Becoming a Member
Who is eligible for HealthChoice?
The HealthChoice Program is mandatory for Medicaid eligibles who qualify, which includes most Medicaid recipients. About 75% of all Medicaid eligibles are in HealthChoice. Any participant who enrolls in Medicaid through Maryland Health Connection, must enroll in HealthChoice.
Who is NOT eligible for the HealthChoice Program?
While most Medicaid recipients are eligible to participate in HealthChoice, due to certain circumstances or conditions of Medicaid eligibility, some are not eligible to be enrolled in an MCO. These recipients include:
- individuals who receive Medicare,
- individuals who are 65 years or older,
individuals who are eligible for Medicaid under spend down,
- Medicaid recipients who have been or expected to be continuously institutionalized for more than 30 successive days in a long term care facility or in an institution for mental diseases (IMD),
- individuals institutionalized in an intermediate care facility for mentally retarded persons (ICF-MR),
- recipients enrolled in the Model Waiver, and
- recipients enrolled in limited coverage categories, such as women who receive family planning services through the Family Planning Program.
How Do I Enroll in the HealthChoice Program?
If you qualify for Medicaid because you receive payments from either Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA), or as a result of the Medicaid application process, you would likely be eligible for HealthChoice. If you applied for Medicaid through Maryland Health Connection, you will be required to enroll in HealthChoice.
HealthChoice enrollment is conducted through an enrollment broker that is contracted by DHMH. The enrollment broker performs outreach, education, and the enrollment of most Medicaid-eligible beneficiaries into HealthChoice. The enrollment broker sends information about Managed Care Organizations (MCOs) that are available in your county of residence so that you can choose your own health plan and provider. The information packet that you will receive includes:
- the names and addresses of participating providers;
- a schedule of the benefits offered, including any benefits offered beyond the basic required package;
- a narrative description of the clinical expertise and experience of the MCO’s network for special needs populations;
- any forms necessary to select an MCO (including a Health Service Needs Information form); and
- the toll-free telephone number of the enrollment unit.
The Enrollment Broker is available to assist you with any aspect of the enrollment process. You may enroll by mail, telephone, and face-to-face meeting, if requested, or if medically necessary. For assistance with enrolling in HealthChoice, please contact the HealthChoice Enrollment Line at (800) 977-7388. You may call Monday-Friday 7:00 a.m. – 7:00 p.m.
Visit the Maryland Health Connection main Medicaid information page for more FAQs and to see benefits covered.
HealthChoice is a program of the Maryland Department of Health and Mental Hygiene.
Source: Department of Health and Mental Hygiene; Maryland HealthChoice Program