Maryland Medicaid DataPort
Calendar Year (CY) vs. Fiscal Year (FY)
A calendar year (CY) begins on January 1 and ends on December 31. For instance, CY 2021 began on January 1, 2021, and ended on December 31, 2021. This is the traditional year observed on calendars.
A fiscal year (FY) begins on July 1 and ends on June 30. For instance, FY 2021 began on July 1, 2020, and ended on June 30, 2021. Many businesses, governments, and other organizations operate on a fiscal year basis.
In accordance with The Hilltop Institute’s cell suppression policy, the DataPort sometimes displays an asterisk (*) instead of a number. This is cell suppression. Data privacy standards require that any cell with a value between 1 and 10 must be suppressed. In addition, any cell that can be used to mathematically derive the value must be suppressed. In cases where only one cell in a table must be suppressed, the DataPort also suppresses the cell with the next highest value, even if that value is greater than 10.
Health Insurance Portability and Accountability Act
Health Information Technology for Economic and Clinical Health
Medicaid Management Information System, version 2
HealthChoice is the name of Maryland’s Medicaid managed care program. For more information about HealthChoice, please visit the Maryland HealthChoice Program website.
HealthChoice Managed Care Organization (MCO) vs. Fee-For-Service (FFS) Medicaid
Most Marylanders in Medicaid are enrolled in HealthChoice, where the Medicaid program pays MCOs, who then compensate the health care providers. However, some individuals are ineligible for enrollment in a HealthChoice MCO and are instead served under FFS Medicaid, where the Medicaid program pays the health care providers directly.
HealthChoice Coverage Categories
Affordable Care Act Expansion:
This category contains enrollees who were determined eligible based on their income, as established by the Affordable Care Act (ACA) Medicaid expansion.
Aged, Blind, or Disabled:
This category contains enrollees who were determined eligible for Medicaid based on their disability or their eligibility for other programs such as Supplemental Security Income (SSI).
Families and Children:
This is a broad category that includes a range of enrollees. Some in this category were determined eligible for Medicaid based on their income, some based on their life circumstances (e.g. formerly in foster care, refugees), and others based on a combination of income and health needs (e.g. pregnant women).
Maryland Children’s Health Program:
This category contains children whose household income qualifies them for coverage. The income guidelines in Maryland Children’s Health Program (MCHP) are higher than in Medicaid Families & Children, and may not extend coverage to adults in the household.
This category consists of enrollees who are not in any of the other categories above. Enrollees in partial-benefit Medicaid programs such as the Family Planning Program and Emergency Services for Undocumented or Ineligible Aliens are included in this category, as well as those eligible for Medicaid through the Women’s Breast & Cervical Cancer Program.
Unknown Coverage Category:
This category contains enrollees for whom the coverage category is missing or blank.
Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services. To learn more about managed care, please visit the Managed Care page on Medicaid.gov.
Maryland Medicaid’s managed care program is called HealthChoice.
Managed Care Organization (MCO)
An MCO is a health care organization that provides services to Medicaid recipients by contracting with a network of licensed/certified health care providers. There are nine MCOs that participate in HealthChoice.
Participating HealthChoice MCOs
Aetna Better Health
CareFirst BlueCross Blue Shield Community Health Plan Maryland
Jai Medical Systems
Maryland Physicians Care
MedStar Family Choice
For more information about HealthChoice and MCOs, please visit the Maryland HealthChoice Program website.
The DataPort shares data from January 2010 to the present. During that time, some MCOs have joined HealthChoice, some have departed, and some have changed names. Here is a summary of MCO changes during the period covered by the DataPort.
- January 2023 – Amerigroup Community Care becomes Wellpoint Maryland
- January 2021 – University of Maryland Health Partners becomes CareFirst BlueCross Blue Shield Community Health Plan Maryland
- November 2017 – Aetna Better Health joins HealthChoice
- January 2016 – Riverside becomes University of Maryland Health Partners
- June 2014 – Kaiser Permanente joins HealthChoice
- October 2013 – Coventry leaves HealthChoice
- February 2013 – Riverside joins HealthChoice
Primary Adult Care Program (PAC)
PAC was a program to extend limited Medicaid benefits to adults who would not otherwise qualify. The program ended after 2013, when the Affordable Care Act Medicaid expansion went into effect.
To find the number of individuals who were enrolled in PAC during 2010, 2011, 2012, or 2013, you will need three separate numbers:
- The total when selecting “All Medicaid” from the Medicaid Enrollment drop-down list.
- The total when selecting “HealthChoice: All MCOs” from the Medicaid Enrollment drop-down list.
- The total when selecting “Fee-for-Service Medicaid” from the Medicaid Enrollment drop-down list.
Subtract the “HealthChoice: All MCOs” and “Fee-for-Service Medicaid” totals from the “All Medicaid” total. The number that remains is the PAC population.
Long Term Services and Support (LTSS)
LTSS Waivers and Programs
Maryland Medicaid’s LTSS include home and community-based services offered through the regular Medicaid program and special Medicaid programs called “waivers.” Each waiver has a different eligibility criteria and target population, such as older adults or individuals with a specific disability.
Brain Injury Waiver
Community Options Waiver
Community Pathways Waiver
Community Supports Waiver
Family Supports Waiver
Increased Community Services Program
Medical Day Care Waiver
All of the above except for the Increased Community Services Program are 1915(c) waivers.
Community Pathways, Community Supports, and Family Supports are also Developmental Disabilities Administration (DDA) waivers.
The Rare and Expensive Case Management (REM) Program is a case management fee-for-service alternative to HealthChoice MCO participation for recipients with specified rare and expensive conditions.
Individuals who are dually eligible for both Medicare and Medicaid fall into two categories: (1) full-benefit dual eligibles (“full duals”) and (2) partial-benefit dual eligibles (“partial duals”). Full duals qualify for full Medicaid benefits, which include services not traditionally covered by Medicare. Maryland’s partial duals are not eligible for Medicaid benefits; instead, they receive assistance with Medicare premiums and cost-sharing through Maryland’s Medicare Savings Program (MSP). Examples of partial duals include Qualified Medicare Beneficiaries (QMBs) and Specified Low-Income Medicare Beneficiaries (SLMBs). For the purposes of LTSS Enrollment, participants are shown as either Not Dual (no Medicare) or Dual (includes both full and partial duals).