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Md Pac Template in PDF

The Maryland Department of Health and Mental Hygiene offers a vital program through the Maryland Primary Adult Care (PAC) Program Eligibility Application. This initiative is designed to cover primary health care, some outpatient mental health services, emergency hospital services, substance abuse services, and prescription drugs for low-income residents who fulfill specific eligibility criteria. It is important for applicants to understand that being 19 years of age or older, not being eligible for Medicare, and being a U.S. citizen or a qualified alien are fundamental requirements to apply.

For those considering applying for the PAC program, it’s crucial to take the first step towards gaining access to essential health care services without the burden of high costs. Click the button below to start filling out your application today.

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Navigating the healthcare system can be daunting, especially for those grappling with financial constraints. The Maryland Primary Adult Care (PAC) Program offers a beacon of hope, targeting a specific segment of the population that requires assistance the most. This program is designed to ensure that eligible Maryland residents, who are 19 years of age or older and not eligible for Medicare, can access essential health care services. The coverage includes primary health care, some outpatient mental health services, certain emergency hospital services, community-based substance abuse services, and prescription drugs. It’s pivotal for applicants to understand that the program has its exclusions, such as prenatal services, thereby necessitating alternative applications for those scenarios. Joining a managed care organization is mandatory for those who qualify, offering a streamlined approach to healthcare without the burden of enrollment fees, deductibles, monthly premiums, or annual benefit limits, although there are minimal co-payments for prescriptions. The process of application is detailed yet accessible, requiring documentation of citizenship or legal alien status, residency, and financial information, but promising support through translation services and accessibility accommodations. The guidance provided makes it clear that understanding and complying with the detailed instructions, from completing the application to the submission process, is crucial for a successful application.

Sample - Md Pac Form

Maryland Department of Health and Mental Hygiene

Maryland Primary Adult Care (PAC) Program

Eligibility Application

The Maryland Primary Adult Care Program (PAC) covers primary health care, some outpatient mental health services, certain emergency hospital services, community based substance abuse services, and prescription drugs for certain low income eligible Maryland residents. Applicants must be 19 years of age or older, not eligible for Medicare, and a U.S. citizen or a qualified alien who meets all requirements for benefits.

The PAC Program does not cover prenatal services. If you are pregnant, please apply for Medical Assistance for Families.

If you have children under the age of 21 in your home, please apply for Medical Assistance for Families.

If you are currently enrolled in the Maryland Family Planning Program and are approved for PAC, your Family Planning will be cancelled.

If you qualify for the program, you will be required to join a managed care organization (MCO). There is no fee to enroll, no deductibles, no monthly premium, and no annual benefit limit. There are small co- payments for prescriptions.

If you have any questions, please see our website, www.dhmh.state.md.us/mma/mmahome or call 1-800- 226-2142 for the more information. If you do not speak English, translation services are available. The application is available in Spanish. The Maryland Relay Service is available at 1-800-735-2258 for individuals with disabilities.

Important Application Information and General Instructions

Read all the instructions before completing the application.

Print clearly in blue or black ink. All information must be readable.

You must include written documentation of all requested information such as Social Security number, citizenship or lawful immigration status, and identity.

Send copies of documentation only. Original documents will not be returned.

Applications will NOT be accepted via email.

The process to determine eligibility takes up to 45 days. Notification of the eligibility determination will be sent by mail.

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

Instructions for Completing the PAC Application

Important: Print with black or blue ink or type in the required information

Section 1

A.Print your First Name, Middle Initial, Last Name, Suffix, and Home Phone Number including area code.

B.Fill in your complete home address for where you live. You must be a Maryland resident. If you are homeless, please write “homeless” in the home address line and fill in the county and state. If you live in Baltimore City, enter "Baltimore City" for the county. You can include a message phone number in the message phone box.

C.If you have a Post Office box to get mail, list it here. If you want a representative or someone else to get your mail, put that person’s name and address in the mailing address box. If you enter “homeless” in section B, you must enter a mailing address in section C.

D.Check the box next to your current living arrangement.

E.Do your parents intend to claim you as a dependant on the current year’s income tax return? If they will not be claiming you, check the box next to No on line E. (Mandatory field – please check yes or no)

F.Check the box next to your current marital status.

