Written by a parent, not a doctor. Nothing here is medical advice.

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Maryland program

Government health insurance for your child (Medical Assistance)

Maryland's free health coverage for children under 19. One application checks Medical Assistance and the Maryland Children's Health Program (MCHP).

What it is

Maryland's free health coverage for children under 19. One application checks Medical Assistance and the Maryland Children's Health Program (MCHP).

A drop in pay can bring your child under Maryland's coverage line. The state checks current monthly income and decides who belongs in your child's household. One application covers both programs, but their rules about other insurance differ.

Eligibility rules
  • Your child must be under 19 and live in Maryland. The state decides which people and income count under its MAGI household rules.
  • Current monthly income is the test. A yearly figure divided by 12 is only an estimate after a change in pay.
  • The combined monthly limits effective February 1, 2026 are $4,283 for one person, $5,809 for two, $7,332 for three, $8,855 for four, $10,381 for five and $11,904 for six.
  • One line covers both programs: 322% of poverty. Below roughly 138% to 199% of poverty, depending on age, your child is in Medicaid; above that, in MCHP, which has stricter rules about other insurance.
If your child already has insurance
  • A work plan does not rule out Medical Assistance. It can rule out the higher-income MCHP groups, so which program your child lands in decides whether it can sit behind your insurance. Ask the counselor to check your child’s age and coverage group before changing either plan.
Before changing either plan
  • The hospital financial counselor can compare the cancer team's participation and the bills each plan would leave.
What you get
  • No monthly premium for your child's hospital care, chemotherapy, medicines and clinic visits.
  • Dental and vision care, with separate checks for rides and nursing at home.
  • Earlier medical bills may qualify for coverage.
What the help covers
  • Healthy Kids is Maryland's child Medicaid benefit. The federal EPSDT rules cover medically necessary services within Medicaid benefit categories for children under 21, rather than every requested service.
  • County health departments arrange eligible transportation. Nursing at home needs a separate assessment and approval.
  • For Medicaid-covered care from an enrolled provider, the primary insurer is billed first. The provider generally may not collect the primary plan's deductible, coinsurance or copay from you, even when Medicaid pays nothing more. Maryland's rule also bars billing you for otherwise covered care denied for missing authorization or lack of medical necessity; a provider's denial is not automatically your debt. Genuinely noncovered services or care outside participating arrangements need a separate review of the rules and any advance agreement.
If you decide to apply
  1. Ask the hospital financial counselor to help with Maryland Health Connection, online or by phone.
  2. Have recent income records, insurance cards and earlier bills ready, including the months they cover.
  3. Ask which plans include your child's hospital, cancer team and pharmacy before choosing.

Maryland Health Connection: 1-855-642-8572. Your local health department or hospital financial counselor can help. · Official page ↗

After you apply
  • The decision standards are 10 days at a local health department and 30 days at the Department or its designee.
  • A participating hospital can determine temporary hospital presumptive eligibility. It begins on the determination date and ends at the end of the following month unless a full application is filed by then; with a timely full application, it continues until the agency decides that application. The hospital financial counselor can check whether this route fits.
  • Children under 19 receive 12 months of continuous coverage, subject to the rule's exceptions.
  • Through 2026, coverage can reach eligible months up to three months before the application month when medical expenses occurred.
  • Applications made on or after January 1, 2027 have a two-month Medicaid lookback for children under federal law. Your child must have met the rules in each earlier month. Earlier applications use the rule for their filing date. The financial counselor can confirm whether any Maryland exception applies and which earlier bills fit.
  • If an already-covered child turns 19 during an acute inpatient stay, the agency checks the rule continuing coverage through that stay. This exception does not establish eligibility for a new applicant or another care setting.
Good to know

The combined income line does not settle whether your child can keep other insurance. The local health department checks the specific coverage group.

Other details
  • MCHP premiums ended April 9, 2024. The application sorts your child into the appropriate group.
  • Coverage follows where your child lives. Treatment in the District of Columbia does not change Maryland residency.
  • There is no waiting period after other insurance ends.

Federal background: Medicaid · CHIP · Medicaid as second insurance.

Official sources
Ask your social worker

“Could Medical Assistance or MCHP help with our child's treatment costs? How would either work with any insurance we have, and could you help us weigh the benefits and drawbacks before deciding whether to apply?”

Why I’m asking: I want treatment covered and a clear explanation before we make any insurance changes.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File at Maryland Health Connection this week, report this month's income and who lives at home, and name the months that already have bills.

Your social worker

The oncology social worker or financial counselor helps you file, asks the hospital to open temporary coverage that day, and chases the decision.

The care team

Nothing for ordinary child coverage. Medical records matter only for the Model Waiver route.

Who decides
The Maryland Department of Health decides eligibility through Maryland Health Connection and the local health department or Department of Social Services. The HealthChoice plan you pick then runs the coverage.
Ask your social worker
“Can you help me file at Maryland Health Connection today and ask this hospital for presumptive eligibility while we wait? Can we list the bills from the three months before, and check the hospital and oncology group take the plan I pick?”

