MedicaidCoverageHigh impact
Emergency and Proposed Amendment to HealthChoice Regulations
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Jan 1, 2005
We identified it
Jun 20, 2026
Summary
Maryland HealthChoice (Medicaid managed care) is implementing comprehensive regulatory changes including new copays ($1 generic drugs, $6 non-emergency ER visits), updated MCO enrollment procedures, revised provider requirements, and new payment structures. These changes affect all Maryland Medicaid MCO operations and member benefits.
Action Required
Immediately: Maryland practices serving Medicaid MCO patients must update billing systems to collect new copays: $1 for generic drugs and $6 for non-emergency ER visits. Verify MCO enrollment status and ensure primary care provider information is current on patient ID cards within 10 days of enrollment notifications. Review clinical trial coverage criteria and update prior authorization processes accordingly. Front desk staff must verify current MCO assignments as family enrollment rules have changed.