Section 2:

G.Write information for yourself and your spouse. Do not list your spouse if he or she does not live with you.

H.Write first name, middle initial and last name and suffix for yourself and your spouse. Send in proof of identity for applicants only. This can be a valid Maryland Driver’s License, MVA ID, or other government photo identity card.

I.Social Security numbers are used only to identify applicants and to help verify total household income.

J.Write the date of birth for yourself and your spouse.

K.Check male or female.

L.Check U.S. Citizenship status. If you check "YES", send proof of citizenship (such as a birth certificate or naturalization approval). If you check “NO”, send proof of alien status from the Immigration and Naturalization Services (INS) that includes the date the applicant became a permanent alien resident and the alien registration number. You are not required to provide this information for persons not applying for PAC benefits.

M.Please check the box for you, your spouse, or both to let us know who is applying for PAC. If both spouses wish to apply, they must be on the same application. All information must be provided for both spouses.

N.Persons eligible to apply for Medicare are not eligible for PAC. However, a non-Medicare spouse may be eligible for PAC. If you are 65 or over, and do not have Medicare, you must send proof that you applied for Medicare from the Social Security Administration.

Section 3:

O.Check race. You may check more than one race for each person applying for PAC.

P.Check whether ethnicity is Hispanic or Latino.

Q.Primary language information is optional. Indicate if a translation service is needed for us to speak to you.

R.Check sections for visually or hearing impaired if they apply to you.

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

This space is for PAC office use only. Do not write or mark on or near the bar code or obscure it in any way. Do not photocopy.

UI I N: ________________________

Primary Adult Care (PAC) Application

Section 1 Complete with your information

First Name

Last Name

Suffix

Home Phone

(

)

Home Street Address (Include Apt)

County

City

State

Zip

Message Phone

(

)

Mailing Name & Street Address or P.O.Box

(If different or for representative)

City

State

Zip

Living Arrangement

□ At Home

□ Nursing Home/Long Term Care Facility

□ Assisted Living

□ Homeless

□ Correctional Facility

□ Rehab Facility

□ Halfway House

□ Other:

Dependent Adult

Do your parents intend to claim you as a dependant for the current year’s income tax return?

□ Yes

□ No

(Mandatory field – Please check yes or no)

Marital Status

□ Never Married

□ Married

□ Separated

□ Divorced

□ Widowed

Section 2

Complete for yourself and your spouse living with you

Relation to Applicant

Self

Spouse

First Name

and Middle Initial

Last Name and Suffix

Social Security No.

Date of Birth

Sex

□ Male

□ Female

□ Male

□ Female

U.S. Citizen?

□ Yes

□ No

□ Yes

□ No

If “no”, immigrant documentation

Number :

Are you applying…

For yourself?

□ Yes

□ No

For your spouse?

□ Yes

□ No

Do you have

□ Yes

□ No If yes,

complete the Claim

□ Yes

□ No

If yes, complete the Claim

Medicare?

number as it appears on your Medicare card:

number as it appears on your Medicare

____________________

card: ____________________

Section 3

Optional Information

□ American Indian or Alaska Native

□ Asian

Race

□ Black or African American

□ Native Hawaiian or other Pacific Islander

□ White

Hispanic/ Latino

□ Yes

□ No

□ Yes

□ No

Primary Language:

Translation services needed?

□ Yes

□ No

Secondary Language:

Are you or your spouse visually impaired? □ Yes

□ No

If yes, do you want large print notices?

