109-518: The Health Insurance Premium Payment Program ( HIPP ) is a Medicaid program that allows a recipient to receive free private health insurance paid for entirely by their state's Medicaid program. A Medicaid recipient must be deemed 'cost effective' by the HIPP program of their state. Ultimately, the program was made optional, and its use is minimal. The Omnibus Budget Reconciliation Act of 1990 (OBRA-90) authorized states to implement an HIPP program. HIPP
218-688: A slave state , Maryland remained in the Union during the American Civil War , and its proximity to Washington D.C. and Virginia made it a significant strategic location . After the Civil War ended, Maryland took part in the Industrial Revolution , driven by its seaports, railroad networks, and mass immigration from Europe. Since the 1940s, the state's population has grown rapidly, to approximately six million residents, and it
327-507: A university , library system , music and dance conservatory , and art museum . Cumberland was Maryland's second-largest city in the 19th century. Nearby supplies of natural resources along with railroads fostered its growth into a major manufacturing center. The Progressive Era of the late 19th and early 20th centuries brought political reforms. In a series of laws passed between 1892 and 1908, reformers worked for standard state-issued ballots (rather than those distributed and marked by
436-544: A "free appropriate public education" under Section 504 of The Rehabilitation Act of 1973. Decisions by the United States Supreme Court and subsequent changes in federal law require states to reimburse part or all of the cost of some services provided by schools for Medicaid-eligible disabled children. The Affordable Care Act (ACA), passed in 2010, substantially expanded the Medicaid program. Before
545-675: A final agreement was signed in 1760. The agreement defined the border between Maryland and Pennsylvania as the line of latitude now known as the Mason–Dixon line . Maryland's border with Delaware was based on a Transpeninsular Line and the Twelve-Mile Circle around New Castle. Most of the English colonists arrived in Maryland as indentured servants , and had to serve a several years' term as laborers to pay for their passage. In
654-474: A new pro-union governor and legislature, President Abraham Lincoln had a number of its pro-slavery politicians arrested, including the Mayor of Baltimore, George William Brown ; suspended several civil liberties, including habeas corpus ; and ordered artillery placed on Federal Hill overlooking Baltimore. In April 1861, Federal units and state regiments were attacked as they marched through Baltimore, sparking
763-505: A program called Access to Baby and Child Dentistry (ABCD) has helped increase access to dental services by providing dentists higher reimbursements for oral health education and preventive and restorative services for children. After the passing of the Affordable Care Act , many dental practices began using dental service organizations to provide business management and support, allowing practices to minimize costs and pass
872-523: A series of newspaper editorials. Maryland's urban and rural communities had different experiences during the Great Depression . The " Bonus Army " marched through the state in 1932 on its way to Washington, D.C. Maryland instituted its first income tax in 1937 to generate revenue for schools and welfare. Passenger and freight steamboat service, once important throughout Chesapeake Bay and its many tributary rivers, ended in 1962. Baltimore
981-477: A significant portion of their funding. Medicaid was established in 1965, part of the Great Society set of programs during President Lyndon Johnson’s Administration , and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid coverage under the provisions of
1090-588: A significant proportion of Medicaid enrollees. As of 2014, 26 states have contracts with managed care organizations (MCOs) to deliver long-term care for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs, which in turn provide comprehensive care and accept the risk of managing total costs. Nationwide, roughly 80% of Medicaid enrollees are enrolled in managed care plans. Core eligibility groups of low-income families are most likely to be enrolled in managed care, while
1199-536: A small portion of the state's northeast corner (which drains into the Delaware River watershed). So prominent is the Chesapeake in Maryland's geography and economic life that there has been periodic agitation to change the state's official nickname to the "Bay State", a nickname that has been used by Massachusetts for decades. The highest point in Maryland, with an elevation of 3,360 feet (1,020 m),
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#17327729073041308-622: A state tobacco buy-out program in the 1990s. In an effort to reverse depopulation due to the loss of working-class industries, Baltimore initiated urban renewal projects in the 1960s with Charles Center and the Baltimore World Trade Center . Some resulted in the break-up of intact residential neighborhoods, producing social volatility, and some older residential areas around the harbor have had units renovated and have become popular with new populations. Maryland has an area of 12,406.68 square miles (32,133.2 km ) and
1417-722: A variety of topography within its borders, contributing to its nickname America in Miniature . It ranges from sandy dunes dotted with seagrass in the east, to low marshlands teeming with wildlife and large bald cypress near the Chesapeake Bay, to gently rolling hills of oak forests in the Piedmont Region , and pine groves in the Maryland mountains to the west. Maryland is bounded on its north by Pennsylvania , on its north and east by Delaware , on its east by
1526-552: Is Hoye Crest on Backbone Mountain , in the southwest corner of Garrett County , near the border with West Virginia, and near the headwaters of the North Branch of the Potomac River. Close to the small town of Hancock , in western Maryland, about two-thirds of the way across the state, less than 2 miles (3.2 km) separates its borders, the Mason–Dixon line to the north, and the northwards-arching Potomac River to
