Frequently Asked Questions
What services does Medical Assistance cover?
Covered services include:
- Ambulance and wheelchair van services and emergency medical transportation
- Ambulatory surgical center services
- Clinic services
- Diabetes care services (covered under HealthChoice)
- Family planning services and supplies
- Home health agency services
- Hospice care
- Hospital inpatient and outpatient services (acute, chronic, psychiatric, rehabilitation, specialty)
- Kidney dialysis services
- Laboratory and x-ray services
- Medical day care services
- Medical equipment and supplies
- Medicare premiums, co-payments, and deductibles
- Mental health treatment, case management, and rehabilitation services
- Nurse anesthetist, nurse midwife, and nurse practitioner services
- Nursing facility services (nursing homes)
- Oxygen services and related respiratory equipment services
- Personal care services
- Pharmacy services (for beneficiaries not eligible for Medicare Part D) – see list of preferred drugs. Many others are also covered – over 99% of all prescription drugs on the market.
- Physical therapy
- Physician services (some dental surgery may be included)
- Podiatry services
- Statewide Evaluation and Planning Services (STEPS) through local health departments)
- Substance abuse treatment services
- Transportation services to Medicaid covered services (through local health departments)
- Vision care services (eye examination every two years)
For people under age 21, Medical Assistance also covers:
- Dental services and dentures
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services
- Eye glasses
- Hearing aids
- Private duty nursing
- School-based health-related services
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How much does it cost?
The monthly premium is $0, $25, $40 or $55. People who sign up for EID almost always save much more than they pay for premiums.
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If I am approved, will my first premium payment be higher than the monthly amount?
Your first premium payment may be higher if you did not return documents to EDD in a timely manner and/or delayed the processing of your application in some way. This is because you must pay the premiums for each month since your application was received, and Medical Assistance will usually charge you for one or two months of premiums in advance as well. Your Medical Assistance will begin the first day of the month your application was received. If you cooperated with EDD or were not asked to provide any additional documents or information, you will not be required to pay premiums for the month(s) you did not know you were eligible. You will have to start making regular premium payments once you receive a notice letting you know you are approved for Medical Assistance.
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When will my Medical Assistance start?
If your EID application is approved, your Medical Assistance will take effect on the first day of the month your application was received by the EligibilityDetermination Division (EDD).
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If my Medical Assistance starts a month or more before I am notified, can I get Medical Assistance to pay for medical expenses I received after the effective date, but before I was notified?
You may be able to get these medical expenses covered by Medical Assistance once you have been approved. Providers have the option to bill Medical Assistance for services in this case, but are not required to do so. You should ask your medical providers as soon as you apply for EID if they will bill Medical Assistance for services once you are approved.
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How do I find work so I can qualify?
See Where do I start my job search?, How do I get the job I want?, What options do I have for employment?, What options do I have for a career? and Work at Home Opportunities on the Maryland Department of Disabilities' website.
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How much do I need to earn from work to get EID?
There is no minimum amount, so your earnings may be small. But the goal of EID is to encourage you to earn as much as you can. That’s why the income limit for EID is so high.
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How long can EID last?
EID can last until your 65th birthday if you:
- Remain eligible,
- Complete applications and submit needed documents every six months, AND
- Pay premiums every month, if your income is high enough to require a premium
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How do I keep EID every six months?
After you have enrolled in EID, you need to reapply (“redetermination”) every six months. The Eligibility Determination Division (EDD) will mail you a packet of information about two months before your redetermination is due. This includes an application and a list of documents you need to send copies of along with your application.
Be sure to return the application and other documents at least a week before the deadline to avoid losing benefits.
EDD will decide if you are still eligible. If so, they will determine how much your premium will be. They will notify you by mail within 30 days of receiving your application.
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Is there an easier way to fill out the redetermination application?
Yes. You can complete, print and mail the shortened application (see also the EID Application Instructions for completing the application). If you save the electronic application on a computer, you can simply update and print it every six months.
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Once I am approved, will I have to get disability reviews again?
Yes. You will have to get a disability review:
- Every 6 – 18 months if your disability is expected to improve
- Every 3 years if your disability might possibly improve
- Every 5 – 7 years if your disability is not expected to improve
At a disability review, your recent medical records will be reviewed to determine whether you have “medically improved” (your disability has gotten better). If you medically improve, you will not longer be eligible for EID.
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I already have private insurance. Can I still get Medical Assistance through EID?
Yes. Medical Assistance can supplement your other insurance. See Detail about private insurance.
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I already have Medical Assistance. Can EID help me?
If you already have Medical Assistance, you cannot be approved for EID. But if you lose eligibility for the type of Medical Assistance you have, then you may be able to use EID to keep Medical Assistance. EID may be a good option if your income or your resources (assets) go over the limit for the other type of Medical Assistance you have.
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I already receive one of these benefits. Can EID help me?
Qualified Medicare Beneficiary (QMB):
Qualified Medicare Beneficiary (QMB) is a benefit for people who have Medicare and very low incomes and assets (resources). QMB covers your Medicare premiums, deductibles and co-insurance. This can save you from $1,000 - $12,000 per year. EID provides Medical Assistance, which is a better benefit than QMB. You can earn much more money if you get EID than if you get QMB. EID also lets you save more money than QMB does.