□ Yes □ No

Are you hearing impaired? □ Yes

□ No

If Yes, should we use Maryland Relay Services? □ Yes

□ No

Please Turn Page and Complete The Other Side

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

PAC FINANCIAL INFORMATION

Section 4 Please complete financial information for yourself and your spouse living with you

Income Type

Received

Self

How Often

Spouse

How Often

Wages

□ Yes

□ No

Self Employment

□ Yes

□ No

Unemployment

□ Yes

□ No

SSI

□ Yes

□ No

SSDI

□ Yes

□ No

Social Security Retirement

□ Yes

□ No

Pension / Retirement

□ Yes

□ No

Railroad Retirement

□ Yes

□ No

Veteran's Benefit

□ Yes

□ No

Workers Compensation

□ Yes

□ No

Insurance Benefit

□ Yes

□ No

Interest / Dividends

□ Yes

□ No

Trust /Annuity

□ Yes

□ No

Other Income

□ Yes

□ No


	Do you have other insurance, including Medicaid that pays for health care? □ Yes				□ No
T	If yes, please write the name of the insurance company or program and your ID/ policy number.
U	Do you require health cares services because of a recent accident or injury?			□ Yes		□ No
Section 5		Signature Section
	I have read and agree to the rights and responsibilities listed elsewhere in this application packet. I swear and affirm
V	under penalty of perjury that all the information I gave is true, correct, and complete to the best of my ability, belief,
	and knowledge.
	Applicant’s Signature:		Date:
W	Spouse’s Signature:		Date:
W	(only if applying)
X	Representative's Signature
	(if applicable):		Date :

When finished: Please remove instructions and mail the application page and required documentation to:

Primary Adult Care Program

P.O. Box 386

Baltimore, MD 21203-0386

Or you can fax it to (410)528-6047

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

Instructions for Completing the PAC Application (Continued)

Section 4: Instructions for Completing Financial Section Income

S.YOU MUST ANSWER ALL QUESTIONS. DO NOT LEAVE ANY BLANK SPACES.

If you are married and living with your spouse, you must provide your spouse’s income even if your spouse is not applying for PAC.

List the GROSS amount (before any deductions) and frequency of all income received.

Additional information may be required if there has been any job status changes in the last 120 days.

If self employed, a signed copy of the latest tax return and schedule C showing business profit or loss must be submitted.

Social security income information must be provided.

If money is received from a source other than employment, a copy of the current income statement from the agency or company that sends the money must be submitted. This would include things like alimony, rent paid, or money received on a regular basis. Please list the type of income as well as the amount and frequency in the “Other income” box.

If little or no income is received, the person or agency providing food and shelter must submit a supporting statement.

T.If you or your spouse have any other form of health insurance, including insurance through your employer, or as a retirement benefit, mark the yes box. Include the name of the insurance company or program through which you have the coverage. You will also need to provide the policy or your ID number.

U.Let us know if you require health care services as a result of a recent accident or injury.

Section 5:

V.Please read the PAC Rights and Responsibilities on the last page of this packet before signing and dating the application.

W.If your spouse is applying for PAC, your spouse has to sign and date the application, indicating he or she also read the rights and responsibilities.

X.If someone else, an Authorized Representative, completed the application on your behalf , he or she must sign and date the application.

PLEASE REMEMBER TO SIGN AND DATE YOUR APPLICATION. AN UNSIGNED APPLICATION IS NOT VALID AND WILL BE RETURNED.

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

PAC RIGHTS AND RESPONSIBILITIES

Please read and save these rights and responsibilities for your records.

I understand and agree to the following:

This application is a request for the Primary Adult Care Program only.

If I am determined eligible for PAC, I understand that I will be required to choose a managed care organization (MCO) or the State will choose one for me.

My Social Security number will be used to verify identity and eligibility. My Social Security number may also be used to cross-match information in federal, state, and local government files.

The Department may conduct independent verification of the statements made by me on this application.

I must notify the Department within 10 business days of any changes in the household income or change of address or living arrangements.

I understand that the information given on this form is confidential and will only be used for the purpose of program administration, except as permitted by Federal and State law.

I have the right to appeal any decision made concerning my eligibility or benefits.

The State may recover monies spent on the cost of care from all third party payments and I agree to cooperate with the State in securing such payments.

I certify that everyone requesting benefits is a U.S. citizen or qualified alien.

I agree to the release of personal and financial information from any financial institution, insurance company, present or past employer, federal, state or local governmental agency, private or public organization to the Department for eligibility determination.

YOUR APPLICATION MUST BE COMPLETE AND SIGNED. IF YOU HAVE QUESTIONS, CALL OUR OFFICE AT 1-800-226-2142 BEFORE YOU SEND YOUR APPLICATION.

