MedicaidCoverageMedium impact
Update to PT 55-23: Healthy Babies Equity Act, Effective July 1, 2023
Maryland Medicaid·MD · OB-GYN, Family Medicine, General Practice +1 more·Provider Transmittal
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Effective July 1, 2023, Maryland Medicaid expands coverage to non-citizen pregnant individuals with income up to 250% FPL and their children up to age one, including comprehensive prenatal, postpartum (4 months), and retroactive coverage (up to 3 months). Eligible individuals enroll in MCOs for prenatal/postpartum periods with carved-out benefits covered fee-for-service. This policy supersedes PT 55-23 guidance.
Action Required
By July 1, 2023: Billing team must update patient eligibility verification procedures in billing software to recognize the new non-citizen pregnant individual category under Maryland Medicaid. Front-desk and verification staff must screen for: (1) non-citizen/undocumented status, (2) current pregnancy or pregnancy within last 4 months, (3) Maryland residency, (4) income up to 250% FPL. Update claim submission protocols to correctly route carved-out benefits to fee-for-service and prenatal/postpartum services to assigned MCO. Configure system to allow retroactive claims back 3 months from application date (but not before April 1, 2023 or prior to pregnancy start). Providers must ensure all staff are informed per transmittal directive. Failure to correctly classify and route claims may result in denials or payment delays.