What Does Medicaid Cover in Maryland: Dental, Vision, and Long-Term Care

Maryland Medicaid covers a wide range of health care: primary and preventive care, hospital and emergency services, prescription drugs, dental, vision, behavioral health and substance use treatment, pregnancy and postpartum care, children’s services, hearing aids, durable medical equipment, rehabilitation therapies, gender-affirming care, telehealth, non-emergency medical transportation, and long-term services and supports. Most of these benefits are delivered through the state’s HealthChoice managed care program, which contracts with nine managed care organizations (MCOs).¹ A few categories, including specialty behavioral health, most dental, and long-term care, are handled separately on a fee-for-service basis.

Core Medical Care

Every HealthChoice MCO must cover the same baseline of medical services. That baseline includes doctor visits and checkups, immunizations, inpatient and outpatient hospital care, emergency room visits (no preauthorization, and out-of-state emergencies count), urgent care within the plan’s network, lab work, x-rays and other imaging, and home health nursing and aide visits when medically necessary.²

Family planning is covered broadly: office visits, lab tests, prescription birth control, condoms available at pharmacies without a prescription, and emergency contraceptives. There are no copays on family planning medications.³ For covered services during valid enrollment, HealthChoice members have no financial liability apart from certain pharmacy copays.⁴

Prescription Drugs

Prescriptions are covered through both the MCOs and a fee-for-service pharmacy program, and the state maintains a Preferred Drug List with separate formularies for mental health and substance use disorder medications.⁵

Since May 2024, adults 21 and older pay small retail pharmacy copays: $1 for preferred or generic drugs, HIV/AIDS medications, and maintenance drugs for chronic conditions like diabetes and high blood pressure, and $3 for non-preferred or brand-name drugs.⁶ Members under 21, pregnant members, Native American members, and members in long-term care facilities are exempt from all copays.⁷ Family planning medications are also excluded from copays.

Dental Care

All Maryland Medicaid members with full coverage are enrolled in the Maryland Healthy Smiles Dental Program. There are no premiums, deductibles, copays, or annual benefit caps.⁸

On January 1, 2023, under SB150, the state significantly expanded adult dental benefits to include diagnostic, preventive, restorative, endodontic, periodontal, and oral surgery services.⁹ Adults are now covered for checkups, cleanings, x-rays, fillings, crowns, root canals, extractions, fluoride treatments, anesthesia, and denture adjustments. What’s not covered for adults 21 and older: dentures themselves, cosmetic procedures, and experimental procedures.⁸

Vision Care

Children under 21 are guaranteed annual eye exams and glasses through HealthChoice.² For adults, the state requires only one eye exam every two years and no glasses, but most MCOs add supplemental benefits on top of that floor.

As of February 2026, every MCO offers adults an annual eye exam. Eyewear allowances vary: Aetna offers up to $200 per year for frames or contacts, CareFirst $150 every two years, Wellpoint $100 annually for either glasses or contacts, and MedStar $25 toward frames annually.¹⁰ These extras can change each year, so it’s worth confirming with your plan before an appointment.

Behavioral Health and Substance Use

Mild behavioral health conditions, like situational anxiety or mild depression, are handled by primary care providers inside the MCO. Specialty services for serious mental illness and substance use disorders are carved out of managed care and paid fee-for-service through the state’s Public Behavioral Health System.¹¹ Carelon Behavioral Health acts as the Administrative Services Organization, authorizing services and processing reimbursements.¹²

Covered specialty services include inpatient psychiatric care, outpatient treatment, partial hospitalization, psychiatric rehabilitation, crisis services, assertive community treatment, targeted case management, and school-based services.¹² For substance use disorders, Maryland covers residential treatment at multiple levels of intensity under a Section 1115 waiver, from clinically managed low-intensity care through medically monitored intensive inpatient services. Residential stays are generally limited to two non-consecutive 30-day periods per year, with extensions possible when medically necessary.¹³ Most behavioral health medications are also carved out and processed through fee-for-service.¹¹ To reach the system, call 1-800-888-1965.

Pregnancy and Postpartum

Maryland Medicaid covers prenatal care, labor and delivery, and postpartum services. Covered postpartum care includes physical recovery visits, mental health treatment for conditions like postpartum depression, management of chronic conditions such as diabetes and high blood pressure, and family planning. Coverage continues for 12 months after the pregnancy ends, whether or not the pregnancy resulted in a live birth, with the clock starting on the last day of the pregnancy and running through the end of that month.¹⁴ Pregnant members are also exempt from pharmacy copays.

Children and Young Adults Under 21

Members under 21 get a particularly deep benefit set through the federal Early and Periodic Screening, Diagnostic, and Treatment program, known in Maryland as the Healthy Kids Program. Under federal law, the state must cover any Medicaid-coverable service that is medically necessary to treat a condition found during screening, even if the service isn’t normally covered for adults.¹⁵

Preventive care follows an American Academy of Pediatrics schedule: well-child visits, immunizations, lead screening at 12 and 24 months, autism screening, developmental assessments, hearing and vision checks, and lab tests.¹⁶ Treatment services available for children include audiology, physical therapy, occupational therapy, speech therapy, applied behavior analysis, vision services, and mental health services.¹⁷ Dental referrals start at age two, and all pharmacy copays are waived.

