Maryland MCHP: Health Insurance for a Grandchild Without Custody

One of the first things grandparents and relatives worry about when a child moves in is health insurance. The good news: Maryland does not require a custody order to enroll a child in the Maryland Children's Health Program. And if you do not claim the child as a tax dependent, your income is irrelevant to the child's eligibility.

How the Income Rules Work in Your Favor

MCHP eligibility uses Modified Adjusted Gross Income (MAGI) rules from the Affordable Care Act. When a non-parent relative applies for health coverage on behalf of a child and does not claim that child as a tax dependent, the child's income is evaluated as a standalone single-person tax household. If the child has no wages, no trust distributions, and no other income, the child's MAGI is $0 — qualifying for full no-cost Medicaid coverage.

There is no asset limit. Your home, savings, retirement accounts, and vehicles have zero impact.

Maryland covers children at these income thresholds (relative to the Federal Poverty Level):

• Up to 211% FPL: Full MCHP Medicaid with no monthly premium
• 212% to 264% FPL: MCHP with a low monthly family premium
• 265% to 322% FPL: MCHP with a standard monthly premium

For a child with zero income, you are looking at full no-cost coverage.

Where to Apply

Two portals accept applications:

1. Maryland Health Connection (marylandhealthconnection.gov) — the state health exchange, optimized for MAGI-based processing
2. MarylandBenefits.gov — the integrated benefits portal, useful if you are also applying for TCA or SNAP at the same time

You can also submit a paper application at your local DSS. Maryland must process Medicaid applications within 45 calendar days. Coverage can be applied retroactively for up to three calendar months before the application month if the child had unpaid medical bills and would have been eligible during that period.

What You Need

A birth certificate or hospital record for the child, a Social Security number (or proof of application), proof of Maryland residency, and documentation of your relationship to the child. If you lack a court order, a sworn statement about the caregiving arrangement is sufficient for the initial application.

12 Months of Continuous Coverage

Once approved, the child receives 12 months of continuous Medicaid coverage. This means the state cannot close the case for minor income fluctuations mid-year. The child stays covered through the annual renewal date.

Coverage includes primary care, dental, vision, prescriptions, specialist referrals, and mental health services through Maryland's HealthChoice managed care network. You choose an MCO at enrollment.

Medical Consent Without Custody

If you do not have a custody order, healthcare providers may ask for proof of your authority to consent to treatment. Maryland law (Health-General § 20-105) allows a relative to execute a sworn health care consent affidavit. This gives you statutory authority to consent to immunizations, emergency care, dental treatment, surgery, and mental health services on behalf of the child.

The Maryland Financial Help Guide covers the MCHP application process, explains how health coverage connects to TCA and SNAP, and includes a document checklist for each program — so you can file everything in one trip to the DSS.

See more Maryland guides →