MedicaidAdministrativeMedium impact
Third Party Liability
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Nov 19, 1999
We identified it
Jun 20, 2026
Summary
Maryland Medicaid MCOs have flexibility in handling third-party insurance co-payments and deductibles - they can either pay them and require enrollees to use third-party coverage, or refuse to pay them but must then provide services directly and seek reimbursement later. Enrollees should never be billed for co-payments/deductibles except when they insist on using third-party coverage against MCO direction.
Action Required
Maryland providers should verify their MCO's specific policy on third-party liability co-payments and deductibles. Ensure staff understand that enrollees with private insurance must check with their MCO before seeking care (except emergencies) and that enrollees cannot be billed for co-pays/deductibles unless they insist on using third-party coverage against MCO guidance.