MedicaidAdministrativeMedium impact
MCO Outreach to Disenrolled Members and Renewal from Assistance
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Apr 14, 2025
We identified it
Jun 20, 2026
Summary
Maryland's MCO (Managed Care Organization) policy resccinds MCO assistance with renewal forms effective immediately. MCOs may now only conduct outreach to disenrolled members within 120 days for procedural reasons (verification failures, incomplete renewals, returned mail) using specific communication methods, but cannot help complete renewal forms. Instead, MCOs must direct members to Maryland Health Connection. This is a state-specific administrative change that affects claims eligibility verification workflows.
Action Required
Effective immediately (April 14, 2025): (1) Billing team must stop accepting renewal form assistance from MCOs in Maryland. Any renewal applications requiring form completion must direct members to Maryland Health Connection portal instead. (2) Update internal processes to verify member eligibility through the 834 files uploaded by MCOs rather than through MCO-assisted renewal documentation. (3) Flag any claims submitted with MCO-assisted renewal documentation dated after April 14, 2025 for potential eligibility verification issues. (4) When working with disenrolled members in Maryland, note that MCO outreach is limited to reason codes 230 (verification outstanding), 235 (no renewal), and 551 (return mail) only—do not expect MCO assistance for other disenrollment reasons. (5) Providers should inform patients directly about Maryland Health Connection renewal requirements rather than relying on MCO support.