1635-505: Is a mandatory Medicaid program for children that focuses on prevention, early diagnosis and treatment of medical conditions. Oral screenings are not required for EPSDT recipients, and they do not suffice as a direct dental referral. If a condition requiring treatment is discovered during an oral screening, the state is responsible for paying for this service, regardless of whether or not it is covered on that particular Medicaid plan. Children enrolled in Medicaid are individually entitled under
1744-403: Is a program that is not solely funded at the federal level. States provide up to half of the funding for Medicaid. In some states, counties also contribute funds. Unlike Medicare, Medicaid is a means-tested , needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility
1853-401: Is a universal program providing health coverage for the elderly. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare. Along with Medicare, Tricare , and ChampVA , Medicaid is one of the four government-sponsored medical insurance programs in
1962-400: Is among the most densely populated U.S. states. As of 2015 , Maryland had the highest median household income of any state, owing in large part to its proximity to Washington, D.C., and a highly diversified economy spanning manufacturing, retail services, public administration, real estate, higher education, information technology, defense contracting, health care, and biotechnology. Maryland
2071-425: Is comparable in overall area with Belgium [11,787 square miles (30,530 km )]. It is the 42nd-largest and 9th-smallest state and is closest in size to the state of Hawaii [10,930.98 square miles (28,311.1 km )], the next smallest state. The next largest state is Maryland's neighbor, West Virginia , which is nearly twice the size of Maryland [24,229.76 square miles (62,754.8 km )]. Maryland possesses
2180-528: Is defined vary from state to state. As of 2019, when Medicaid has been expanded under the PPACA, eligibility is determined by an income test using Modified Adjusted Gross Income , with no state-specific variations and a prohibition on asset or resource tests. While Medicaid expansion available to adults under the PPACA mandates a standard income-based test without asset or resource tests, other eligibility criteria such as assets may apply when eligible outside of
2289-403: Is for families who have at least one person who gets Medicaid and can get private insurance through a family member's work. As of 2008, relatively few states had premium assistance programs, and enrollment was relatively low. Interest in this approach remained high, however. In some states the HIPP program has been institutionalized by non profit organizations to assist Medicaid recipients with
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#17327729073042398-413: Is largely consistent by state, and requirements on how to qualify or what benefits are provided are standard. However AFDC has differing eligibility standards that depend on: Beyond the variance in eligibility and coverage between states, there is a large variance in the reimbursements Medicaid offers to care providers; the clearest examples of this are common orthopedic procedures . For instance, in 2013,
2507-626: Is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligible or medi-medi's. In 2001, about 6.5 million people were enrolled in both Medicare and Medicaid. In 2013, approximately 9 million people qualified for Medicare and Medicaid. There are two general types of Medicaid coverage. "Community Medicaid" helps people who have little or no medical insurance. Medicaid nursing home coverage helps pay for
2616-430: Is now St. Mary's County . They purchased the site from the paramount chief of the region, who was eager to establish trade. St. Mary's became the first capital of Maryland, and remained so for 60 years until 1695. More settlers soon followed. Their tobacco crops were successful and quickly made the new colony profitable. However, given the incidence of malaria , yellow fever , and typhoid , life expectancy in Maryland
2725-565: Is one of the most multicultural states in the country; it is one of the six states where non-Whites compose a majority of the population , with the fifth-highest percentage of African Americans , and high numbers of residents born in Africa , Asia , Central America , and the Caribbean . The state's central role in U.S. history is reflected by its hosting of some of the highest numbers of historic landmarks per capita. The western portion of
2834-531: Is worse than that of people with higher income. The Census Bureau reported in September 2019 that states that expanded Medicaid under ACA had considerably lower uninsured rates than states that did not. For example, for adults between 100% and 399% of poverty level, the uninsured rate in 2018 was 12.7% in expansion states and 21.2% in non-expansion states. Of the 14 states with uninsured rates of 10% or greater, 11 had not expanded Medicaid. A July 2019 study by
2943-410: The 2008–2009 recession resulted in a substantial increase in Medicaid enrollment in 2009. Nine U.S. states showed an increase in enrollment of 15% or more, putting a heavy strain on state budgets. The Kaiser Family Foundation reported that for 2013, Medicaid recipients were 40% white, 21% black, 25% Hispanic, and 14% other races. Unlike Medicaid, Medicare is a social insurance program funded at
3052-550: The Aberdeen Proving Ground , and the Edgewood Arsenal were established. Existing facilities, including Fort McHenry , were greatly expanded. After Georgia congressman William D. Upshaw criticized Maryland openly in 1923 for not passing Prohibition laws, Baltimore Sun editor Hamilton Owens coined the "Free State" nickname for Maryland in that context, which was popularized by H. L. Mencken in
