MedicaidAdministrativeHigh impact
Prohibition on Charging Medicaid Participants for Covered Services
Maryland Medicaid·MD·General Provider
Effective date
Jun 3, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid providers are strictly prohibited from billing Medicaid participants or their families for any covered services, including balance billing or charging for denied covered services that required pre-authorization. Violations can result in provider termination and federal sanctions.
Action Required
Immediately: All staff must be trained on prohibition of billing Medicaid participants for any covered services. Billing team must review all Medicaid accounts to ensure no balance billing or additional charges beyond program-specified co-pays. Update billing system workflows to prevent charging Medicaid patients for denied covered services. Verify Medicaid eligibility using EVS system before rendering services at https://encrypt.emdhealthchoice.org/emedicaid/ or 1-866-710-1447. Failure to comply may result in provider termination and federal sanctions.