How to apply

First step: Apply at marylandhealthconnection.gov or call 1-855-642-8572 this week. Ask the hospital counselor today whether this hospital can open temporary coverage while the state decides.

  1. Apply at marylandhealthconnection.gov this week and ask the hospital counselor for temporary coverage today.
  2. List every month with bills so the three-month look-back covers the admission.
  3. Pick a HealthChoice plan that the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply at marylandhealthconnection.gov or call 1-855-642-8572. Ask the hospital's financial counselor for hospital presumptive eligibility the same day.

What to gather

  • Child's birth certificate or ID and Social Security number
  • Maryland address
  • This month's income for each adult in the tax household
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: 10 days from an application filed at a local health department, 30 days at the Department or another designee, with extensions allowed. Temporary coverage from a participating hospital can start the same day.

What a yes looks like

A notice with coverage dates and a choice of HealthChoice plan. Check the hospital and the oncology group are in that plan before choosing. 12 months of coverage follows.

What a no looks like, and the next move

Read whether the state said no on income, a document or a category. If it is income, ask about the Model Waiver by name and appeal by the date on the notice.

Watch out

  • Maryland publishes one combined line for Medical Assistance and MCHP. You do not choose between them; the state sorts it out.
  • MCHP has an other-insurance rule and the state's wording is inconsistent. Do not cancel a work plan before you ask the local health department what it means for your child.
  • Coverage follows where your child lives. Treatment at a Washington DC hospital does not move your child onto DC's programme, and does not take Maryland coverage away.

Dates that change this

2026-02-01: The child and adult income limits are the table headed 'Monthly Income Limit Effective February 1, 2026'. February 1 is verified for this edition only; no recurring annual date was published, so check the state page before relying on it in 2027.

2027-01-01: From January 2027 new federal work and renewal requirements start for some adults aged 19 to 64. The state says this is not a change to children's coverage; children keep 12-month continuous eligibility.

2026-10-01: From October 2026 federal rules narrow which non-citizens can hold full coverage. The state lists pregnant people and children who currently qualify among the groups that keep it; ask the local health department how it applies to your child. (not yet confirmed against the final rule)

2027-01-01: Federal law shortens retroactive coverage for children from three months to two from January 2027. Maryland had published no implementing instruction when this was written, so the three-month rule is what the current regulation says. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full coverage with no premium for a child. One published line covers Medical Assistance and MCHP together: $5,809 a month for two, $7,332 for three, $8,855 for four, $10,381 for five and $11,904 for six, effective February 1, 2026.

  • $5,809/month — Combined Medical Assistance and MCHP child ceiling, household of 2
  • $7,332/month — Combined Medical Assistance and MCHP child ceiling, household of 3
  • $8,855/month — Combined Medical Assistance and MCHP child ceiling, household of 4
  • $10,381/month — Combined Medical Assistance and MCHP child ceiling, household of 5
  • $11,904/month — Combined Medical Assistance and MCHP child ceiling, household of 6
  • $4,283/month — Combined Medical Assistance and MCHP child ceiling, household of 1
  • $0/month — Monthly premium for a child in MCHP since April 9, 2024

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, through the Healthy Kids programme · Nursing and home health at home when the state approves it · Rides to appointments through the county health department · Dental and vision

Legal protection: 12 months of continuous coverage once approved, subject to the rule's exceptions · Coverage can reach back up to three months before the application month where there were medical bills

What it costs the family: No premium. The former MCHP premiums for families between 212 and 322 percent of the poverty level were permanently removed on April 9, 2024.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
One published combined Medicaid/MCHP ceiling at 322% FPL (COMAR MAGI budget group). Inside the state's system: Title XIX at 199% under age 1, 143% ages 1-5, 138% ages 6-18, then MCHP groups P13 138-189%, P14 190-211%, D02 212-264%, D04 265-322%. No dollar cells are published for the internal bands. The 5-point disregard is conditional (COMAR 10.09.24).
Insurance status condition
Title XIX Medical Assistance can coexist with private insurance. MCHP's higher-income coverage has separate other-insurance restrictions; an offer is not enrollment. Maryland Health Connection checks the specific category and applicable exceptions before promising secondary coverage.
Residency
Maryland (where the child lives, not where the hospital is)
Continuous eligibility
12 months for a child under 19 (COMAR 10.09.11.11)
Retroactive months
up to 3 with medical expenses in those months (COMAR 10.09.11.07)
Processing standard
10 days at a local health department; 30 days at the Department or its designee (COMAR 10.09.24.04)
Waiting period
None. Legacy COMAR 10.09.43.05 still prints a six-month post-voluntary-termination wait; federal regulation 42 CFR 457.805 prohibits a CHIP waiting period, and the legacy provision is not applied.

The trap: Maryland publishes ONE combined line at 322 percent of the poverty level for Medicaid and MCHP together. Inside the state's own system the child is sorted by age, with tighter Title XIX ceilings of 199 percent under 1, 143 percent from 1 to 5 and 138 percent from 6 to 18; the state does not publish dollar figures for those, and the family does nothing differently either way. The five-point allowance is applied only when it would change the answer, so it is not added on top again.

Where I read this

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