# Health - General (GHG)

## Title 15. Assistance Programs

### Subtitle 1. Medical and Pharmacy Assistance Programs

#### Section 15-103

(a) The Secretary shall administer the Maryland Medical Assistance Program.

(b) The Program:

  (1) Subject to the limitations of the State budget, shall provide medical and other health care services for indigent individuals or medically indigent individuals or both;

  (2) Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical, dental, and other health care services, including services provided in accordance with Sec. 15-141.5 of this subtitle, for all eligible pregnant women whose family income is at or below 250% of the poverty level for the duration of the pregnancy and for 1 year immediately following the end of the woman's pregnancy;

  (3) Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical and other health care services for all eligible children currently under the age of 1 year whose family income falls below 185% of the poverty level;

  (4) Beginning on January 1, 2012, shall provide, subject to the limitations of the State budget and as permitted by federal law, family planning services to all women whose family income is at or below 200% of the poverty level;

  (5) Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical and other health care services for all children who are at least 1 year old and under the age of 5 years whose family income falls below 133% of the poverty level;

  (6) Beginning on January 1, 2014, shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical care and other health care services for all children who are at least 6 years old and under the age of 19 years whose family income falls below 133% of the poverty level;

  (7) Shall provide, subject to the limitations of the State budget and as permitted by federal law, comprehensive medical care and other health care services for all legal immigrants who meet Program eligibility standards and who arrived in the United States before August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act;

  (8) Shall provide, subject to the limitations of the State budget and any other requirements imposed by the State, comprehensive medical care and other health care services for all legal immigrant children under the age of 18 years and pregnant women who meet Program eligibility standards and who arrived in the United States on or after August 22, 1996, the effective date of the federal Personal Responsibility and Work Opportunity Reconciliation Act;

  (9) Beginning on January 1, 2014, shall provide, subject to the limitations of the State budget, and as permitted by federal law, medical care and other health care services for adults whose annual household income is at or below 133% of the poverty level;

  (10) Subject to the limitations of the State budget, and as permitted by federal law:

    (i) Shall provide comprehensive medical care, dental care, and other health care services for former foster care adolescents who, on their 18th birthday, were in foster care under the responsibility of the State and are not otherwise eligible for Program benefits; and

    (ii) May provide comprehensive medical care, dental care, and other health care services for former foster care adolescents who, on their 18th birthday, were in foster care under the responsibility of any other state or the District of Columbia;

  (11) May include bedside nursing care for eligible Program recipients;

  (12) Shall provide services in accordance with funding restrictions included in the annual State budget bill;

  (13) Beginning on January 1, 2023, shall provide, subject to the limitations of the State budget, and as permitted by federal law, dental services for adults, including diagnostic, preventive, restorative, and periodontal services, whose annual household income is at or below 133 percent of the federal poverty level;

  (14) Shall provide, subject to the limitations of the State budget, medically appropriate drugs that are approved by the United States Food and Drug Administration for the treatment of hepatitis C, regardless of the fibrosis score, and that are determined to be medically necessary;

  (15) Shall provide, subject to the limitations of the State budget, health care services appropriately delivered through telehealth to a patient in accordance with Sec. 15-141.2 of this subtitle;

  (16) Beginning on January 1, 2021, shall provide, subject to the limitations of the State budget and Sec. 15-855(b)(2) of the Insurance Article, and as permitted by federal law, services for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy, for eligible Program recipients, if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis purposes in accordance with Sec. 15-855(d) of the Insurance Article;

  (17) Beginning on January 1, 2022, may not include, subject to federal approval and limitations of the State budget, a frequency limitation on covered dental prophylaxis care or oral health exams that requires the dental prophylaxis care or oral health exams to be provided at an interval greater than 120 days within a plan year;

  (18) Shall provide, subject to the limitations of the State budget, comprehensive medical care and other health care services to noncitizen pregnant women who would be eligible for the Program but for their immigration status and to their children up to the age of 1 year;

  (19) Shall provide coverage of abortion care services to Program recipients in the manner described in Sec. 15-857(b)(1)(ii) and (2) of the Insurance Article;

  (20) Beginning on July 1, 2023, shall provide, subject to federal approval and limitations of the State budget, community violence prevention services in accordance with Sec. 15-141.3 of this subtitle;

  (21) Beginning on January 1, 2023, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for self-measured blood pressure monitoring for all Program recipients diagnosed with uncontrolled high blood pressure, including:

    (i) The provision of validated home blood pressure monitors; and

    (ii) Reimbursement of health care provider and other staff time used for patient training, transmission of blood pressure data, interpretation of blood pressure readings and reporting, and the delivery of co-interventions, including educational materials or classes, behavioral change management, and medication management;

  (22) Beginning on January 1, 2024, shall provide gender-affirming treatment in accordance with Sec. 15-151 of this subtitle;

  (23) Beginning on July 1, 2025, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for biomarker testing in accordance with Sec. 15-859 of the Insurance Article;

  (24) Beginning on January 1, 2025, shall provide coverage for prostheses in accordance with Sec. 15-844 of the Insurance Article;