REVISED 01/2010. PREVIOUS EDITIONS ARE OBSOLETE.

↓ Md Pac PDF Form

Document Data

Fact	Detail
Eligibility Age	Applicants must be 19 years of age or older.
Medicare Eligibility	Applicants not eligible for Medicare can apply.
Residency Requirement	Must be a Maryland resident to apply.
Citizenship Requirement	U.S. citizen or a qualified alien meeting all requirements for benefits.
Services Covered	Covers primary health care, some outpatient mental health services, emergency hospital services, community-based substance abuse services, and prescription drugs.
Services Not Covered	Prenatal services are not covered under the PAC Program.
Enrollment Fee	No fee to enroll, no deductibles, no monthly premium, and no annual benefit limit.
Co-payments	Small co-payments for prescriptions are required.
Governing Laws	Administered by the Maryland Department of Health and Mental Hygiene, following state-specific health care laws and regulations.

How to Write Md Pac

After completing the Maryland Primary Adult Care (PAC) Program Eligibility Application, you are taking the first step towards accessing a range of health services offered to low-income residents in Maryland. This comprehensive application will require detailed information about your personal and financial circumstances. It’s important to provide accurate and up-to-date information to ensure that your eligibility for the program can be assessed correctly. The following step-by-step instructions guide you through each section of the application form, ensuring that you complete it accurately and submit all the necessary documentation.

Section 1: Personal Information
1. A. Print your full name (First Name, Middle Initial, Last Name, Suffix) and home phone number, including the area code.
2. B. Enter your complete home street address, including apartment if applicable, your county, city, and state. If homeless, write “homeless” and provide the county and state. If in Baltimore City, specify "Baltimore City" for the county.
3. C. If you have a P.O. box or a designated person to receive your mail, list that information. If you entered “homeless” in section B, you must provide a mailing address here.
4. D. Check the box that describes your current living arrangement.
5. E. Indicate whether your parents intend to claim you as a dependent on their income tax return by checking yes or no. This is mandatory.
6. F. Choose your marital status from the options provided.
Section 2: Applicant and Spouse Information
1. G. List information for yourself and your spouse, if applicable. Do not list a spouse who does not live with you.
2. H. Write first name, middle initial, and last name, and suffix for both yourself and spouse.
3. I. Provide Social Security numbers. Note that these are used to identify applicants and verify household income.
4. J. Enter the date of birth for yourself and your spouse.
5. K. Indicate the sex of both applicants.
6. L. Check U.S. Citizenship status and provide proof where necessary. If not a citizen, provide immigrant documentation.
7. M. Indicate who is applying for PAC by checking the appropriate boxes.
8. N. If you are 65 or over and do not have Medicare, provide proof that you have applied for Medicare.
Section 3: Demographic Information
1. O. Check the appropriate boxes to indicate race. More than one option may be checked.
2. P. Indicate whether ethnicity is Hispanic or Latino.
3. Q. State primary and, if applicable, secondary languages. Indicate if translation services are needed.
4. R. Check if you or your spouse are visually or hearing impaired and require specific accommodations.
Section 4: Financial Information
1. S. List all sources and amounts of income for both yourself and your spouse. If married, include your spouse's income even if they are not applying for PAC.
2. T. Indicate if you or your spouse have any other form of health insurance and provide details.
3. U. Let the PAC Program know if health care services are required due to a recent accident or injury.
Section 5: Signature
1. V. Read the PAC Rights and Responsibilities provided in the application packet. Then sign and date the application.
2. W. If your spouse is applying, they must also sign and date the application.
3. X. If an authorized representative is completing the application on your behalf, they must sign and date the application.

Once you have completed all sections and signed the application, remove any instruction pages and mail the application along with the required documentation to the Primary Adult Care Program at the provided address. Alternatively, you can fax it to the number provided. Remember, an unsigned application will not be processed and will be returned to you, potentially delaying your access to the important health care services provided by the PAC Program.

Understanding Md Pac

What is the Maryland Primary Adult Care (PAC) Program?

