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ADAA : PAC and Medicaid Overview

Q:         What is PAC and who does it cover?

A:         PAC is the Primary Adult Care Program.  PAC is an eligibility group in the Medicaid program.  PAC is available to adults without dependent children who have incomes below 116% of the federal poverty level (FPL) or $12,552 annually.  Adults with dependent children who have incomes below 116% of the FPL are eligible for more comprehensive health care benefits under Medical Assistance for Families.  For   information on PAC, such as brochures, fact sheets, and application forms, please go to http://mmcp.dhmh.maryland.gov/mpac/SitePages/Home.aspx

Q:        What is the difference between Medicaid, PAC, Medical Assistance for Families and HealthChoice?

A:        These are all terms used to describe different aspects of the state Medicaid program, which provides health care coverage for low-income individuals.  Medicaid is the name for the federal and state funded program that provides Medical Assistance to low-income and elderly persons.  Medical Assistance for Families is a Medicaid eligibility group in Maryland.  Medical Assistance for Families is the designation given to the group of parents covered by a law passed in 2007.  People were first enrolled on July 1, 2008.  PAC is a Medicaid eligibility group for adults without dependent children which also receives state and federal funds.  PAC does not provide the comprehensive benefits that are covered by the Medicaid program.  HealthChoice is the name of Maryland’s managed care program which contracts with Managed Care organizations (MCOs) to provide health care to individuals enrolled in Medicaid.  Most individuals with Medicaid and all individuals enrolled in PAC are enrolled in MCOs. 

Q:        What changed in January 2010?

A:        The PAC program began covering most substance abuse services provided by Medicaid (similar to those services covered for people in HealthChoice).  These services include: Substance Abuse Assessment, Individual Outpatient Therapy, Group Outpatient Therapy, Intensive Outpatient, and Methadone Maintenance.  The main Medicaid substance abuse services not covered by PAC are those provided by a hospital based provider in a setting that is regulated by the Health Services Cost Review Commission (HSCRC).  There are only a few of these providers in Maryland.

Q:        What is the Substance Abuse Improvement Initiative? 

A:        The Substance Abuse Improvement Initiative (SAII) began as a voluntary agreement between providers and HealthChoice MCOs to develop common procedures and rules for Medicaid coverage of substance abuse treatment.  Within the SAII, the self-referral protocol allows an individual to receive treatment for certain services from providers, regardless of whether the provider has a contract with the MCO, as long as the provider meets the requirements laid out in the SAII.  Under this agreement, MCOs voluntarily paid the Medicaid fee schedule to non-participating providers for these self-referred substance abuse services.  This voluntary agreement is being incorporated in regulation by DHMH for dates of service beginning January 1, 2010.  The DHMH website provides information on the SAII and the self-referral protocol and related forms.  It will also be used by the MCOs for persons in PAC.

Q:        Do all the MCOs participate in the PAC program?

A:        Not all of the MCOs participate in the PAC program, but most do.  The only MCOs that do not currently participate in PAC are Diamond (a Coventry MCO) and MedStar.

Q:        Which MCOs serve my jurisdiction and how many people do they serve?

A:        Seven MCOs participate in the Medicaid HealthChoice program.  Only 5 MCOs participate in the PAC program.    The following charts show Medicaid MCO and PAC enrollment by county and by MCO. This will help you know which MCOs have the most enrollment in your region.

           MCO PAC Coverage by County (pdf)           MCO HealthChoice Coverage by County (pdf)