There is a Maryland Children’s Health Program.
The Maryland Children’s Health Program shall provide, subject to the limitations of the State budget and any other requirements imposed by the State and as permitted by federal law or waiver, comprehensive medical care and other health care services to an individual who:
Does not qualify for coverage under § 15–103(b) of this title; and
Has a family income at or below 300 percent of the federal poverty guidelines and who is under the age of 19 years.
The Department shall provide eligible individuals and health care providers with an accurate directory or other listing of all available providers:
In written form, made available upon request; and
On an Internet database.
The Department shall update the Internet database at least every 30 days.
The written directory shall include a conspicuous reference to the Internet database.
The Department shall develop a process for providing information about the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article to each Program enrollee or potential Program enrollee when providing information about the Program.
The Department shall monitor applications to determine whether employers and employees have voluntarily terminated coverage under an employer sponsored health benefit plan that included dependent coverage in order to participate in the Maryland Children’s Health Program established under § 15–301 of this subtitle.
The Department, in particular, shall review applications of individuals who qualified for Program benefits under the Maryland Children’s Health Program established under § 15–301 of this subtitle.
An application may be disapproved if it is determined that an individual under the age of 19 years to be covered under the Maryland Children’s Health Program, for whom the application was submitted, was covered by an employer sponsored health benefit plan with dependent coverage which was voluntarily terminated within 6 months preceding the date of the application.
In determining whether an applicant has voluntarily terminated coverage under an employer sponsored health benefit plan for purposes of paragraph (1) of this subsection, a voluntary termination may not be construed to include:
Loss of employment due to factors other than voluntary termination;
Change to a new employer that does not provide an option for dependent coverage;
Change of address so that no employer sponsored health benefit plan is available;
Discontinuation of health benefits to all dependents of employees of the applicant’s employer; or
Expiration of the applicant’s continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
The Department shall be responsible for enrolling program recipients in managed care organizations under the Maryland Children’s Health Program established under § 15–301 of this subtitle.
The Department may contract with an entity to perform any part or all of its enrollment responsibilities under paragraph (1) of this subsection.
The Department or its enrollment contractor, to the extent feasible in its marketing, outreach, and enrollment programs, shall hire individuals receiving assistance under the Family Investment Program established under Title 5, Subtitle 3 of the Human Services Article.
To the extent allowed under federal law and regulations, the Secretary shall implement expedited eligibility for any individual who applies through the local health department for the Maryland Children’s Health Program under § 15–301 of this subtitle, including any individual with associated food stamp, cash assistance, or medical assistance cases.
The Secretary shall designate organizations that may:
Assist individuals in the application process; and
Perform other outreach functions.
In designating the organizations under paragraph (2) of this subsection, the Secretary shall ensure the inclusion of statewide and local organizations that provide services to children of all ages in each region of the State, and shall provide such organizations with:
Forms that are necessary for parents, guardians, and other individuals to submit applications to the Maryland Children’s Health Program on behalf of a child; and
Information on how to assist parents, guardians, and other individuals in completing and filing such applications.
For purposes of increasing the number of eligible individuals who enroll in the Maryland Children’s Health Program established under § 15–301 of this subtitle, the Department shall develop and implement a school–based outreach program.
As appropriate to carry out its responsibilities under paragraph (1) of this subsection, the Department may enter into contracts with county boards of education to provide information at public schools on the Maryland Children’s Health Program established under § 15–301 of this subtitle.
For purposes of this subsection, “community–based organization” includes child care centers, schools, and school–based health clinics.
In addition to the school–based outreach program established under subsection (a) of this section, the Department, in consultation with the Maryland Medicaid Advisory Committee established under § 15–103.2 of this title, shall develop mechanisms for outreach for the program with a special emphasis on identifying children who may be eligible for program benefits under the Maryland Children’s Health Program established under § 15–301 of this subtitle.
From the mechanisms to be developed for outreach under paragraph (2) of this subsection, one mechanism shall include the development and dissemination of mail–in applications and appropriate outreach materials through community–based organizations, community–based providers, the Office of the State Comptroller, the Departments of Human Services and Health, county boards of education, and any other appropriate State agency or unit the Department considers appropriate.
The Department shall collaborate with the Office of the Comptroller or the Office of the State Treasurer to:
Form a one–sentence statement advising that individuals who cannot afford health insurance may be eligible to enroll in the Maryland Children’s Health Program; and
Print the statement formed under item (i) of this paragraph:
On each State–issued tax refund check stub;
Once each pay quarter, on each State–issued employee paycheck stub; and
On each State–issued child support payment check stub.
The statement shall contain a telephone number or other contact information that an individual may use to receive more information on eligibility for the Maryland Children’s Health Program.
The statement may be altered by the Department in collaboration with the Office of the Comptroller or the Office of the State Treasurer to:
Provide the most current information;
Fit within the space constraints of the different types of checks listed in paragraph (1)(ii) of this subsection; or
Combine it with the statement required under § 15–102.1(c) of this title, if appropriate.
On or before January 1, 2025, subject to the limitations of the State budget and as permitted by federal law, the Department:
Shall establish an Express Lane Eligibility Program to enroll individuals in the Program and the Maryland Children’s Health Program based on eligibility findings by the Supplemental Nutrition Assistance Program;
May not consider any other income or eligibility requirements;
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 § 1115 of the federal Social Security Act to implement the Express Lane Eligibility Program; and
Subject to subsection (b) of this section, shall make all reasonable efforts to expedite enrollment of eligible individuals in the Express Lane Eligibility Program.
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.
Subject to the limitations of the State budget and as permitted by federal law or waiver, the Maryland Children’s Health Program may provide guaranteed eligibility for each enrollee for up to 6 months unless an enrollee obtains health insurance through another source.
Except for a drug or device for which the U.S. Food and Drug Administration has issued a black box warning, the Maryland Children’s Health Program may not apply a prior authorization requirement for a contraceptive drug or device that is:
An intrauterine device; or
An implantable rod;
Approved by the U.S. Food and Drug Administration; and
Obtained under a prescription written by an authorized prescriber.
The Maryland Children’s Health Program shall provide coverage for a single dispensing to an enrollee of a supply of prescription contraceptives for a 12–month period.
The Maryland Children’s Health Program shall provide coverage for services rendered to an enrollee by a licensed pharmacist acting within the pharmacist’s lawful scope of practice to the same extent as services rendered by any other licensed health care provider.
Reimbursement for services provided under subsection (a) of this section may not be conditioned on whether the licensed pharmacist is:
Employed by a physician, pharmacy, or facility; or
Acting under a physician’s orders.
The Maryland Children’s Health Program may not require prior authorization for a transfer to a special pediatric hospital.