The Maryland Primary Adult Care (PAC) Program is a health coverage program offered by the Maryland Department of Health and Mental Hygiene. It is designed to provide primary health care, some outpatient mental health services, certain emergency hospital services, community-based substance abuse services, and prescription drugs. This program is specifically for low-income Maryland residents who are 19 years of age or older, are not eligible for Medicare, and are either U.S. citizens or qualified aliens who meet all requirements for benefits.

Who is eligible for the PAC Program?

To be eligible for the PAC Program, applicants must fulfill the following criteria:

Must be 19 years of age or older.
Cannot be eligible for Medicare.
Must be a U.S. citizen or a qualified alien meeting all benefit requirements.

It's important to note that the PAC Program does not cover prenatal services; pregnant individuals should apply for Medical Assistance for Families instead. Additionally, individuals with children under 21 years old in the home should also apply for Medical Assistance for Families.

What are the requirements for applying to the PAC Program?

When applying for the PAC Program, it is mandatory to:

Read all instructions before completing the application.
Print clearly in blue or black ink or type the required information.
Include written documentation for all requested information such as Social Security number, citizenship or lawful immigration status, and identity.
Send copies of documentation only; original documents will not be returned.
Note that applications will not be accepted via email.

Additionally, applicants must join a managed care organization if they qualify for the program. There is no enrollment fee, deductibles, monthly premium, or annual benefit limit. However, small co-payments for prescriptions may apply.

How long does it take to process the PAC Application?

The process of determining eligibility for the PAC Program takes up to 45 days. Applicants will receive notification of the eligibility determination by mail. It's essential for applicants to ensure that all required information and documentation are complete and accurate to avoid any delays in the processing time.

Is assistance available for non-English speakers or individuals with disabilities?

Yes, the PAC Program offers support for non-English speakers and individuals with disabilities:

Translation services are available for those who do not speak English. The application is also available in Spanish.
The Maryland Relay Service is available at 1-800-735-2258 for individuals with disabilities needing assistance with the application process.

These services ensure that all eligible individuals have the opportunity to apply for and access the benefits offered by the PAC Program.

Common mistakes

When filling out the Maryland Primary Adult Care (PAC) Program Eligibility Application, attention to detail is critical. Common mistakes can delay the processing of applications or lead to the denial of benefits for which individuals might otherwise qualify. Identifying and avoiding these pitfalls can significantly improve the chances of being accepted into the PAC program.

Not reading the instructions carefully: Applicants often skip the detailed instructions provided at the beginning of the application, which can lead to misunderstandings about the requirements and how to properly complete the form.
Using ink of the wrong color or illegible handwriting: The application specifies that all entries must be made in blue or black ink and be readable. Unreadable applications cannot be processed, leading to delays or outright rejections.
Omitting required documentation: A frequent error is failing to include necessary documentation such as proof of identity, citizenship or legal alien status, and income. This oversight can significantly delay the review process.
Sending original documents: Applicants are instructed to send copies of the required documents, not the originals, as the latter will not be returned. Losing important original documents can cause personal difficulties.
Applying via email: The instructions specify that applications submitted through email will not be accepted, yet some might overlook this and attempt digital submissions instead of the required physical mailing or faxing.
Incomplete sections: Leaving sections of the application blank, especially those related to income, insurance, or Medicare status, frequently occurs. Incomplete applications cannot be processed until all information is provided.
Incorrect living arrangement information: Applicants sometimes provide inaccurate descriptions of their living arrangements or fail to designate a mailing address if homeless. Accurate details ensure that correspondence reaches the applicant.
Failing to indicate the need for translation services: Non-English speakers might overlook the section where they can request translation services, which can aid in understanding the application process and requirements.
Not signing the form: Perhaps one of the most common and avoidable mistakes is neglecting to sign and date the application. An unsigned application is considered invalid and cannot be processed.

Understanding and mitigating these errors are instrumental to the submission of a valid and complete application for the Maryland Primary Adult Care (PAC) Program. This underscores the importance of thoroughly reviewing all sections of the application, adhering closely to instructions, and double-checking the inclusion of all required documentation and signatures before submission.

