MedicaidAdministrativeLow impact
PT 19-26: HealthChoice MCO Timeframes for Written Acknowledgements of Enrollee Grievances
Maryland Medicaid·MD·Managed Care
Effective date
Sep 15, 2025
We identified it
Jun 18, 2026
Summary
Maryland HealthChoice MCOs must now follow specific timeframes for acknowledging enrollee grievances in writing: emergency medical grievances require written resolution within 24 hours, non-emergency medical grievances within 5 days, and administrative grievances require written acknowledgment within 5 days if unresolved. This clarifies communication requirements between MCOs and Medicaid enrollees for complaint resolution processes.
Action Required
Patient services staff should review current grievance handling procedures to ensure compliance with Maryland HealthChoice acknowledgment timeframes. Update internal processes to track grievance receipt dates and ensure written acknowledgments are sent for administrative grievances within 5 days if unresolved. This primarily affects patient relations rather than billing operations.