Maryland delivers most Medicaid benefits through HealthChoice, a mandatory managed care program operating under a Section 1115 demonstration first implemented in 1997. Nine managed care organizations cover physical health and most behavioral health administration for the majority of the state's Medicaid population; long-term services and supports are delivered separately through a set of home- and community-based waivers, a State Plan personal-care option, and PACE, rather than through the MCOs themselves. In 2024, the most recent year CMS reports enrollment, HealthChoice's nine plans covered roughly 1.67 million members.
HealthChoice's nine current MCOs are Aetna Better Health of Maryland, CareFirst BlueCross BlueShield Community Health Plan Maryland, Jai Medical Systems, Kaiser Permanente, Maryland Physicians Care, MedStar Family Choice, Priority Partners, UnitedHealthcare Community Plan, and Wellpoint Maryland. In 2024, the most recent year CMS reports enrollment, the nine plans were led by Priority Partners (384,354), Wellpoint Maryland (350,641), and Maryland Physicians Care (266,727). All nine plans currently operate under the same CY2026 HealthChoice MCO Agreement, a single agreement MDH applies identically across the program rather than negotiating separate terms per plan. The current 1115 demonstration authorizing HealthChoice runs through December 31, 2026, with a 2027-2031 renewal application already under CMS review.
Long-term services and supports sit outside the HealthChoice MCO benefit. The Developmental Disabilities Administration administers three separate 1915(c) HCBS waivers for people with intellectual and developmental disabilities: Community Pathways, the state's primary and largest waiver, and the Family Supports Waiver and Community Supports Waiver, both of which remain independently authorized rather than having been absorbed into Community Pathways. Older adults and people with physical disabilities who need an institutional level of care can instead access services through the Home and Community-Based Options Waiver, and members with acquired brain injury or autism spectrum disorder have their own dedicated 1915(c) waivers; Community First Choice, a State Plan option under Section 1915(k), and a narrower 1915(i) benefit for children and youth with intensive behavioral health needs run alongside these waivers. Hopkins ElderPlus is Maryland's one active PACE organization.
Not integrated into managed care
Behavioral health is carved out from the nine HealthChoice MCOs and administered statewide through a single Administrative Services Organization. Carelon is the current ASO, authorizing and managing specialty mental health and substance use disorder services under the Public Behavioral Health System.
Carved out
Dental coverage under the Maryland Healthy Smiles Dental Program is administered statewide by SKYGEN USA, the current Dental Administrative Service Organization. MDH has announced a planned transition to DentaQuest; SKYGEN USA remains the current operating DASO.
Each HealthChoice MCO administers its own pharmacy benefit and pharmacy benefit manager for its members, working from a Preferred Drug List that MDH's Pharmacy and Therapeutics Committee sets and updates. Provider Synergies, a Magellan Medicaid Administration affiliate, supports the state by negotiating supplemental drug rebates and helping develop the PDL. Mental health and substance use disorder medications follow a separate, state-set formulary and clinical criteria rather than each MCO's own general drug list.
Maryland's core Medicaid claims-processing system, MMIS II, is over 30 years old and is partway through a multi-year Modular Transformation that is replacing it component by component. SLI Government Solutions provides independent verification and validation oversight of the modernization effort; no current fiscal-agent or MMIS operating vendor has been named for the system.
Last updated: Aug 29, 2026
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