Hearing Aids

Since July 1, 2018, Maryland Medicaid has covered hearing aids, cochlear implants, and auditory osseointegrated devices for adults over 21, not just children.¹⁸ A primary care referral and an audiologist’s medical-necessity assessment are required. For adults, hearing aid replacement is covered every five years unless the MCO approves an earlier replacement.¹⁹

Durable Medical Equipment, Prosthetics, and Orthotics

Medically necessary durable medical equipment such as wheelchairs, crutches, and incontinence supplies is covered, along with prosthetic and orthotic devices.²⁰ Effective January 1, 2025, under the “So Every Body Can Move Act,” prosthetic coverage expanded to include devices used for physical activities like running, swimming, and biking, in addition to daily use at home, school, or work.²¹

Under the fee-for-service program, prior authorization is required for prosthetic and orthotic devices costing $1,000 or more, and for orthotics specifically at $500 or more; MCOs may set their own thresholds.²² Repairs are covered. Replacements are available for devices less than three years old when the need arises from a change in the patient’s condition or irreparable damage not caused by misuse.²¹

Rehabilitation Therapies

Physical therapy is covered for members of all ages.²³ For children under 21, occupational therapy, speech-language pathology, and chiropractic services are available as carved-out fee-for-service benefits under EPSDT. For adults 21 and older, occupational therapy and speech therapy run through the MCOs, and chiropractic services are generally not covered.²⁴ Podiatry is a covered service, but for adults, routine foot care is limited to members with vascular disease affecting the area from the hip to the toes.³

Gender-Affirming Care

Maryland Medicaid covers medically necessary gender-affirming care, with coverage substantially expanded on January 1, 2024, under the Trans Health Equity Act.²⁵ Covered services include hormone therapy and lab monitoring, puberty suppression, genital reassignment surgery, facial surgery, top surgery, voice therapy and voice surgery, hair removal, fertility preservation, post-transition preventive screenings, and behavioral health therapy for gender dysphoria.²⁶ Most surgical procedures require pre-authorization. For minors, a multidisciplinary team including a mental health professional must confirm the need for services, and parental consent is required.²⁷

Telehealth

Live audio-video telehealth visits are reimbursed, and the Preserve Telehealth Access Act of 2025 made audio-only telephone visits permanently billable as well.²⁸ Patients can be at home or any secure location. Providers must obtain and document patient consent before each session, and the technology has to be HIPAA-compliant. If an audio-video session drops to audio-only because of technical problems, it can still be billed as an audio-only encounter when the service is appropriate for that format.²⁹

Non-Emergency Medical Transportation

Members who have no other way to reach appointments can get free rides to and from doctor visits, hospital appointments, and other medical services, provided by a mix of staff drivers, taxis, buses, and vans.³⁰ Rides are arranged through the local health department, usually by calling the county transportation office the week before the visit.³¹

Long-Term Care and Home-Based Services

Long-term services and supports are available for older adults, people with physical or intellectual disabilities, medically fragile children, and people eligible for both Medicaid and Medicare. These benefits are paid fee-for-service, outside HealthChoice.³²

The state runs several pathways:

Nursing home coverage is an entitlement for residents of Medicaid-certified nursing facilities. Residents contribute nearly all their monthly income toward the cost, minus a $106 personal needs allowance (as of July 2025), Medicare premiums, and spousal allowances.³³
Community First Choice provides personal assistance, nurse monitoring, home-delivered meals, assistive technology (capped at $15,000 every three years), environmental adaptations, and transition support for people moving from institutions back into the community.³⁴
Four active 1915(c) home and community-based waivers cover medically fragile children (220 spots), children with autism (3,100 spots, currently full), medical day care (8,521 spots), and the Community Pathways program for individuals with developmental disabilities (21,446 spots).³⁵

Waiting lists are substantial. As of April 2026, documented waitlists included roughly 6,200 individuals for the autism waiver, 23,750 for physical disability services, 3,302 for developmental disability services, and 182 for medically fragile children.³⁵

What Members Actually Pay

For most covered services, nothing. The main out-of-pocket costs are the $1 and $3 pharmacy copays for adults 21 and older, with children, pregnant members, Native American members, members in long-term care, and family planning drugs all exempt. Nursing home residents contribute nearly all their income toward their cost of care, keeping the $106 monthly personal needs allowance plus Medicare premiums and spousal allowances.

Federal Changes Coming to Eligibility

Federal law H.R. 1, enacted July 4, 2025, will change who stays covered. Beginning October 2026, certain non-citizen categories, including asylees, refugees, and individuals granted parole for at least one year, will no longer qualify. Green card holders meeting the five-year residency rule, Cuban and Haitian non-citizens, COFA migrants, and qualifying pregnant people and children remain eligible.³⁶

Starting in January 2027, qualified adults ages 19 to 64 will face a work requirement of 80 hours per month of approved activities, with exemptions based on health conditions. Coverage renewals will also shift from every 12 months to every 6 months. The state estimates these changes will affect roughly 300,000 Marylanders.³⁶

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2
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3
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4
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14
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18
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19
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20
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21
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22
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23
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24
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25
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26
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27
Maryland Department of Health. Gender Affirming Care
28
Center for Connected Health Policy. Maryland Telehealth Policy
29
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30
Worcester County Health Department. Transportation
31
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32
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33
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34
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35
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36
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