MedicaidCoverageMedium impact
Update to MCO Transmittal #173 (PT 54-23): Healthy Babies Equity Act, Effective July 1, 2023
Maryland Medicaid·MD · OB-GYN, General Practice, Family Medicine +1 more·Provider Transmittal
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Maryland Medicaid expands coverage effective July 1, 2023, to include non-citizen pregnant individuals and their children up to age one with income up to 250% FPL. Two new coverage groups (X11 prenatal, X12 postpartum) will provide comprehensive benefits identical to standard Medicaid pregnant/postpartum coverage, with retroactive coverage available up to three months prior to application (not before April 1, 2023). This policy supersedes MCO Transmittal #173 (PT 54-23).
Action Required
By July 1, 2023: Billing team must update claims processing systems to recognize and correctly route two new coverage groups—X11 (Healthy Babies Prenatal) and X12 (Healthy Babies Postpartum)—ensuring they are reimbursed at rates identical to P02/P11 groups. Update encounter forms and eligibility verification tools to screen for non-citizen pregnant patients with income up to 250% FPL. Configure systems to allow retroactive claims dating back up to three months from application date (minimum April 1, 2023). Ensure all managed care organization enrollments are processed automatically, with automatic X11-to-X12 transitions at pregnancy end. Train billing and eligibility staff on new coverage criteria and postpartum period definition (end of pregnancy through last day of month in which four-month postpartum period ends). Remove references to MCO Transmittal #173 from internal processes. Failure to process claims correctly will result in denials and delayed payments for affected beneficiaries.