3161-694: The Atlantic Ocean , and on its south and west, across the Potomac River , by West Virginia and Virginia . The mid-portion of its border with Virginia is interrupted by Washington, D.C. , which sits on land that was originally part of Montgomery and Prince George's counties and including Georgetown, Maryland , which was ceded to the United States federal government in 1790 to form the Washington, D.C. Chesapeake Bay nearly bisects
3270-627: The Baltimore riot of 1861 , the first bloodshed in the Civil War. Of the 115,000 Marylanders who joined the military during the Civil War, around 85,000, or 77%, joined the Union army , while the remainder joined the Confederate Army . The largest and most significant battle in the state was the Battle of Antietam on September 17, 1862, near Sharpsburg . Although a tactical draw, the battle
3379-471: The Ohio River from the eastern seaboard. The state remained in the Union during the American Civil War , due in significant part to demographics and Federal intervention. The 1860 census, held shortly before the outbreak of the civil war, showed that 49% of Maryland's African Americans were free . Governor Thomas Holliday Hicks suspended the state legislature, and to help ensure the election of
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3488-1161: The Patuxent ), the Nanticoke (including the Tocwogh , the Ozinie and other subdivisions), the Powhatan , the Lenape , the Susquehannock , the Shawnee , the Tutelo , the Saponi , the Pocomoke and the Massawomeck . George Calvert, 1st Baron Baltimore (1579–1632), sought a charter from King Charles I for the territory between Massachusetts to the north and Virginia to the immediate south. After Baltimore died in April 1632,
3597-536: The Supplemental Security Income (SSI) program for the aged, blind and disabled. States are required under federal law to provide all AFDC and SSI recipients with Medicaid coverage. Because eligibility for AFDC and SSI essentially guarantees Medicaid coverage, examining eligibility/coverage differences per state in AFDC and SSI is an accurate way to assess Medicaid differences as well. SSI coverage
3706-567: The "Act concerning Religion" in 1649 granting religious liberty to all Trinitarian Christians. In 1650, the Puritans revolted against the proprietary government. "Protestants swept the Catholics out of the legislature ... and religious strife returned." The Puritans set up a new government prohibiting both Roman Catholicism and Anglicanism . The Puritan revolutionary government persecuted Maryland Catholics during its reign, known as
3815-454: The "aged" and "disabled" eligibility groups more often remain in traditional " fee for service " Medicaid. Because service level costs vary depending on the care and needs of the enrolled, a cost per person average is only a rough measure of actual cost of care. The annual cost of care will vary state to state depending on state approved Medicaid benefits, as well as the state specific care costs. A 2014 Kaiser Family Foundation report estimates
3924-608: The "plundering time". Mobs burned down all the original Catholic churches of southern Maryland. The Puritan rule lasted until 1658 when the Calvert family and Lord Baltimore regained proprietary control and re-enacted the Toleration Act. After England's Glorious Revolution in 1688, Maryland outlawed Catholicism. In 1704, the Maryland General Assembly prohibited Catholics from operating schools, limited
4033-510: The 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage. A 2016 study found that residents of Kentucky and Arkansas , which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. Residents of Texas , which did not accept
4142-461: The 1730s. Hostilities erupted in 1730 and escalated through the first half of the decade, culminating in the deployment of military forces by Maryland in 1736 and by Pennsylvania in 1737. The armed phase of the conflict ended in May 1738 with the intervention of King George II, who compelled the negotiation of a cease-fire. A provisional agreement had been established in 1732. Negotiations continued until
4251-552: The 18th century, individual priests and lay leaders claimed Maryland farms belonging to the Jesuits as personal property and bequeathed them in order to evade the legal restrictions on religious organizations' owning property. The royal charter granted Maryland the land north of the Potomac River up to the 40th parallel . A problem arose when Charles II granted a charter for Pennsylvania . The grant defined Pennsylvania's southern border as identical to Maryland's northern border,
4360-416: The 1980s, many states received waivers from the federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to
4469-403: The 40th parallel. But the grant indicated that Charles II and William Penn assumed the 40th parallel would pass close to New Castle, Delaware when it falls north of Philadelphia , the site of which Penn had already selected for his colony's capital city. Negotiations ensued after the problem was discovered in 1681. A compromise proposed by Charles II in 1682 was undermined by Penn's receiving
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4578-498: The ACA. A 2012 Supreme Court decision established that states may continue to use pre-ACA Medicaid eligibility standards and receive previously established levels of federal Medicaid funding; in states that make that choice, income limits may be significantly lower, and able-bodied adults may not be eligible for Medicaid at all. Medicaid is the largest source of funding for medical and health-related services for people with low income in
4687-474: The Affordable Care Act was a federally-funded increase in 2013 and 2014 in Medicaid payments to bring them up to 100% of equivalent Medicare payments, in an effort to increase provider participation. Most states did not subsequently continue this provision. In 2002, Medicaid enrollees numbered 39.9 million Americans, with the largest group being children (18.4 million or 46%). From 2000 to 2012,