- BENEFIT
- QMB - Covers Medicare premiums, deductibles & co-insurance; greatly reduces Medicare prescription drug plan costs
- EID/Medical Assistance - Covers Medicare premiums, deductibles & co-insurance; greatly reduces Medicare prescription drug plan costs. Covers some services that Medicare does not
- INCOME LIMIT
- QMB - Countable income under $1,025/month (if you’re not married); $1,374/month (if you’re married) in 2017
- EID/Medical Assistance - Countable income under $2,970/month (if you’re not married); $4,005/month (if you’re married) in 2017
- RESOURCE(ASSET)LIMIT
- QMB - $8,890 (if you’re not married); $14,590 (if you’re married)
- EID/Medical Assistance - $10,000 (if you're not married); $15,000 (if you're married); 401(k), 403(b), pension, Keogh plans not counted
Specified Low Income Medicare Beneficiary (SLMB)
Specified Low-Income Medicare Beneficiary (SLMB) is a benefit for people who have Medicare and very low incomes and assets (resources). SLMB covers your Medicare Part B premiums and greatly reduces your costs for Medicare prescription drug plans (Part D). This can save you at least $1,000 per year. EID provides Medical Assistance, which is a better benefit than SLMB. You can earn much more money if you get EID than if you get SLMB. EID also lets you save more money than SLMB does.
- BENEFIT
- SLMB - Covers Medicare Part B premiums, greatly reduces Medicare prescription drug plan costs
- EID/Medical Assistance - Covers Medicare premiums, deductibles & co-insurance; greatly reduces Medicare prescription drug plan costs. Covers some services that Medicare does not
- INCOME LIMIT
- SLMB - Countable income under $1,376/month (if you’re not married); $1,847/month (if you’re married) in 2017
- EID/Medical Assistance - Countable income under $2,970/month (if you’re not married); $4,005/month (if you’re married) in 2017
- RESOURCE(ASSET)LIMIT
- SLMB - $8,890 (if you’re not married); $14,590 (if you’re married)
- EID/Medical Assistance - $10,000 (if you're not married); $15,000 (if you're married); 401(k), 403(b), pension, Keogh plans not counted
If you get SLMB, but you are eligible for EID, you can enroll in Medical Assistance to replace SLMB.
Medical Assistance Spend Down
Medical Assistance Spend Down: If your income is too high to get Medical Assistance, you may be able to “spend down” to qualify. Spending down means you have to pay for medical expenses out of your own pocket – usually thousands of dollars worth – every six months to get Medical Assistance. EID lets you get Medical Assistance a better way. You don’t have to pay thousands of dollars, just a fairly small monthly premium ($0, $25, $40 OR $55). You can earn much more and save more.
- BENEFIT
- Medical Assistance Spend Down - Full Medical Assistance
- EID/Medical Assistance - Full Medical Assistance
- INCOME LIMIT
- Medical Assistance Spend Down - Countable income under $350/month (if you’re not married); $392/month (if you’re married). If your income is higher, you need to “spend down” – pay for medical expenses out of your pocket.
- EID/Medical Assistance - Countable income under $2,873/month (if you’re not married); $3,878/month (if you’re married) in 2012 / Pay monthly premium of $0, $25, $40 or $55 / No spending down / May save you thousands of dollars a year
- RESOURCE(ASSET)LIMIT
- Medical Assistance Spend Down - $2,500 (if you’re not married); $3,000 (if you’re married)
- EID/Medical Assistance - $10,000 (if you're not married); $15,000 (if you're married); 401(k), 403(b), pension, Keogh plans not counted
If you get Medical Assistance through EID, you no longer need to “spend down”.
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I now get my Medical Assistance through a managed care organization (MCO). Will this change if I switch to EID?
Yes. EID gives you “fee for service” Medical Assistance. You don’t enroll in a MCO. You can see any provider who accepts fee for service Medical Assistance. You do not have to get permission from a MCO.
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Who will decide if I am eligible?
The Eligibility Determination Division (EDD), a branch of Maryland’s Medical Assistance program in the Maryland Department of Health . EDD can be reached at 410-767-7090.
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How long will it take until I know whether I have been approved?
If you get Social Security Disability checks, or you got Social Security Disability or SSI checks in the last few years, it usually takes 30 days to get a decision in the mail once your application has been returned. If you have never received disability checks from Social Security, it takes up to 90 days to get a decision by mail.
If the EID worker needs more information to process your application, she or he will send you a letter.
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I already applied. How do I find out the status of my application?
To check on the status of your application once you have mailed it in, you can call the Medical Assistance Eligibility Unit at 410-767-7090.
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If I am found to be eligible for EID, what else do I need to do?
You may need to pay a monthly premium (fee). After you pay your premium, you will then receive a white and red Medical Assistance card by mail. You will not get Medical Assistance until you pay the premium.
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If you’re approved, when does your coverage start?
Coverage begins the first day of the month that the Eligibility Determination Division (EDD) receives your application, even if you weren’t approved until a later month. That means Medical Assistance may, in some cases, be able to cover medical expenses you have already received, as long as you got them no earlier than the starting date on your Medical Assistance card.
What can I do if my application is denied?
You can appeal the denial. Legal Assistance may be available from Disability Rights Maryland.
Can I get Medical Assistance through EID if I get services through a Medicaid Waiver?
Yes, you can for the following Waivers:
- Community Pathways
- New Directions
- Living at Home
- Older Adults
- Traumatic Brain Injury
If your income or resources exceed the usual limits for the Medicaid Waiver programs, you may be able to enroll in EID if you are eligible, and keep your Waiver services.
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