MedicaidCoverageHigh impact
Medicaid Benefit Expansion for Coverage of Adult Vaccinations, Effective October 1, 2023
Maryland Medicaid·MD · Allergy & Immunology, Family Medicine, Internal Medicine +1 more·Provider Transmittal
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Effective October 1, 2023, Maryland Medicaid expanded coverage to include comprehensive adult vaccinations (age 19+) with no copayments or cost-sharing for administration. Vaccines must be FDA-approved and administered per ACIP recommendations. This change applies to all Medicaid and CHIP enrollees in Maryland and requires billing teams to ensure proper claim submission without cost-sharing barriers.
Action Required
By April 30, 2024: Billing team must verify that all adult vaccination claims for Maryland Medicaid and CHIP members are processed WITHOUT copayments or cost-sharing charges. Update billing system settings to waive patient cost-sharing for vaccine administration services. Verify with each HealthChoice MCO that their systems are configured to accept claims without cost-sharing. Educate front desk and billing staff to NOT collect copayments from Medicaid/CHIP members for any FDA-approved vaccinations administered per ACIP guidelines. Train providers to document vaccine details and ensure ACIP recommendation compliance. Contact mdh.healthchoiceprovider@maryland.gov or individual MCOs with any reimbursement questions. Failure to waive cost-sharing will result in improper billing and potential compliance violations.