4796-594: The Constitution of 1864 with the Constitution of 1867 . Following the end of Reconstruction in 1877, Democrats devised means of disenfranchising blacks, initially by physical intimidation and voter fraud, later by constitutional amendments and laws. Blacks and immigrants, however, resisted Democratic Party disfranchisement efforts in the state. Maryland blacks were part of a biracial Republican coalition elected to state government in 1896–1904 and comprised 20% of
4905-617: The Federal government, although states would need to pay for 10% of those costs by 2020. However, in 2012, the Supreme Court held in National Federation of Independent Business v. Sebelius that withdrawing all Medicaid funding from states that refused to expand eligibility was unconstitutionally coercive. States could choose to maintain pre-existing levels of Medicaid funding and eligibility, and some did; over half
5014-510: The Maryland General Assembly passed an Act Concerning Religion , which enshrined the principle of toleration . Religious strife was common in Maryland's early years, and Catholics remained a minority, albeit in greater numbers than in any other English colony. Maryland's early settlements and population centers clustered around waterways that empty into the Chesapeake Bay . Its economy was heavily plantation-based and centered mostly on
5123-736: The Medicaid expansion, did not see a similar improvement during the same period. Kentucky opted for increased managed care, while Arkansas subsidized private insurance. Later, Arkansas and Kentucky governors proposed reducing or modifying their programs. From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas. A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies because they had fewer low-income enrollees, whose health, on average,
5232-567: The National Bureau of Economic Research (NBER) indicated that states enacting Medicaid expansion exhibited statistically significant reductions in mortality rates. The ACA was structured with the assumption that Medicaid would cover anyone making less than 133% of the Federal poverty level throughout the United States; as a result, premium tax credits are only available to individuals buying private health insurance through exchanges if they make more than that amount. This has given rise to
5341-461: The PPACA expansion, including coverage for eligible seniors or disabled. These other requirements include, but are not limited to, assets, age, pregnancy, disability, blindness, income, and resources, and one's status as a U.S. citizen or a lawfully admitted immigrant . As of 2015, asset tests varied; for example, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for
5450-521: The Piedmont in the Coastal Plain, though it straddles the border between the two regions. Earthquakes in Maryland are infrequent and small due to the state's distance from seismic/earthquake zones. The M 5.8 Virginia earthquake in 2011 was felt moderately throughout Maryland. Buildings in the state are not well-designed for earthquakes and can suffer damage easily. As well as this, notably
5559-622: The Social Security Act of 1935 and became effective on January 1, 1991. This program was formed due to the costs that Medicaid programs were paying for discount price outpatient drugs. The Omnibus Budget Reconciliation Act of 1993 (OBRA-93) amended Section 1927 of the Act, bringing changes to the Medicaid Drug Rebate Program. It requires states to implement a Medicaid estate recovery program to recover from
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#17327729073045668-438: The Union after ratifying the new federal Constitution in 1788. In December 1790, prior to the move of the national capital from Philadelphia in 1800, Maryland donated land selected by first President George Washington to the federal government for its creation. The land was provided along the north shore of the Potomac River from Montgomery and Prince George's counties, as well as from Fairfax County and Alexandria on
5777-841: The United States, providing free health insurance to 85 million low-income and disabled people as of 2022; in 2019, the program paid for half of all U.S. births. As of 2017, the total annual cost of Medicaid was just over $ 600 billion, of which the federal government contributed $ 375 billion and states an additional $ 230 billion. States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities . As of 2022 45% of those receiving Medicaid or CHIP were children. Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets;
5886-916: The United States. The U.S. Centers for Medicare & Medicaid Services in Baltimore , Maryland provides federal oversight. Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers. Medicaid expansion has enhanced access to healthcare services. Studies have shown improved self-reported health following expansion and an association between expansion and certain positive health outcomes. Expanding Medicaid has been associated with significant declines in mortality related to specific conditions, including various types of cancer, cardiovascular disease, and liver disease. Additionally, studies have found decreased maternal mortality and, in some cases, reductions in infant mortality among certain populations. Beginning in
5995-646: The additional grant of what is now Delaware. Penn successfully argued that the Maryland charter entitled Lord Baltimore only to unsettled lands, and Dutch settlement in Delaware predated his charter. The dispute remained unresolved for nearly a century, carried on by the descendants of William Penn and Lord Baltimore—the Calvert family , which controlled Maryland, and the Penn family , which controlled Pennsylvania. The border dispute with Pennsylvania led to Cresap's War in
6104-638: The aged/blind/disabled pathway up to 100% of the Federal Poverty Level . Maryland Maryland ( US : / ˈ m ɛr ɪ l ə n d / MERR -il-ənd ) is a state in the Mid-Atlantic region of the United States . It borders Virginia to its south, West Virginia to its west, Pennsylvania to its north, Delaware and the Atlantic Ocean to its east, and the national capital of Washington, D.C. to
