Medical Assistance Ineligible Consumers

Information for Medicaid Assistance Ineligible Consumers

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Medical Assistance Ineligible (MAI) consumers are individuals for whom, because of the severity of mental illness and financial need, the cost of medically necessary and appropriate mental health services will be subsidized by the Mental Hygiene Administration (MHA). The benefits are subject to the availability of funds appropriated to the MHA. The term 'benefit' as referred to MAI consumers does not guarantee rights to services. The term 'uninsured' refers to consumers who have no insurance.

Medical Assistance Ineligible Consumers

Application/Registration Process

Special Circumstances

Eligibility Requirements

Residency

If you do not have Medicaid you may have to pay for some of the cost of your care. Your provider can help you figure how much you need to pay, if any. If you need help, contact your Core Service Agency (CSA).

Medical Assistance Ineligible Consumers

This population may be served in the PMHS if they meet the following criteria:

Meet the criteria for Pharmacy Assistance;
Have been served in the PMHS after 7/1/2002;
Are currently homeless;
Are on Conditional Release from MD Medicaid Psychiatric Hospital;
Have been discharged from a Maryland Medicaid Psychiatric Hospital within the last 3 months; and/or
Have been discharged from prison within the last 3 months.

Psychiatric Rehabilitation Services for MAI Consumers:

After July 1, 2002, to be eligible for psychiatric rehabilitation and residential rehabilitation services, the consumer must be in the target population. Target population is defined as those children, adolescents, and adults for whom, because of the seriousness of their mental illness, extent of functional disability, and financial need, the Department has declared priority for publicly funded services. Target population includes:

Child or Adolescent with serious emotional disturbance which is a condition that is:
1) Diagnosed with a mental health diagnosis, according to a current diagnostic and statistical manual of the American Psychiatric Association; and
2) Characterized by a functional impairment that substantially interferes with or limits the child's role or functioning in the family, school, or community activities.

Adult with a serious and persistent mental disorder which is:
1) Diagnosed according to a current diagnostic and statistical manual of the American Psychiatric Association; and
2) Characterized by impaired role functioning on a continuing or intermittent basis for at least two years.

Outpatient Services for MAI Consumers:

For outpatient services, the consumer must have a Pharmacy Assistance Program Card or meet the criteria for Pharmacy Assistance and have an urgent need for immediate outpatient services.

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Application/Registration Process

Requests for services for MAI consumers can come from the provider or the consumer by calling MAPS-MD at 1-800-888-1965. MAPS-MD will conduct a preliminary assessment over the phone to establish that the consumer is eligible to receive services in the PMHS. The consumer will then be referred to a provider according to his or her level of need (routine, urgent, or emergent). A provider could also request services for MAI consumers through Care Connections. Requests will be forwarded to the CSA for review and authorization.

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Special Circumstances

A co-pay for services may be required.

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Eligibility Requirements

In order to be eligible for benefits, an applicant must be a citizen of the United States with a valid social security number or be one of the following:

An alien who is lawfully admitted for permanent residence;
An alien who is permanently residing in the United States under order of law, in accordance with the provisions of the Immigration and Nationality Act, 8 U.S.C. ''1011 et seq., including an alien who is lawfully present in the United States under '212(d)(5) of the Immigration and Nationality Act, 8 U.S.C. '1182(d)(5);
An alien lawfully admitted to the United States on or after April 1, 1981, under the Refugee Assistance Act of 1980, PL 96-212, 8 U.S.C. ''1521-1525, and who has resided in the United States for less than 36 months;
An alien who has been granted (and maintains) temporary lawful residence status under section 245A of the Immigration and Nationality Act, P.L. 99-603, 8 U.S.C. '1255a, and is in one of the excepted groups; or
An alien who is a pregnant woman or child and has permanent residence, and/or has been lawfully granted temporary resident status.

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Residency

In order to be eligible for benefits, an applicant shall be a resident of Maryland:

An applicant is a resident of Maryland if, at the time of application, the person is voluntarily living in Maryland with the intention of making Maryland the applicant's home. If an applicant has entered the State for a temporary purpose and is not intending to become a resident of Maryland, the applicant is not eligible. Residency is retained until abandoned. Temporary absence from the State with the intention to return to the State does not interrupt continuity of residency.

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