Documents used along the form

The Maryland Primary Adult Care (PAC) Program application is a vital step for low-income Maryland residents in obtaining necessary health services. However, to successfully navigate the process, applicants often need to prepare several other forms and documents. Understanding these additional requirements can streamline the process and ensure that applicants receive the benefits for which they are eligible.

Proof of Identity: A government-issued photo ID is essential, such as a Maryland Driver's License or an MVA ID card. This document is crucial for verifying the applicant's identity as part of the enrollment process.
Proof of Citizenship or Legal Alien Status: Documents like a birth certificate, passport, or naturalization papers are required to establish U.S. citizenship. Alternatively, non-citizens need to provide documents from the U.S. Citizenship and Immigration Services (USCIS) proving lawful alien status.
Social Security Number Verification: A Social Security card or official document from the Social Security Administration that includes the number assists in verifying the applicant's SSN, which is vital for assessing eligibility and income.
Proof of Income: Pay stubs, tax returns, or official documentation verifying sources of income confirm the applicant's financial situation. This information is necessary to determine if the income level meets the eligibility criteria for the PAC program.
Proof of Maryland Residency: Documents such as utility bills, lease agreements, or mortgage statements establish proof of residency. Applicants must reside in Maryland to qualify for the PAC program.
Medicare Eligibility or Denial Letter: For applicants 65 years and older without Medicare, documents showing that they have applied for Medicare or a denial letter from Medicare are required. This determines if the applicant is eligible for the PAC program instead.
Health Insurance Information: If an applicant has other health insurance, including Medicaid, details of this insurance need to be provided. This could include an insurance card or a policy document, which helps in coordinating benefits.

These documents, alongside the completed Maryland PAC Application, form a comprehensive packet that applicants submit for review. By gathering and submitting all the relevant forms and documents promptly, applicants can ensure a smoother processing of their application. This preparation significantly aids in the timely determination of their eligibility for health care benefits under the Maryland PAC program.

Similar forms

The Md PAC form is similar to other forms used by health and human services programs to assess eligibility and gather necessary information from applicants. These forms often share common elements aimed at ensuring individuals and families receive the appropriate level of support and services based on their specific circumstances and needs.

One document resembling the Md PAC application form is the Application for Medical Assistance (Medicaid). Both applications request detailed personal information, such as name, contact details, household composition, income, and insurance status. The purpose of gathering this data is to determine eligibility for health services. However, Medicaid applications typically require additional information related to a wider range of services and eligibility criteria, as Medicaid covers a broader spectrum of healthcare needs and individuals of all ages, including prenatal care and services for those with disabilities.

Another similar document is the Supplemental Nutrition Assistance Program (SNAP) Application. Like the Md PAC form, SNAP applications collect personal, financial, and household information to assess eligibility for benefits. Both forms inquire about income, household size, and residency. However, SNAP applications focus more intensively on financial details and food security issues, aiming to provide nutritional assistance to individuals and families who need it most.

The Temporary Assistance for Needy Families (TANF) Application also shares similarities with the Md PAC form, particularly in the collection of financial and family composition information designed to establish eligibility for financial aid. The TANF program, however, has a broader goal than the Md PAC program, seeking to help families achieve independence through work, training, and other support services, in addition to providing temporary financial assistance. As such, TANF applications may include sections on employment history and job training needs that are not typically part of the Md PAC application process.

Dos and Don'ts

When filling out the Maryland Primary Adult Care (PAC) Program Eligibility Application, here are some key dos and don'ts that can help guide you through the process:

Do read all the instructions provided before you start filling out the application. This will help you understand what information is needed and how to provide it properly.
Do print clearly in blue or black ink or type your answers to ensure that all information is legible and can be easily read by the PAC program staff.
Do provide written documentation for all requested information, including your Social Security number, citizenship or lawful immigration status, and identity.
Do send copies of your documentation along with your application. Remember, original documents will not be returned, so it's important to keep your originals safe.
Don't attempt to submit your application via email, as applications are not accepted through this format. Follow the submission guidelines provided in the application instructions.
Don't leave any fields blank. If a question does not apply to you, mark it as "N/A" or "Not Applicable" to indicate that you did not overlook the question.
Don't write or mark near the barcode or in any space marked for PAC office use only, as this could lead to processing delays for your application.
Don't forget to sign and date your application. An unsigned application is considered invalid and will be returned to you, delaying the process.