6213-665: The average difference in reimbursement for 10 common orthopedic procedures in the states of New Jersey and Delaware was $ 3,047. The discrepancy in the reimbursements Medicaid offers may affect the type of care provided to patients. In general, Medicaid plans pay providers significantly less than commercial insurers or Medicare would pay for the same care, paying around 67% as much as Medicare would for primary care and 78% as much for other services. This disparity has been linked to lower provider rates of participation in Medicaid programs vs Medicare or commercial insurance, and thus decreased access to care for Medicaid patients. One component of
6322-490: The charter was granted to his son, Cecilius Calvert, 2nd Baron Baltimore (1605–1675), on June 20, 1632. Officially, the new "Maryland Colony" was named in honor of Henrietta Maria of France , wife of Charles I. Lord Baltimore initially proposed the name "Crescentia", the land of growth or increase, but "the King proposed Terra Mariae [Mary Land], which was concluded on and inserted in the bill." The original capital of Maryland
6431-554: The colonies, following Virginia in 1662. Many of the free black families migrated to Delaware, where land was cheaper. As the flow of indentured laborers to the colony decreased with improving economic conditions in England, planters in Maryland imported thousands more slaves and racial caste lines hardened. Maryland was one of the thirteen colonies that revolted against British rule in the American Revolution . Near
6540-562: The corporate ownership of property to hamper religious orders from expanding or supporting themselves, and encouraged the conversion of Catholic children. The celebration of the Catholic sacraments was also officially restricted. This state of affairs lasted until after the American Revolutionary War (1775–1783). Wealthy Catholic planters built chapels on their land to practice their religion in relative secrecy. Into
6649-514: The cost of expansion was $ 6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion. In some states that chose not to expand Medicaid, income eligibility thresholds are significantly below 133% of
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#17327729073046758-592: The cost of living in a nursing home for those who are eligible; the recipient also pays most of his/her income toward the nursing home costs, usually keeping only $ 66.00 a month for expenses other than the nursing home. Some states operate a program known as the Health Insurance Premium Payment Program (HIPP). This program allows a Medicaid recipient to have private health insurance paid for by Medicaid. As of 2008 relatively few states had premium assistance programs and enrollment
6867-508: The cost of private coverage. Certain groups of people, such as migrants, face more barriers to health care than others due to factors besides policy, such as status, transportation and knowledge of the healthcare system (including eligibility). Medicaid eligibility policies are very complicated. In general, a person's Medicaid eligibility is linked to their eligibility for Aid to Families with Dependent Children (AFDC), which provides aid to children whose families have low or no income, and to
6976-402: The cultivation of tobacco . Demand for cheap labor from Maryland colonists led to the importation of numerous indentured servants and enslaved Africans . In 1760, Maryland's current boundaries took form following the settlement of a long-running border dispute with Pennsylvania. Many of its citizens played key political and military roles in the American Revolutionary War . Although it was
7085-465: The difficult task of getting into the HIPP program. Medicaid In the United States , Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides
7194-405: The early years, the line between indentured servants and African slaves or laborers was fluid, and white and black laborers commonly lived and worked together, and formed unions. Mixed-race children born to white mothers were considered free by the principle of partus sequitur ventrem , by which children took the social status of their mothers, a principle of slave law that was adopted throughout
7303-711: The eastern and western halves of Maryland were linked for the first time by the Chesapeake Bay Bridge , which replaced a nearby ferry service. Maryland's regions experienced economic changes following WWII. Heavy manufacturing declined in Baltimore. In Maryland's four westernmost counties, industrial, railroad, and coal mining jobs declined. On the lower Eastern Shore , family farms were bought up by major concerns and large-scale poultry farms and vegetable farming became prevalent. In Southern Maryland, tobacco farming nearly vanished due to suburban development and
7412-403: The electorate and immigrants comprised 15%, and the legislature had difficulty devising requirements against blacks that did not also disadvantage immigrants. The Progressive Era also brought reforms in working conditions for Maryland's labor force. In 1902, the state regulated conditions in mines ; outlawed child laborers under the age of 12; mandated compulsory school attendance; and enacted
7521-509: The electorate. Compared to some other states, blacks were better established both before and after the civil war. Nearly half the black population was free before the war, and some had accumulated property. Half the population lived in cities. Literacy was high among blacks and, as Democrats crafted means to exclude them, suffrage campaigns helped reach blacks and teach them how to resist. Whites did impose racial segregation in public facilities and Jim Crow laws, which effectively lasted until
7630-552: The end of the American Revolutionary War (1775–1783), on February 2, 1781, Maryland became the last and 13th state to approve the ratification of the Articles of Confederation and Perpetual Union , first proposed in 1776 and adopted by the Second Continental Congress in 1778, which brought into being the United States as a united, sovereign and national state . It also became the seventh state admitted to
