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Receive complete pharmacy services.
Mental Health Formulary , Substance Use Disorder Medication Clinical Criteria Final and AIDS/HIV drugs - All other drugs are provided by HealthChoice Managed Care Organizations (MCOs).
Receive only contraceptives and sexually transmitted infections treatment.
Fully dual eligible Medicare beneficiaries receive most drugs excluded from Medicare Coverage -- All other drugs are provided by Medicare Prescription Drug Programs (PDPs). Please note that beginning 01/01/2013, drug coverage for Benzodiazepines and Barbiturates for those patients that are both Medicaid and Medicare eligible,will be provided by Medicare Part D Prescription Drug Plans and not the Maryland Medicaid Pharmacy Program. This change may cause patient co-payments to vary.
Yes, however, all applicants must be U.S. citizens or qualified aliens.
Medicaid is available to low-income persons in certain categories. Federal Medicaid laws require that every state cover certain groups. For example, people who receive money through Supplemental Security (SSI) or Temporary Cash Assistance (TCA) automatically receive Medicaid. In addition, persons may qualify for Medicaid because of high medical expenses (commonly hospital or nursing home care), if they have low income and assets and are aged, blind, or disabled. Coverage is also allowed for certain optional categories. For full eligibility requirements for the groups covered by Maryland's Medicaid Program, see Medical Care Programs Eligibility.
The HealthChoice program is Maryland's Medicaid's managed care program. It is a mandatory program for most of the Medical Assistance population. A recipient in HealthChoice will receive health care services through a managed care organization (MCO). Approximately 80 percent of the Medicaid population participates in HealthChoice.
The Family Planning program provides medical services related to family planning for women who lost their Medicaid coverage after they were covered for a pregnancy and for women who meet the Program's eligibility criteria. The covered services include medical office visits, physical examinations, contraceptives, related laboratory services, certain anti-infective medications, family planning supplies, reproductive education, counseling and referral, and tubal ligation.
Medicare Part D provides complete pharmacy services to individuals who are eligible for both Medicare and Medicaid except certain drugs that are excluded from Medicare. Medicaid provides most of those excluded drugs to dual eligible recipients. For contact information on each of the Medicare Part D Prescription Drug Plans .Click here
The amount of the co-payment depends upon the program. The following table shows the amounts for generic and preferred brand name drugs as well as other brand name drugs.
Generic and Preferred
Brand Name Drugs
Other Brand
Name Drugs
Please see the Apply for Medicaid page for information.
Recipients with pharmacy related issues may call the toll-free Medicaid Pharmacy Program Recipient Access Hotline at 1-800-492-5231, press 3. Local Baltimore Metropolitan area callers may dial 410-767-5800. Calls are accepted from 8:00 a.m. to 5:00 p.m. Monday through Friday. Callers may leave a message before or after hours and on weekends and holidays. Pharmacy staff will return calls on the next business day.