  • Ophthalmology-Vision care
  • Prescription Medication
  • Immunizations (includes vaccinations)
  • Transportation facilities to Medical Appointments
  • Substance abuse Treatment

More exhaustive details on the benefits can be obtained from the HealthChoice MCO comparison chart or by visiting the Maryland CHIP website.

How to apply for MCHP?

Applying for MCHP can be done in any one of the following ways:

  • You can visit a local health department,
  • You can apply online,
  • Download the mobile app,
  • Call at 1-855-642-8572 (TTY: 1-855-642-8573)

If found eligible the approval takes 14 days and a medical assistance card is issued giving details clarifying how to select a managed care organization and a doctor. For further details and any assistance, you can visit their website.

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