7739-472: The estate of deceased beneficiaries the long-term-care-related costs paid by Medicaid, and gives states the option of recovering all non-long-term-care costs, including full medical costs. Medicaid also offers a Fee for Service (Direct Service) Program to schools throughout the United States for the reimbursement of costs associated with the services delivered to students with special education needs. Federal law mandates that children with disabilities receive
7848-422: The exact qualifications vary by state. Medicaid spent $ 215 billion on such care in 2020, over half of the total $ 402 billion spent on such services. Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings. Medicaid covers healthcare costs for people with low incomes, while Medicare
7957-572: The federal level and focuses primarily on the older population. Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and (through the End Stage Renal Disease Program ) people of all ages with end-stage renal disease . The Medicare Program provides a Medicare part A covering hospital bills, Medicare Part B covering medical insurance coverage, and Medicare Part D covering purchase of prescription drugs . Medicaid
8066-426: The form of waivers for certain Medicaid requirements so long as they follow certain objectives. In its implementation, this has meant using Medicaid funds to pay for low-income citizens' health insurance; this private-option was originally carried out in Arkansas but was adopted by other Republican-led states. However, private coverage is more expensive than Medicaid and the states would not have to contribute as much to
8175-497: The generalized hypothesis that Democrats favor generous eligibility policies while Republicans do not. When the Supreme Court allowed states to decide whether to expand Medicaid or not in 2012, northern states, in which Democratic legislators predominated, disproportionately did so, often also extending existing eligibility. Certain states in which there is a Republican-controlled legislature may be forced to expand Medicaid in ways extending beyond increasing existing eligibility in
8284-483: The law to comprehensive preventive and restorative dental services, but dental care utilization for this population is low. The reasons for low use are many, but a lack of dental providers who participate in Medicaid is a key factor. Few dentists participate in Medicaid – less than half of all active private dentists in some areas. Cited reasons for not participating are low reimbursement rates, complex forms and burdensome administrative requirements. In Washington state,
8393-429: The law was passed, some states did not allow able-bodied adults to participate in Medicaid, and many set income eligibility far below the Federal poverty level. Under the provisions of the law, any state that participated in Medicaid would need to expand coverage to include anyone earning up to 138% of the Federal poverty level beginning in 2014. The costs of the newly covered population would initially be covered in full by
8502-445: The nation's first workers' compensation law. The workers' compensation law was overturned in the courts, but was redrafted and finally enacted in 1910. The Great Baltimore Fire of 1904 burned for more than 30 hours, destroying 1,526 buildings and spanning 70 city blocks. More than 1,231 firefighters worked to bring the blaze under control. With the nation's entry into World War I in 1917, new military bases such as Camp Meade ,
8611-407: The national anthem. National Road, later renamed U.S. Route 40 , was authorized in 1817 as the federal highway, and ran from Baltimore to St. Louis . The Baltimore and Ohio Railroad (B&O), the first chartered railroad in the United States, opened its first section of track for regular operation in 1830 between Baltimore and Ellicott City , and in 1852 it became the first rail line to reach
8720-632: The national average per capita annual cost of Medicaid services for children to be $ 2,577, adults to be $ 3,278, persons with disabilities to be $ 16,859, aged persons (65+) to be $ 13,063, and all Medicaid enrollees to be $ 5,736. The Social Security Amendments of 1965 created Medicaid by adding Title XIX to the Social Security Act , 42 U.S.C. §§ 1396 et seq. Under the program, the federal government provided matching funds to states to enable them to provide Medical Assistance to residents who met certain eligibility requirements. The objective
8829-620: The national uninsured population lives in those states. As of March 2023, 40 states have accepted the Affordable Care Act Medicaid extension, as has the District of Columbia , which has its own Medicaid program; 10 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. The Centers for Medicare and Medicaid Services (CMS) estimated that
8938-675: The parties); obtained closed voting booths to prevent party workers from "assisting" voters; initiated primary elections to keep party bosses from selecting candidates; and had candidates listed without party symbols, which discouraged the illiterate from participating. These measures worked against ill-educated whites and blacks. Blacks resisted such efforts, with suffrage groups conducting voter education. Blacks defeated three efforts to disenfranchise them, making alliances with immigrants to resist various Democratic campaigns. Disenfranchisement bills in 1905, 1907, and 1911 were rebuffed, in large part because of black opposition. Blacks comprised 20% of
9047-507: The passage of federal civil rights legislation in the mid-1960s. Baltimore grew significantly during the Industrial Revolution , due in large part to its seaport and good railroad connections, attracting European immigrant labor. Many manufacturing businesses were established in the Baltimore area after the Civil War. Baltimore businessmen, including Johns Hopkins , Enoch Pratt , George Peabody , and Henry Walters , founded notable city institutions that bear their names, including respectively
