Eligibility

Click here to check on a patient’s eligibility for Maryland Medicaid benefits. Or, call the State’s Eligibility Verification System (EVS) at 866-710-1447.

If you need general information related to applying for Medicaid benefits, call 800-492-5231 or click here.

If you have other questions related to your patients’ enrollment in CareFirst Community Health Plan Maryland (CareFirst CHPMD), please call us at 1-410-779-9359 or 1-800-730-8543.


The Maryland HealthChoice Program

HealthChoice is Maryland’s Medicaid managed care program. Almost three- quarters of the Medicaid population and the Maryland Children’s Health Program (MCHP) are enrolled in this Program. The HealthChoice Program’s philosophy is based on providing quality cost-effective and accessible health care that is patient- focused.

HealthChoice Eligibility

All individuals qualifying for Maryland Medical Assistance or MCHP are enrolled in the HealthChoice Program, except for the following categories:

  • Individuals who receive Medicare;
  • Individuals age 64 1/2 or over;
  • Individuals who are eligible for Medicaid under spend down;
  • Medicaid participants who have been or are expected to be continuously institutionalized for; more than 30 successive days in a long term care facility or in an institution for mental; disease (IMD);
  • Individuals institutionalized in an intermediate care facility for persons with intellectual disabilities (ICF-MR);
  • Participants enrolled in the Model Waiver;
  • Participants who receive limited coverage, such as women who receive family planning; services through the Family Planning Waiver, or Employed Individuals with Disabilities Program;
  • Inmates of public institutions, including a State operated institution or facility;
  • A child receiving adoption subsidy who is covered under the parent’s private insurance;
  • A child under State supervision receiving adoption subsidy who lives outside of the State; or
  • A child who is in an out-of-State

All Medicaid participants who are eligible for the HealthChoice Program, without exception, will be enrolled in an MCO or in the Rare and Expensive Case Management Program (REM).  The REM program is discussed in detail in Section IV.

Members must complete an updated eligibility application every year in order to maintain their coverage through the HealthChoice Program.

HealthChoice Members are permitted to change MCOs if they have been in the same MCO for 12 months or more.

HealthChoice providers are prohibited from steering members to a specific MCO. You are only allowed to provide information on which MCOs you participate with if a current or potential member seeks your advice about selecting an MCO.

Medicaid-eligible individuals who are not eligible for HealthChoice will continue to receive services in the Medicaid fee-for-service system.