Following these dos and don'ts can help ensure that your application is filled out correctly and processed smoothly, bringing you one step closer to the benefits offered by the Maryland Primary Adult Care (PAC) Program.

Misconceptions

There are several common misconceptions about the Maryland Department of Health and Mental Hygiene's Maryland Primary Adult Care (PAC) Program Eligibility Application. Understanding these misconceptions can help applicants navigate the process more effectively. Below are ten such misconceptions explained clearly:

Only for the elderly: Some people mistakenly believe that the PAC program is solely for the elderly. In reality, it is available to Maryland residents who are 19 years of age or older, provided they meet the other eligibility criteria.
Covers all health services: There is a myth that the PAC program covers all types of health services. However, it specifically covers primary health care, some outpatient mental health services, certain emergency hospital services, community-based substance abuse services, and prescription drugs for eligible residents. It does not cover services like prenatal care.
Non-citizens cannot apply: Another misunderstanding is that only U.S. citizens can apply for the PAC program. Qualified aliens who meet all requirements for benefits are also eligible to apply.
High application costs: It is wrongly assumed that there are high fees associated with applying for the PAC program. The truth is there is no fee to enroll.
Contrary to some beliefs, applications cannot be submitted via email. This program requires a paper application process.
Immediate eligibility notification: Some applicants expect immediate notification of their eligibility. The process to determine eligibility takes up to 45 days, and the notification is sent by mail.
Unlimited benefits: A common misconception is that the PAC program offers unlimited health benefits. While there is no annual benefit limit, the program specifically outlines what services are covered.
Medicare eligibility: There's a misunderstanding that individuals eligible for Medicare can also receive PAC benefits. In fact, individuals eligible for Medicare cannot apply for PAC; however, a non-Medicare spouse may be eligible.
Application in English only: Some people may not apply, thinking the application and support are only available in English. The application is available in Spanish, and translation services are provided for other languages as needed.
Automatic enrollment in Managed Care Organization (MCO): Finally, there is a misconception that enrollment into a MCO is optional. If one qualifies for the PAC program, joining a MCO is required.

Understanding these misconceptions can help ensure that eligible Maryland residents can apply for and receive the benefits for which they qualify without unnecessary confusion or delay.

Key takeaways

Filling out the Maryland Primary Adult Care (PAC) Program Eligibility Application is an important step for residents who are seeking assistance with primary health care and certain other services. Here are five key takeaways to guide you through this process:

Eligibility Criteria: To be eligible for the PAC program, applicants must be 19 years of age or older, not eligible for Medicare, and must be a U.S. citizen or a qualified alien who meets all the requirements for benefits. It’s important to note that the program does not cover prenatal services or individuals currently enrolled in the Maryland Family Planning Program.
Application Process: Applicants are required to join a managed care organization (MCO) if they qualify for the PAC program. There is no fee to enroll, no deductibles, no monthly premium, and no annual benefit limit, although there are small co-payments for prescriptions. All applicants must provide written documentation of requested information such as Social Security number, citizenship or lawful immigration status, and identity.
Instructions for Completion: It is crucial to read all instructions carefully before filling out the application. All information should be printed clearly in blue or black ink to ensure readability. Applicants must not send original documents as they will not be returned, and applications cannot be accepted via email.
Financial Information: Accurate financial information is essential, including the gross amount and frequency of all income received for both the applicant and spouse, if applicable. This section of the application also requires information regarding any other health insurance coverage and if health care services are needed due to a recent accident or injury.
Final Steps: Review the PAC Rights and Responsibilities before signing and dating the application. If the application is signed by an authorized representative on behalf of the applicant, that representative must also sign and date the form. An unsigned application will not be processed and will be returned to the applicant.

Remember, the process to determine eligibility for the PAC program takes up to 45 days, and applicants will be notified of the determination by mail. For any questions or additional information, assistance is available through the provided contact details on the application instructions. Ensuring that each step is carefully followed can greatly assist in navigating the process smoothly and efficiently.

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