9156-466: The population was enrolled in Medi-Cal for at least 1 month in 2009–10. As of 2017, the total annual cost of Medicaid was just over $ 600 billion, of which the federal government contributed $ 375 billion and states an additional $ 230 billion. According to CMS, the Medicaid program provided health care services to more than 92 million people in 2022. Loss of income and medical insurance coverage during
9265-446: The poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($ 6,250 to $ 19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford
9374-464: The poverty line. Some of these states do not make Medicaid available to non-pregnant adults without disabilities or dependent children, no matter their income. Because subsidies on commercial insurance plans are not available to such individuals, most have few options for obtaining any medical insurance. For example, in Kansas , where only non-disabled adults with children and with an income below 32% of
9483-571: The proportion of hospital stays for children paid by Medicaid increased by 33% and the proportion paid by private insurance decreased by 21%. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $ 295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people. In 2009, 62.9 million Americans were enrolled in Medicaid for at least one month, with an average enrollment of 50.1 million. In California , about 23% of
9592-424: The recovery is limited to probate estates or extends beyond.) Several political factors influence the cost and eligibility of tax-funded health care. According to a study conducted by Gideon Lukens, factors significantly affecting eligibility included "party control, the ideology of state citizens, the prevalence of women in legislatures, the line-item veto, and physician interest group size". Lukens' study supported
9701-623: The same basic framework. As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is categorical —that is, to enroll one must be a member of a category defined by statute; some of these categories are: low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, low-income disabled people who receive Supplemental Security Income (SSI) and/or Social Security Disability (SSD), and low-income seniors 65 and older. The details of how each category
9810-1442: The same organization that handles Medicaid in a state may also manage the additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors. State participation in Medicaid is voluntary; however, all states have participated since 1982. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly. There are many services that can fall under Medicaid and some states support more services than other states. The most provided services are intermediate care for mentally disabled, prescription drugs and nursing facility care for under 21-year-olds. The least provided services include institutional religious (non-medical) health care, respiratory care for ventilator dependent and PACE (inclusive elderly care ). Most states administer Medicaid through their own programs. A few of those programs are listed below: As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama , Alaska , Arizona, Colorado , Florida , and Georgia . States must comply with federal law, under which each participating state administers its own Medicaid program, establishes eligibility standards, determines
9919-462: The saving on to patients currently without adequate dental care. While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the general rules under which Medicaid operates, each state runs its own program. Under certain circumstances, an applicant may be denied coverage. As a result, the eligibility rules differ significantly from state to state, although all states must follow
10028-684: The scope and types of services it will cover, and sets the rate of reimbursement physicians and care providers. Differences between states are often influenced by the political ideologies of the state and cultural beliefs of the general population. The federal Centers for Medicare and Medicaid Services (CMS) closely monitors each state's program and establishes requirements for service delivery, quality, funding, and eligibility standards. Medicaid estate recovery regulations also vary by state. (Federal law gives options as to whether non-long-term-care-related expenses, such as normal health-insurance-type medical expenses are to be recovered, as well as on whether
10137-521: The smallest states in the U.S., it features a variety of climates and topographical features that have earned it the moniker of America in Miniature . In a similar vein, Maryland's geography, culture, and history combine elements of the Mid-Atlantic, Northeastern , and Southern regions of the country. What is now Maryland was originally inhabited by tribes such as the Piscataway (including
10246-475: The so-called Medicaid coverage gap in states that have not expanded Medicaid: there are people whose income is too high to qualify for Medicaid in those states, but too low to receive assistance in paying for private health insurance, which is therefore unaffordable to them. States may bundle together the administration of Medicaid with other programs such as the Children's Health Insurance Program (CHIP), so
10355-752: The south shore of the Potomac in Virginia ; however, the land donated by the Commonwealth of Virginia was later returned to that state by the District of Columbia retrocession in 1846. Influenced by a changing economy, revolutionary ideals, and preaching by ministers, numerous planters in Maryland freed their slaves in the 20 years after the Revolutionary War . Across the Upper South the free black population increased from less than 1% before
10464-692: The south. Portions of Maryland are included in various official and unofficial geographic regions. For example, the Delmarva Peninsula is composed of the Eastern Shore counties of Maryland, the entire state of Delaware , and the two counties that make up the Eastern Shore of Virginia , whereas the westernmost counties of Maryland are considered part of Appalachia . Much of the Baltimore–Washington corridor lies just south of
