MedicaidReimbursementMedium impact
Reimbursement for Inpatient Hospital Stays for HealthChoice Recipients Who Become Ineligible for Medical Assistance
Maryland Medicaid·MD·Managed Care Organizations
Effective date
May 9, 2005
We identified it
Jun 20, 2026
Summary
MCOs are no longer responsible for paying inpatient hospital stays for HealthChoice recipients beyond the date when the recipient becomes ineligible for Medical Assistance. This clarifies existing policy by limiting MCO financial responsibility to the period of active Medicaid eligibility.
Action Required
Immediately: Billing team must verify HealthChoice recipient eligibility status for all inpatient hospital stays and ensure claims are only submitted to the MCO for dates when the patient was actively eligible for Medical Assistance. For stays extending beyond eligibility termination, bill the MCO only through the last date of eligibility and seek alternative payment arrangements for remaining days.