  (25) Beginning on January 1, 2026, shall provide, subject to the limitations of the State budget, and as permitted by federal law, coverage for self-measured blood pressure monitoring for eligible Program recipients in accordance with Sec. 15-141.6 of this subtitle;

  (26) Beginning on January 1, 2026, shall provide coverage for a transfer to a special pediatric hospital in accordance with Sec. 15-158 of the Insurance Article;

  (27) Beginning on January 1, 2026, if providing coverage for the delivery of anesthesia, shall provide coverage for the delivery of anesthesia in accordance with Sec. 15-862 of the Insurance Article;

  (28) Beginning on January 1, 2026, shall provide calcium score testing in accordance with Sec. 15-863 of the Insurance Article; and

  (29) Beginning on January 1, 2027, may provide comprehensive coverage for the treatment of obesity under Sec. 15-160 of this subtitle.

(c) Subject to restrictions in federal law or waivers, the Department may:

  (1) Impose cost-sharing on Program recipients; and

  (2) For adults who do not meet requirements for a federal category of eligibility for Medicaid:

    (i) Cap enrollment; and

    (ii) Limit the benefit package.

(d) Subject to the limitations of the State budget, the Department shall implement the provisions of Title II of the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, to include:

  (1) Parents and caretaker relatives who have a dependent child living in the parents' or caretaker relatives' home; and

  (2) Adults who do not meet requirements, such as age, disability, or parent or caretaker relative of a dependent child, for a federal category of eligibility for Medicaid and who are not enrolled in the federal Medicare program, as enacted by Title XVII of the Social Security Act.

(e)

  (1) On or before January 1, 2025, subject to the limitations of the State budget, and as permitted by federal law, the Department:

    (i) Shall establish an Express Lane Eligibility Program to enroll individuals in the Program and Maryland Children's Health Program based on eligibility findings by the Supplemental Nutrition Assistance Program;

    (ii) May not consider any other income or eligibility requirements;

    (iii) To the extent that a waiver is needed to maximize the number of State residents who may qualify for the Express Lane Eligibility Program, shall apply to the Centers for Medicare and Medicaid Services for one or more waivers under Sec. 1115 of the federal Social Security Act to implement the Express Lane Eligibility Program; and

    (iv) Subject to paragraph (2) of this subsection, shall make all reasonable efforts to expedite enrollment of eligible individuals in the Express Lane Eligibility Program.

  (2) The Department may propose or implement the use of Express Lane Eligibility for renewals before proposing or implementing the use of Express Lane Eligibility for initial enrollment.

(f)

  (1) The Department shall ensure that payments for services provided by a hospital located in a contiguous state or in the District of Columbia to an enrollee under the Program shall be reduced by 20% if the hospital fails to submit discharge data on all Maryland patients receiving care in the hospital to the Health Services Cost Review Commission in a form and manner the Commission specifies.

  (2) Paragraph (1) of this subsection does not apply to a hospital that presently provides discharge data to the public in a form the Health Services Cost Review Commission determines is satisfactory.

(g)

  (1)

    (i) In this subsection the following words have the meanings indicated.

    (ii) "Certified nurse practitioner" means a registered nurse who is licensed in this State, has completed a nurse practitioner program approved by the State Board of Nursing, and has passed an examination approved by that Board.

    (iii) "Nurse anesthetist" means a registered nurse who is:

      (1) Certified under the Health Occupations Article to practice nurse anesthesia; and

      (2) Certified by the Council on Certification or the Council on Recertification of Nurse Anesthetists.

    (iv) "Nurse midwife" means a registered nurse who is licensed in this State and has been certified by the American College of Nurse-Midwives as a nurse midwife.

    (v) "Optometrist" has the meaning stated in Sec. 11-101 of the Health Occupations Article.

  (2) The Secretary may contract for the provision of care under the Program to eligible Program recipients.

  (3) The Secretary may contract with insurance companies or nonprofit health service plans or with individuals, associations, partnerships, incorporated or unincorporated groups of physicians, chiropractors, dentists, podiatrists, optometrists, pharmacists, hospitals, nursing homes, nurses, including nurse anesthetists, nurse midwives and certified nurse practitioners, opticians, and other health practitioners who are licensed or certified in this State and perform services on the prescription or referral of a physician.

  (4) For the purposes of this section, the nurse midwife need not be under the supervision of a physician.

  (5) Except as otherwise provided by law, a contract that the Secretary makes under this subsection shall continue unless terminated under the terms of the contract by the Program or by the provider.

(h) As permitted by federal law or waiver, the Secretary may administer the Medicare Option Prescription Drug Program, established under Sec. 15-124.3 of this subtitle, as part of the Maryland Medical Assistance Program.

(i) By regulation, the Department shall adopt a methodology to ensure that federally qualified health centers are paid reasonable cost-based reimbursement that is consistent with federal law.

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Md. Code Ann., Health-Gen. (as displayed at mgaleg.maryland.gov, October 16, 2026)