10573-413: The southwest. With a total area of 12,407 square miles (32,130 km ), Maryland is the ninth-smallest state by land area , and its population of 6,177,224 ranks it the 19th-most populous state and the fifth-most densely populated . Maryland's capital is Annapolis , and the most populous city is Baltimore . Maryland's coastline was first explored by Europeans in the 16th century. Prior to that, it
10682-567: The state contains stretches of the Appalachian Mountains , the central portion is primarily composed of the Piedmont , and the eastern side of the state makes up a significant portion of Chesapeake Bay . Sixteen of Maryland's twenty-three counties, and the city of Baltimore, border the tidal waters of the Chesapeake Bay estuary and its many tributaries, which combined total more than 4,000 miles of shoreline. Although one of
10791-559: The state, and the counties east of the bay are known collectively as the Eastern Shore . Most of the state's waterways are part of the Chesapeake Bay watershed, with the exceptions of a tiny portion of extreme western Garrett County (drained by the Youghiogheny River as part of the watershed of the Mississippi River ), the eastern half of Worcester County (which drains into Maryland's Atlantic coastal bays), and
10900-553: The traditionally Southern and Tidewater culture that previously dominated most of the state. Agricultural tracts gave way to residential communities, some of them carefully planned such as Columbia , St. Charles , and Montgomery Village . Concurrently the Interstate Highway System was built throughout the state, most notably I-95 , I-695 , and the Capital Beltway , altering travel patterns. In 1952,
11009-585: The war to 14% by 1810. Abolitionists Harriet Tubman and Frederick Douglass were born slaves during this time in Dorchester County and Talbot County , respectively. During the War of 1812 , the British military attempted to capture Baltimore, which was protected by Fort McHenry . During its bombardment the song " The Star-Spangled Banner " was written by Francis Scott Key ; it was later adopted as
11118-679: The western shore of the upper Chesapeake Bay . A dispute with traders from Virginia over Kent Island in the Chesapeake led to armed conflict. In 1644, William Claiborne , a Puritan, seized Kent Island while his associate, the pro-Parliament Puritan Richard Ingle , took over St. Mary's. Both used religion as a tool to gain popular support. The two years from 1644 to 1646 when Claiborne and his Puritan associates held sway were known as "The Plundering Time". They captured Jesuit priests, imprisoned them, then sent them back to England. In 1646, Leonard Calvert returned with troops, recaptured St. Mary's City, and restored order. The House of Delegates passed
11227-619: Was St. Mary's City , on the north shore of the Potomac River , and the county surrounding it, the first erected/created in the province, was first called Augusta Carolina, after the King, and later named St. Mary's County. Lord Baltimore's first settlers arrived in the new colony in March 1634, with his younger brother the Honorable Leonard Calvert (1606–1647), as first provincial Governor of Maryland . They made their first permanent settlement at St. Mary's City in what
11336-421: Was a major war production center during World War II . The biggest operations were Bethlehem Steel 's Fairfield Yard, which built Liberty ships ; and Glenn Martin , an aircraft manufacturer. Maryland experienced population growth following World War II. Beginning in the 1960s, as suburban growth took hold around Washington, D.C. and Baltimore, the state began to take on a more mid-Atlantic culture as opposed to
11445-492: Was about 10 years less than in New England . Maryland was founded to provide a haven for England's Roman Catholic minority. Although Maryland was the most heavily Catholic of the English mainland colonies, the religion was still in the minority, consisting of less than 10% of the total population. In 1642, a number of Puritans left Virginia for Maryland and founded the city of Providence, now called Annapolis , on
11554-444: Was considered a strategic Union victory and a turning point of the war. A new state constitution in 1864 abolished slavery and Maryland was first recognized as a "Free State" in that context. Following passage of constitutional amendments that granted voting rights to freedmen , in 1867 the state extended suffrage to non-white males. The Democratic Party rapidly regained power in the state from Republicans . Democrats replaced
11663-490: Was inhabited by several Native American tribes, mostly the Algonquian peoples . As one of the original Thirteen Colonies , Maryland was founded by George Calvert , 1st Baron Baltimore, a Catholic convert who sought to provide a religious haven for Catholics persecuted in England. In 1632, Charles I of England granted Lord Baltimore a colonial charter , naming the colony after his wife, Henrietta Maria . In 1649,
11772-520: Was relatively low. Interest in this approach remained high, however. Included in the Social Security program under Medicaid are dental services . Registration for dental services is optional for people older than 21 years but required for people eligible for Medicaid and younger than 21. Minimum services include pain relief, restoration of teeth and maintenance for dental health. Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
11881-524: Was to help states assist residents whose income and resources were insufficient to pay the costs of traditional commercial health insurance plans. By 1982, all states were participating. The last state to do so was Arizona. The Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program (HIPP) were created by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90). This act helped to add Section 1927 to
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